Frequent Hospital Admissions Research Articles

Management of Malignant Bowel Obstruction: An Innovative Proactive Outpatient Nurse-Led Model of Care for Patients With Advanced Gynecologic Cancer.

Malignant bowel obstruction (MBO) in patients with advanced gynecologic cancer (GyCa) can negatively impact clinical outcomes and quality of life. Oncology nurses can support these patients with adequate tools/processes. Patients with GyCa with/at risk of MBO endure frequent emergency or hospital admissions, impacting patient care. Optimizing oncology nurses' role to improve care for patients with GyCa with/at risk of MBO, the gynecology oncology interprofessional team collaborated to develop a proactive outpatient nurse-led MBO model of care (MOC). The MBO MOC involves a risk-based algorithm engaging interdisciplinary care, utilizing standardized tools, risk-based assessment, management, and education for patients and nurses. The MOC has improved patient-reported confidence level of bowel self-management and decreased hospitalization. Following education, nurses demonstrated increased knowledge in MBO management. An outpatient nurse-led MBO MOC can improve patient care and may be extended to other cancer centers, fostering collaboration and best practice.

Proactive Health Support: a randomised controlled trial of telephone-based self-management support for persons at risk of hospital admission.

Persons with frequent hospital admissions have a disease burden that may exceed their self-management skills. The evidence base of telephone-based interventions to support self-management is poor with mixed results. The aim of this study is to evaluate the effect of Proactive Health Support (PaHS): telephone-based self-management support for persons with risk of hospitalizations. This study is a national randomised controlled trial of PaHS versus usual universal tax-funded healthcare. Participants were persons at risk of emergency hospital admissions. The intervention began with a physical start-up session followed by telephone sessions of self-management support. The two co-primary outcomes were Health-Related Quality of Life (HRQoL) (Mental Health Component Summary Score of SF36v2) analysed with mixed models and hospital admissions analysed with Poisson regression at 6months. Secondary outcomes were at 3- and 12-month follow-up and disease subgroup analyses. During the study period, 6,402 persons were randomised (3,190 intervention, 3,212 control). HRQoL was significantly improved at 6months (Est. 1.4992, P = <0.0001) and at 3 and 12months on all 10 scales. There was no overall effect on hospital admissions at 6 months with an adjusted estimate of 0.0074 (P = 0.8691). Persons with diabetes had significant improvement of HRQoL and reduced hospital admissions. The PaHS intervention improved HRQoL for all participants and reduced hospital admissions for persons with diabetes only.

P.119 Home infusion for antisense oligonucleotide therapy

Having a child with a chronic disease and adapting the child to receive a lifelong treatment which recquires hospitalization at regular intervals is difficult. In addition to financial and moral difficulties of frequent hospital admissions, it also increases the risk of infection. Here we emphasize the importance and advantages of home infusion treatment. We included twelve boys diagnosed with Duchenne Muscular Dystrophy (DMD) who were being followed by our Pediatric Neurology Department. Nine of our boys have been enrolled from outside the city. After completion of eight weeks of treatment in our hospital every week for intravenous drug administration, consent form was obtained from the family for home infusion. When the boys switched to home therapy; they were reached out by specialist nurses every week, and the appropriate drug dose was administered intravenously. During the infusion vital signs were followed up and shared with physicians. There were no complications observed during the nine month period in boys who are still continuing their treatment at home. In conclusion, home treatment with an experienced team should definitely be considered among the treatment options as it provides convenience in many moral and financial ways which increases the quality of life of the child and the family who are struggling with a chronic disease. Our application denotes that home treatment can be realized in other chronic disorders, genetic or not.

Exploring provider roles, continuity, and mental models in cirrhosis care: A qualitative study.

BACKGROUND: Advanced cirrhosis results in frequent emergency department visits, hospital admissions and readmissions, and a high risk of premature death. We previously identified and compared differences in the mental models of cirrhosis care held by primary and specialty care physicians and nurse practitioners that may be addressed to improve coordination and transitions in care. The aim of this paper is to further explore how challenges to continuity and coordination of care influence how health care providers adapt in their approaches to and development of mental models of cirrhosis care. METHODS: Cross-sectional formal elicitation of mental models using Cognitive Task Analysis. Purposive and chain-referral sampling took place over 6 months across Alberta for a total of 19 participants, made up of family physicians (n = 8), specialists (n = 9), and cirrhosis nurse practitioners (n = 2). RESULTS: Lack of continuity in cirrhosis care, particularly informational and management continuity, not only hinders health care providers' ability to develop rich mental models of cirrhosis care but may also determine whether they form a patient-centred or task-based mental model, and whether they develop shared mental models with other providers. CONCLUSIONS: The system barriers and gaps that prevent the level of continuity needed to coordinate care for people with cirrhosis lead providers to create and work under mental models that perpetuate those barriers, in a vicious cycle. Understanding how providers approach cirrhosis care, adapt to the challenges facing them, and develop mental models offers insights into how to break that cycle and improve continuity and coordination.

Association between temperature and natural mortality in Belgium: Effect modification by individual characteristics and residential environment

BackgroundThere is strong evidence of mortality being associated to extreme temperatures but the extent to which individual or residential factors modulate this temperature vulnerability is less clear. MethodsWe conducted a multi-city study with a time-stratified case-crossover design and used conditional logistic regression to examine the association between extreme temperatures and overall natural and cause-specific mortality. City-specific estimates were pooled using a random-effect meta-analysis to describe the global association. Cold and heat effects were assessed by comparing the mortality risks corresponding to the 2.5th and 97.5th percentiles of the daily temperature, respectively, with the minimum mortality temperature. For cold, we cumulated the risk over lags of 0 to 28 days before death and 0 to 7 days for heat. We carried out stratified analyses and assessed effect modification by individual characteristics, preexisting chronic health conditions and residential environment (population density, built-up area and air pollutants: PM2.5, NO2, O3 and black carbon) to identify more vulnerable population subgroups. ResultsBased on 307,859 deaths from natural causes, we found significant cold effect (OR = 1.42, 95%CI: 1.30–1.57) and heat effect (OR = 1.17, 95%CI: 1.12–1.21) for overall natural mortality and for respiratory causes in particular. There were significant effects modifications for some health conditions: people with asthma were at higher risk for cold, and people with psychoses for heat. In addition, people with long or frequent hospital admissions in the year preceding death were at lower risk. Despite large uncertainties, there was suggestion of effect modification by air pollutants: the effect of heat was higher on more polluted days of O3 and black carbon, and a higher cold effect was observed on more polluted days of PM2.5 and NO2 while for O3, the effect was lower. ConclusionsThese findings allow for targeted planning of public-health measures aiming to prevent the effects of extreme temperatures.

Retrospective case-control study exploring pretransplant predictors for loss of kidney transplant function or death among indigenous kidney transplant recipients.

The factors affecting the outcomes among Indigenous kidney transplant recipients is not fully understood. We conducted a retrospective case control study to identify risk factors beyond those explained by the ANZDATA registry. To identify the risk factors for loss of kidney transplant function or death among Indigenous kidney transplant recipients. Cases were defined as all Indigenous Australian kidney transplant recipients from 1 January 2005 to 31 December 2015 from the major hospitals in the Northern Territory (NT) and South Australia (SA) who experienced graft loss (including patient death) up to 2-years post-transplant. Controls (matched 4:1) were defined as all indigenous kidney transplant recipients during the same period with functioning transplants at 2-years post-transplant operation. Matching was done on gender and diabetes status. Regression analysis adjusted for age was used for comparing cases and controls. There were 17 cases and 68 matched controls. Among cases, the odds ratio for more than one hospital admission episode (compared with ≤1 episode) in the 2-year pretransplant period was 6.2 (95% confidence interval, 1.2-32.5). However, there were no significant differences in the frequency of comorbidities at renal replacement therapy start, cardiovascular intervention pretransplant, pretransplant infection screening, age and gender of the donors, frequency of admission episodes where an infection was documented, the total length of inpatient stay or admission to intensive care unit during pretransplant hospital admission between cases and controls. Early graft loss was associated with a higher frequency of hospital admissions in the 2-years pretransplant period. In contrast, other measured factors in the pretransplant period did not predict these adverse outcomes.

PB2227: HEALTH-RELATED QUALITY OF LIFE OVER TIME IN PEDIATRIC PATIENTS WITH SICKLE CELL DISEASE ADMITTED FOR VASO-OCCLUSIVE CRISIS.

Background: Sickle cell disease (SCD) is the most common inherited hemoglobinopathy characterized by chronic hemolytic anemia, vaso-occlusive crises (VOCs), multi-organ damage and an impaired health-related quality of life (HRQoL). Previous studies have shown that the occurrence of VOCs affects the HRQoL substantially in children with SCD. However, there is limited evidence about the HRQoL changes over time following hospitalization for VOC. Aims: The aim of this study is to evaluate the longitudinal impact of hospital admission for VOCs on the HRQOL in pediatric patients with SCD. Methods: In this retrospective cohort study, children between the age of 8 and 18 years with SCD treated at the Amsterdam University Medical Centers were included. As part of standard care, these children complete once a year Patient Reported Outcomes measures (PROMs) on the KLIK PROM portal (www.hetklikt.nu). HRQoL was measured with the Pediatric Quality of Life Inventory (PedsQL) (score ranging from 0-100, a higher score indicates better QoL). Data were collected from the medical files of patients, who filled out at least two PedsQL questionnaires between 2012 and 2021. The effect of the occurrence and frequency of hospital admissions for VOCs on the HRQoL was evaluated using a linear mixed model 3, 6, 9 and 12 months after hospital admission, adjusted for age and SCD genotype. Results: In total, 109 children were included with a median age of 11.8 years (IQR: 9.2 – 14.2), including 72 patients (66%) with the severe genotype: HbSS or HbSβ0. During follow-up, 45 patients (41%) were admitted to the hospital for a VOC. If hospitalization occurred 6 and 12 months prior to the PedsQoL measurement, a decrease of 3.61 (p=0.049) and 3.80 points (p=0.007) in HRQoL respectively, was seen compared to patients without hospitalization. As for the frequency of VOC admission in the preceding 12 months, a decrease of 2.28 points in HRQoL was observed for every additional admission (p=0.012). Summary/Conclusion: The negative longitudinal association between hospital admission for VOC and HRQoL in pediatric patients with SCD gets worse and persists up to 12 months. These findings highlight the importance of monitoring using PROMS in clinical practice and extra attention and support for the negative consequences of the hospital admission for VOCs, affecting the HRQoL.

Classification of Distinct Patterns of Ischemic Cholangiopathy Following DCD Liver Transplantation: Distinct Clinical Courses and Long-term Outcomes From a Multicenter Cohort.

As the number of donation after circulatory death (DCD) liver transplants (LTs) performed in the United States continues to increase annually, there has been interest by policy makers to develop a more robust exception point safety net for patients who develop ischemic cholangiopathy (IC) following DCD LT. As such, there is a need for better understanding of the clinical course and long-term outcomes in patients who develop IC, as well as determining if IC can be classified into distinct categories with distinctly different clinical outcomes. All DCD LT performed at Mayo Clinic Florida, Mayo Clinic Arizona, and Mayo Clinic Rochester from January 1999 to March 2020 were included (N = 770). Outcomes were compared between 4 distinct radiologic patterns of IC: diffuse necrosis, multifocal progressive, confluence dominant, and minor form. In total, 88 (11.4%) patients developed IC, of which 42 (5.5%) were listed for retransplantation of liver (ReLT). Patients with diffuse necrosis and multifocal progressive patterns suffered from frequent hospital admissions for cholangitis in the first year following DCD LT (median 3 and 2), were largely stent dependent (100% and 85.7%), and almost universally required ReLT. Patients with confluence dominant disease were managed with multiple stents and frequently recovered, ultimately becoming stent free without need for ReLT. Patients with the minor form IC did well with limited need for stent placement or repeat procedures and did not require ReLT. Graft survival was different between the 4 distinct IC patterns (P < 0.001). The present analysis provides a detailed analysis on the natural history and clinical course of IC. Patients developing IC can be classified into 4 distinct patterns with distinct clinical courses.

The Efficacy of Marijuana Use for Pain Relief in Adults With Sickle Cell Disease: A Systematic Review.

Sickle Cell Disease (SCD) is a disease that affects many around the world and often accounts for frequent hospital admissions every year, secondary to uncontrolled pain. Marijuana is increasingly being used for its medicinal ability to treat pain in chronic medical conditions. Therefore, it is imperative to determine how effective it would be in providing pain relief to patients with SCD. We systematically screened five databases for relevant data: PubMed, Medline, PubMed Central (PMC), Cochrane Library, and Google Scholar. The inclusion and exclusion criteria were implemented. A quality appraisal was then done using the Cochrane Bias assessment for randomized controlled trials (RCTs), Newcastle-Ottawa tool for observational studies, and Scale for the Assessment of Narrative Review Articles (SANRA) checklist for traditional review articles. From seven articles, information was gathered; one systematic review, one RCT, two surveys, one cross-sectional study, one retrospective study, and one questionnaire-based study. Our review concluded that based on the literature assessed, marijuana use in SCD patients either worsened their painful crises or offered little to no help compared to opioids or hydroxyurea usage. There were limited RCTs published in addition to papers investigating the long-term effects of marijuana use in SCD. We hope that further data is gathered in these areas to sufficiently address whether cannabis use is efficacious for pain relief in patients with SCD.

Cyclic Vomiting Syndrome in the Emergency Department: A 10-Year Review of Clinical Presentation and Management.

The aims of the study were (1) to determine how frequently patients with cyclic vomiting syndrome (CVS) present to the pediatric emergency department (ED) with CVS-related symptoms, (2) to identify variables in clinical presentation that occur frequently in patients with multiple ED visits, and (3) to compare ED management of CVS with recommended guidelines. This study is a retrospective chart review of all ED visits for CVS between April 1, 2008, and April 1, 2018, at a single center. Patients were identified from a master list of patients diagnosed with CVS in a pediatric gastroenterology clinic at the same center between June 1, 2004, and June 19, 2018. Of the 181 CVS clinic patients identified, 65 had visited to the ED (35.9%). Two hundred twenty-eight visits met inclusion criteria. A total of 42.5% of these visits were made by a small number of high-intensity patients (n = 6) who had an average of 16.1 visits each. These patients represented less than 10% of the total patient group. Patients with frequent visits had longer visits (536.52 vs 380.55 minutes), more frequent hospital admissions (57.73% vs 29.01%), and more visits to the ED before a formal diagnosis of CVS was made (5.83 vs 1.22), but few other distinguishing characteristics. Only 27% of eligible visits were managed with an available order set, and management varied from recommended guidelines. An ambiguous presentation makes the identification and consistent management of CVS in the ED difficult. Physicians should consider CVS for patients who present multiple times with unremitting vomiting to ensure appropriate referral for diagnosis and prophylactic treatment. Future studies are warranted to evaluate anticipatory processing and treatment of the "high-intensity patients" who account for much of the clinical morbidity and resource utilization.

Step-by-step guide to creating the best syncope units: From combined United States and European experiences.

Syncope can be caused by many physiological and pathophysiological conditions. Causes of syncope encompass a wide range of conditions from benign vasovagal syncope to life-threatening arrhythmias. The lack of a standardized method of evaluation and management of this large patient population leads to a wide practice variation which results in broad-based testing, frequent hospital admission and high healthcare cost. The concept of a syncope observational unit was created for inpatients and outpatients in the United States and Europe. Studies have demonstrated that syncope units, staffed by trained health care providers with sufficient resources could expedite and improve diagnostic yield, reduce hospital admission, and result in decreased healthcare cost with favorable clinical outcomes. The implementation of a standardized syncope unit has been challenging because resources and health care systems are variable regionally, nationally, and internationally. In this review, we provide an overview of the evidences that support a standardized syncope unit practice. We provide step-by-step algorithms for the "best syncope units" in the inpatient and outpatient settings by combining the synergistic experiences from the United States and Europe.

A Descriptive Study to Assess the Quality of Life Among Cancer Patients Residing in Private Accommodations Nearby SKIMS, Soura

Background: The World Health Organisation has explained the quality of life as the ability of a person to perceive himself in such a position that he can attain his or her goals, meet his or her expectations, live up to his or her standards and be able to resolve concerns. These all things are to be done by an individual by being in his or her culture or society based on the value system or approved behaviour of his or her society. There are various indicators of quality of life and to mention here are not only employment, wealth, and environment but essentially refer to the physical, mental, social, and spiritual health, education, recreational abilities, leisure time, religious beliefs, safety, care, support, security and freedom. The quality-of-life test is done to check the general condition of the patient suffering from cancer. It helps us to understand psychological, social and spiritual aspects of the disease condition in addition to science and symptoms of the disease or disease progression or adverse effects of the anticancer therapy. Quality of life is a multi-dimensional issue particularly in Cancer patients as it does not affect patients only but the family as well so assessment of the quality of life is essential in cancer care. Aim and Objectives: To assess the QoL among the cancer patients residing in private residences nearby SKIMS Soura, using the QoL scale and to find the association between the quality of life of cancer patients with their demographic variables. Material and Methods: A quantitative research approach with a descriptive research design was adopted to assess the quality of life among cancer patients residing in private accommodations nearby the SKIMS source in Srinagar Kashmir. The population for the present study consists of cancer patients undergoing chemotherapy while living temporarily in private accommodations nearby SKIMS Soura Srinagar Kashmir. Thirty study subjects were selected for this study by non-probability purposive sampling technique. The researchers used a modified QoL-ACD scale, a 22-item questionnaire for the data collection as available for open use. Results: The study revealed that the majority of study subjects, 21 (70%) were practising religion, majority of study subjects 7 (23.33%) were in the age group of 46-55 years. The results revealed that half 15 (50%) were males and the other half 15 (50%) were females. The results showed 9 (30%) had completed their 10th standard. In terms of monthly income, a maximum of 14 (46.67%) had a monthly income greater than 15000. The study also revealed that the majority 21 (70%) had average QoL, and 9 (30%) had good QoL. There was none of the study subjects had poor quality of life. It came to the fore during the investigation of the problem that there was no significant association between the level of quality of life of cancer patients residing in private accommodations nearby SKIMS Soura with age (p=0.08) gender (p=0.50), educational background (p=0.45), practising religion (p=0.15), primary care provider (p=0.29), family income per month (p=0.25). Conclusion: Cancer is a terrifying term that harms a patient's quality of life as well as their social, emotional, and physical support networks, as well as those of their family. It makes the family more accountable for providing care, depletes their financial reserves, and exposes them to unfavourable situations. Cancer certainly harms patients' quality of life, which is connected to the nature of the illness, the type of therapy received, and how long the patient has been unwell. Cancer patients' quality of life is significantly reduced by the necessity for frequent hospital admissions, unpleasant emotions, and many physical ailments that change over time.

Baseline Level and Reduction in PaCO2 are Associated with the Treatment Effect of Long-Term Home Noninvasive Positive Pressure Ventilation in Stable Hypercapnic Patients with COPD: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

PurposeThe evidence of long-term home noninvasive positive pressure ventilation (LTHNIPPV) in patients with stable hypercapnic chronic obstructive pulmonary disease (COPD) is controversial. In this meta-analysis study, we sought to establish whether a baseline level and reduction in partial pressure of arterial carbon dioxide (PaCO2) were associated with the treatment effect of LTHNIPPV in these patients.Patients and MethodsSix electronic databases were comprehensively searched from January 1980 until June 2020. Randomized clinical trials (RCTs) comparing LTHNIPPV with control treatment were included. Two authors independently extracted data, assessed the study quality, and used the GRADE approach to evaluate evidence quality. The main outcome was mortality.ResultsNineteen studies involving 1482 patients (LTHNIPPV, n = 730; control, n = 752) were included. LTHNIPPV significantly reduced mortality (relative risk [RR] = 0.76; 95% confidence interval [CI]: 0.61–0.95; p = 0.02; I2 = 14%), the frequency of hospital admissions, PaCO2, and improved partial pressure of oxygen (PaO2) compared to control treatment. LTHNIPPV also relieved dyspnea and improved exercise capacity and health-related quality of life (HRQL) but showed no significant benefit for improving the forced expiratory volume in one second in predicted (FEV1% pred). Subgroup analysis revealed that the baseline level and reduction in PaCO2 were associated with decreased mortality (baseline PaCO2 ≥ 55 mmHg RR = 0.69, P = 0.02; vs baseline PaCO2 < 55 mmHg RR = 0.87, P = 0.32; and higher dPaCO2 RR = 0.42, P < 0.0001; vs lower dPaCO2 RR = 0.91, P = 0.38).ConclusionLTHNIPPV significantly reduced mortality. The baseline level and reduction in PaCO2 were associated with the treatment effect of LTHNIPPV in patients with stable hypercapnic COPD. Large-scale, multicenter RCTs are needed to confirm our results.

Intra-sphincteric botulinum toxin in the management of functional biliary pain.

Background and study aims The management of functional biliary-type pain remains a clinical challenge. Intra sphincteric botulinum toxin putatively exerts an anti-spasmodic and anti-nociceptive effect. The objective of this study was to examine the clinical response to intra sphincteric botulinum toxin in patients with functional biliary-type pain. Patients and methods This was a cross-sectional (hypothesis-generating) study of prospectively collected data from patients referred to a tertiary center from 2014 to 2019. The efficacy of ampullary botulinum toxin injection for relief of pain was recorded at post-procedure outpatient review. Opioid analgesia, neuromodulatory medication, and frequency of hospital admissions were recorded. Results A total of 119 consecutive patients (109 women, 10 men, mean age 45 years; range 17–77) underwent 411 intra-sphincteric botulinum toxin injection procedures (mean 2 procedures; range 1–15). A total of 103 patients (87 %) had a significant improvement in pain on post-procedure review and 77 % and 76 % of patients were opioid and admission free, respectively. Of the patients, 59 % were prescribed tricyclic antidepressants (amitriptyline), 18 % duloxetine, 13 % pregabalin, and 3 % mirtazapine. Loss of response with the initial dose of botulinum toxin occurred in 56 % of patients. Pain control was reestablished in 80 % of patients in this cohort following botulinum toxin injection at a higher dose. Conclusions These data suggest that botulinum toxin may improve outcomes in patients with functional biliary pain. Further controlled studies are needed to clarify the role of Botox and neuromodulatory agents.

Abstract EP26: Impacts Of Social Isolation During The COVID-19 Pandemic On Congestive Heart Failure Disease Management

Background: We investigated the impact of social isolation associated with the COVID-19 pandemic on the severity and frequency of congestive heart failure (CHF) symptoms and the frequency of hospital admissions. Hypothesis: We assessed the hypothesis that the psychosocial impacts of loneliness, as manifested during the COVID19 pandemic, caused potentially worsened congestive heart failure (CHF) symptom frequency and severity as well as the frequency of hospitalizations. Material and methods: This was a single tertiary center cohort study of inpatients admitted with a primary diagnosis of congestive heart failure. Each patient was asked to rate the extent of isolation related to the pandemic and the extent of changes in the severity and frequency of symptoms on a numeric scale during an in-person interview. The number of admission due to CHF since the start of the pandemic and in the two years before the start of the pandemic was also compared. Results: The study cohort included 40 patients, 52.5% females, 69.7+/-13.3 years old. Of these patients, 47.5% reported near-complete pandemic-related isolation and an additional 32.5% reported mild isolation. Symptom worsening was reported in 55% of all patients, which was more common in socially isolated patients (73.7%), while patients who maintained social contacts more commonly reported no change or improvement in symptoms (61.9%, p=0.024). There was also a strong trend in increased symptom frequency associated with social isolation (63.2% in isolated patients vs. 33.3% in the rest of the cohort, p=0.059). The pandemic period was also associated with a significant overall reduction in CHF-related hospital admissions, from 1.9+/-1.3 to 0.7+/-1.4 times (p=0.001), but no significant differences according to the social isolation status. Conclusions: Our findings suggest that the COVID-19 pandemic resulted in a significant symptom increase in patients who reported social isolation. At the same time and despite this symptom increase, a significant reduction in CHF-related hospital admissions suggests reluctance of patients to be treated in the hospital environment. The effects of interventions aimed at reducing social isolation should be investigated.

Evaluating a community respiratory physiotherapy service for children with neurodisability.

BackgroundChildren with neurodisability are at an increased risk of respiratory problems and complications, which often result in prolonged, frequent hospital admissions and are the biggest cause of mortality in this client group. The Children’s Community Respiratory Physiotherapy Service (CCRPS) was established in 2010 to support children with severe neurodisabilities at home during acute chest infections and to prevent emergency department attendances and hospital admissions. This service evaluation looked at patient/parent satisfaction and prevented admissions to ensure clinical and cost-effectiveness, despite the rising demand for the service.MethodsOver a 3-month period, patients and parents/carers on the CCRPS caseload were given a Picker feedback survey following 100 emergency visits from the team. The number of prevented hospital admissions for respiratory tract infection over 12 months (April 2019–March 2020) was identified from existing CCRPS data and hospital admissions costs saved were estimated.ResultsThe Picker survey responses were extremely positive with all respondents reporting that they felt well looked after and that the main reason for the emergency visit was dealt with well. Based on key indicators, the CCRPS prevented 182 hospital admissions for respiratory tract infection in 2019/2020, equating to 1638 bed days and estimated cost savings ranging between £751 728 and £1 009 986.ConclusionsThe Picker survey response demonstrates the positive impact that the CCRPS has on both quality of life and experience for patients and families. The CCRPS rapid response service prevents hospital admissions for respiratory tract infections in children and young people with severe neurodisability and the cost savings from admissions prevented allows the service to more than pay for itself.

An Analysis of Hospital Costs for Childhood Cancer Care.

This study used a linked dataset consisting of all childhood cancers recorded over the course of 10 years in New South Wales (NSW), Australia, to evaluate the hospital and emergency department costs (from a payer perspective) and resources used by patients with childhood cancer. We also analyzed determinants responsible for high-frequency hospital admissions, hospital length of stay (LoS), and hospital costs. We analyzed linked data at the individual patient level for a retrospective cohort of 2,966 patients with cancer aged <18 years with a diagnosis date between 2001 and 2012 from the NSW Central Cancer Registry, Australia. We reported costs and use of hospitalization and emergency department presentation 1 year before the date of diagnosis, 1 year after diagnosis, and 2 to 5 years after diagnosis. We also examined the association between cancer types and hospital admission and hospital costs from the payer perspective. Patient characteristics associated with the frequency of hospital admissions, hospital LoS, and hospital costs were also determined using a generalized linear model. Most hospital admission costs occurred in the first year after diagnosis, accounting for >70% of hospital costs within 5 years after diagnosis. The estimated median annual cost of hospitalization in the first year after diagnosis was A$88,964 (interquartile range [IQR], A$34,399-A$163,968) for patients diagnosed at age 0 to 14 years and A$23,384 (IQR, A$5,585-A$91,565) for those diagnosed at age 15 to 17 years. Higher frequency of hospital admissions, hospital LoS, and hospital costs were significantly associated with younger age at cancer diagnosis, cancer metastases, and living in remote/disadvantaged socioeconomic areas. Our study represents one of the first in Australia to include detailed hospitalization cost information for all childhood cancer cases. This study highlights the high hospital use by pediatric patients and the importance of early diagnosis. Our findings also demonstrate the health inequities experienced by patients from remote areas and the lowest socioeconomic areas.

Bronchial asthma control, quality of life, and psychiatric disorders vicious cycle: Asyut society point of view

BackgroundPoorly controlled bronchial asthma limits patients’ quality of life (QOL), the condition which may potentiate the development of psychiatric disorders. The aim of this study was the assessment of anxiety and depression in bronchial asthma patients, and their interrelation with both level of asthma control and quality of life in our society.ResultsThis study included 102 bronchial asthma patients, and 50 healthy control individuals. Patients had poorer QOL, and higher anxiety and depression scores compared to healthy control, moreover these scores were higher in uncontrolled asthma patients compared to controlled group. Poor QOL, frequent hospital admissions, and poor asthma control were the predictors for psychiatric disorders.ConclusionDepression and anxiety are frequently encountered in patients with bronchial asthma in our society; poor symptom control, poor QOL, and frequent hospital admissions are the main predictors for these psychiatric disorders.

Emergency Department Utilization, Hospital Admissions, and Office-Based Physician Visits Among Under-Resourced African American and Latino Older Adults

ObjectivesThis study uses a theoretical model to explore (a) emergency department (ED) utilization, (b) hospital admissions, and (c) office-based physician visits among sample of under-resourced African American and Latino older adults.MethodsNine hundred five African American and Latino older adults from an under-resourced urban community of South Los Angeles participated in this study. Data was collected using face-to-face interviews. Poisson and logistic regression analysis were used to estimate the parameters specified in the Andersen behavioral model. Predictors included predisposing factors, defined as demographic and other personal characteristics that influence the likelihood of obtaining care, and enabling factors defined as personal, family, and community resources that support or encourage efforts to access health services.ResultsAfrican American older adults have a greater frequency of hospital admissions, ED, and physician visits than their Latino counterparts. About 25%, 45%, and 59% of the variance of the hospital admissions, ED utilization, and physician visits could be explained by predisposing and enabling characteristics. Lower health-related quality of life was associated with a higher number of hospital admissions, ED, and physician visits. Financial strain and difficulty accessing medical care were associated with a higher number of hospital admissions. Being covered by Medicare and particularly Medi-Cal were positively associated with higher hospital admissions, ED, and physician visits.DiscussionCompared to African American older adults, Latino older adults show higher utilization of (a) emergency department (ED) utilization, (b) hospital admissions, and (c) office-based physician visits. A wide range of predisposing and enabling factors such as insurance and financial difficulties correlate with some but not other types of health care use. Multi-disciplinary, culturally sensitive, clinic- and community-based interventions are needed to address enabling and predisposing factors that influence ED utilization and hospital admission among African American and Latino older adults in under-resourced communities.

Effect of Counselling on Compliance of Hydroxyurea Therapy and Frequency of Hospital Admissions among Patients with Sickle Cell Disease- A Longitudinal Study

Introduction: Sickle Cell Disease (SCD) is an autosomal recessive multisystem disorder, characterised by anaemia, recurrent episodes of pain and chronic organ damage. Hydroxyurea (HU), a disease modifying agent with proven efficacy in reducing painful episodes in SCD patients thereby improving quality of life. Compliance to hydroxyurea therapy is a liming factor in management of SCD. Aim: To compare adherence to HU therapy and frequency of hospital admissions before and after counselling. Materials And Methods: This longitudinal study was conducted in Department of Paediatrics at Gandhi Medical College and associated Hamidia Hospital Bhopal, Madhya Pradesh, India, from 1st January 2020 to 30th June 2021. Patients with SCD, between the age group of 1-14 years, in a study period were recruited for the study. After enrolment, data regarding HU therapy and admissions in the previous one year was recorded for each registered patient. This was followed by detailed counselling sessions, which were repeated at 3 monthly intervals for a period of 1 year. Post-counselling data collection was done to evaluate the response. The effect of counselling was assessed using Chi-square test (for categorical variables) and Analysis of Variance (ANOVA) or paired t-test (for continuous variables). A p-value&lt;0.05 was considered statistically significant. Results: Initially, a total of 42 patients were registered, out of which only 31 patients could be followed-up till the last counselling. Mean age of the patients was 7.8±3.5 years, and 20 (64.5%) cases were males. As per history and previous year data total of 26 (83%) patients were already on HU therapy. Frequency of crises, hospital admissions, school absenteeism, and blood transfusion reduced significantly post counselling. The common factor associated with non adherence to therapy were non availability of drugs 21 (67.7%), followed by improper follow-up 20 (64.5%) and unawareness 17 (54.8%). Financial problems, non-palatability and distance from the hospital were other associated factors in 11 (35.5%), 4 (12.9%) and 2 (6.5%) cases, respectively. Conclusion: With counselling, better drug compliance to HU therapy was observed. This is expected to help in achieving better disease control in terms of reduced need for blood transfusion, hospital admissions as well as school absenteeism.