Higher Hospital Admission Research Articles

Evaluation of a practical expert defined approach to patient population segmentation: a case study in Singapore

BackgroundSegmenting the population into groups that are relatively homogeneous in healthcare characteristics or needs is crucial to facilitate integrated care and resource planning. We aimed to evaluate the feasibility of segmenting the population into discrete, non-overlapping groups using a practical expert and literature driven approach. We hypothesized that this approach is feasible utilizing the electronic health record (EHR) in SingHealth.MethodsIn addition to well-defined segments of “Mostly healthy”, “Serious acute illness but curable” and “End of life” segments that are also present in the Ministry of Health Singapore framework, patients with chronic diseases were segmented into “Stable chronic disease”, “Complex chronic diseases without frequent hospital admissions”, and “Complex chronic diseases with frequent hospital admissions”. Using the electronic health record (EHR), we applied this framework to all adult patients who had a healthcare encounter in the Singapore Health Services Regional Health System in 2012. ICD-9, 10 and polyclinic codes were used to define chronic diseases with a comprehensive look-back period of 5 years. Outcomes (hospital admissions, emergency attendances, specialist outpatient clinic attendances and mortality) were analyzed for years 2012 to 2015.ResultsEight hundred twenty five thousand eight hundred seventy four patients were included in this study with the majority being healthy without chronic diseases. The most common chronic disease was hypertension. Patients with “complex chronic disease” with frequent hospital admissions segment represented 0.6% of the eligible population, but accounted for the highest hospital admissions (4.33 ± 2.12 admissions; p < 0.001) and emergency attendances (ED) (3.21 ± 3.16 ED visits; p < 0.001) per patient, and a high mortality rate (16%). Patients with metastatic disease accounted for the highest specialist outpatient clinic attendances (27.48 ± 23.68 visits; p < 0.001) per patient despite their relatively shorter course of illness and high one-year mortality rate (33%).ConclusionThis practical segmentation framework can potentially distinguish among groups of patients, and highlighted the high disease burden of patients with chronic diseases. Further research to validate this approach of population segmentation is needed.

A Nurse Led Clinic’s contribution to Patient Education and Promoting Self-care in Heart Failure Patients: A Systematic Review

Introduction: Heart failure (HF) is a medical condition whereby the heart’s efficency is compromised. Typical symptoms include breathlessness, tiredness and ankle swelling and signs of increased heart rate, lung congestion or raised jugular venous pressure. It is confirmed by the presence of a structural or functional abnormality of the heart on echocardiograph. HF significantly affects the patient’s quality of life (QoL). HF is a major problem for society affecting 1-2% of adults in developed countries (Mosterd and Hoes 2007), in excess of 90,000 people in Ireland are affected (Corry et al. 2015). Background: The incidence and prevalence as well as high hospital admission rates, increase the cost of and burden of HF. Chronic disease management programmes developed nurse-led clinics and collaboration of the multi-disciplinary team (MDT) to improve HF guideline implementation and outcomes. Educating patients on the self-care skills and knowledge necessary to control symptoms and avoid hospitalisation, which include daily weight, symptom monitoring and seeking timely medical care for deterioration is vital. Self-care is the decisions and choice of behaviours by the individual in order to maintain life, healthy functioning and well-being (Reigel and Carlson 2002, Jaarsma et al. 2003). Cowie et al (2014) examined Acute HF in Europe and the USA recommending: Optimising care accross institutions, improving patient education/ support, providing equitable care, enhancing end of life care, and increasing HF prevention. Aim: To examine the evidence for the role of the nurse-led clinic in patient education on the outcomes of Self-Care and QoL for HF patients. Methodology: A search of the databases CINHAL, PubMed, Science Direct and Medline was conducted. Search criteria: Adult HF patients aged over 18years, attending Nurse-led HF clinics/ nurse managed HF care programmes, English language only, No geographical limit, Published 2006-2016. Inclusion Criteria: Original Research, Interventions delivered through nurse led clinics, patient education, self-care skills, health assessment, and referral to MDT. Grey literature- online reports x 2 and small unpublished local population study. Results: Sixty eight studies were identified spanning 12 countries, various components of disease management programmes such as goal setting & motivational interviewing, educational and self-care needs, barriers and facilitators. Characteristics included all classes of HF, group or individualised programmes. Themes identified included: learning needs; knowledge, symptom recognition, barriers to learning, self-care skills, role of social/ caregiver support and a therapeutic nurse/patient/relationship. Conclusion: The patient’s need to be connected is highlighted by the review. Quantitative measures of self-care tools and patient satisfaction are augmented by patient reported outcomes and rich qualitative data. Cognitive impairment and depression may interfere with learning, decision-making and perception of symptoms.. The evidence supports the need for individualised patient educational plans and management strategies. Lifestyle changes may include controlling or modifiying risk factors (Dickstein et al. 2008). Adherence to guidelines and supporting patient autonomy are also important. Patients must learn and understand the relevant self-care behaviour required (Stromberg 2005, McMurray et al. 2012), gain the necessary skills to act on deteriorating symptoms and ways of increasing activity adjusted to functional capacity and energy conservation. Through education adapted to patient’s needs and goals, Self-Care is promoted and quality of life is improved. Further research is needed into other factors that affect QoL screening and the use of nursing taxonomies.

AI empowered context-aware smart system for medication adherence

Purpose Poor medication adherence leads to high hospital admission rate and heavy amount of health-care cost. To cope with this problem, various electronic pillboxes have been proposed to improve the medication adherence rate. However, most of the existing electronic pillboxes use time-based reminders which may often lead to ineffective reminding if the reminders are triggered at inopportune moments, e.g. user is sleeping or eating. Design/methodology/approach In this paper, the authors propose an AI-empowered context-aware smart pillbox system. The pillbox system collects real-time sensor data from a smart home environment and analyzes the user’s contextual information through a computational abstract argumentation-based activity classifier. Findings Based on user’s different contextual states, the smart pillbox will generate reminders at appropriate time and on appropriate devices. Originality/value This paper presents a novel context-aware smart pillbox system that uses argumentation-based activity recognition and reminder generation.

Depression in youth recovering from concussion: Correlates and predictors

ABSTRACTObjectives: Although depression can be a serious consequence of concussion, little is known about the factors that predict depression and concussion recovery outcomes in children. The purpose of this study was to explore the risk and possible predictors of developing significant depressive symptoms in children recovering from concussion.Methods: A prospective cohort study was conducted in a paediatric tertiary care clinic. Depression data were collected from 92 children using the Children’s Depression Inventory-2 (CDI-2) screening tool. Correlations, t-tests and logistic regression were used to examine the associations between depression scores and demographic as well as injury-related factors.Results: Depressive symptoms were found in 22% of the children (T score on CDI-2 >65). Children with evidence of depressive symptomatology had significantly higher mean post-concussive symptom inventory (PCSI) scores in recovery (p = 0.004) than children who were not depressed. Variables of i) Sex; ii) hospital admission; iii) number of head injuries; iv) post-concussion symptom score and v) experience of prolonged symptoms were predictive of clinically significant CDI T scores, explaining 36% of the variation in the binary logistic model.Conclusion: Depression is commonly reported in this subset of children. High post-concussive symptom scores and hospital admission were strong predictors of depression. Screening for depression should be standard practice in concussion management in children and youth.

Strategy to fight against malnutrition in chronic patients with complex health needs

Disease-related malnutrition (DRM) is a prevalent condition amongst older people as well as patients in all healthcare settings around the world. Chronic patients with complex health needs (CPCHN defined as those with complex chronic conditions that involve multiple health requirements, complex social support needs, or both) are especially vulnerable to malnutrition. Malnutrition is associated with increased morbidity, a higher hospital admission and readmission rate, increased needs for social resources and even a high mortality. In Catalonia, CPCHN account for 3.5-5 % of the Catalan population (250,000 to 375,000 patients), and we have data pointing to a high prevalence of malnutrition in CPCHN admitted in hospitals for an acute episode (36 % malnourished, 47 % risk of malnutrition). Nevertheless, the prevalence of DRM in CPCHN in the community has been not sufficiently studied. In addition, health and social risk factors for malnutrition are unknown in these population. Taking all these into account, it is necessary to establish an integrated and a collaborative health and social strategy for the screening and management of nutritional care, mainly from a community-based as well as a patient-centered approach. The strategy to tackle against malnutrition in CPCHN is led by the Department of Health of Catalonia (PPAC, PIAISS), the Spanish Society of Parenteral and Enteral Nutrition (SENPE) and the Family and Community Nursing Association (AIFICC), with the support of the University of Vic. This strategy is based on a Decalogue of actions to fight against malnutrition previously identified by a consensus among experts from scientific societies, social services and public health, incorporating the vision of patients and caregivers. Aims : 1. Highlight the DRM problem in CPCHN launching a prevalence study of DRM in the CPCHN selecting a representative sample of Catalonian society. 2. Establish an integrated and a collaborative intervention plan (nutritional and social) linked to the detection of malnutrition and/or social dysfunction. Results and impact : 1. The prevalence study of DRM in the CPCHN is a prospective observational and multicenter randomized study that has been performed in a region of Catalonia, representative of the Catalan society (80 % urban, 20 % rural). The sample size calculated was 384 patients, a total of 404 patients have been participated. A very high prevalence of malnutrition and risk of malnutrition has been found (46.5 % risk, 5.9 % malnutrition) Living alone, polypharmacy and dysphagia were the most important social and health determinants that influence DRM and will allow us to focus strategies to improve patient care. 2. The integrated and collaborative intervention plan to tackle against DRM in CPCHN is based on a protocol that includes the clinical, nutritional and social risk screenings. With this aim, Primary Care teams (doctors and nurses) and Social Service professionals (Primary Care and community resources) are coordinated with the Nutritional Support Unit in the reference hospital in a collaborative manner. The first step has been to incorporate mandatory nutritional and social risk factors screenings in patients identified as CPCHN. A positive nutritional or social screening have been linked to comprehensive nutritional and social assessment plans that will allow diagnosing and encoding malnutrition and identifying patients at risk of social dysfunction. Diagnosis of DRM or social dysfunction is linked to an integrated intervention plan (nutritional and social), that includes case-conferences in the case of patients with complex needs. Highlights : Prior to the development of the strategy for dealing with DRM in CPCHN, a low implementation of nutritional screening was detected. This fact was probably due to a low awareness of DRM, but also for lack of a feasible and efficient plan of approach, that must include not only the health aspects but also the social determinants that accompany the disease. Contingencies : The implementation of this strategy is time-consuming, and requires an integrated health and social work. Tutorials have been attached to the shared medical history of Catalonia to guide professionals in the application of the screenings. Timeline : The prevalence study of DRM in the community has been finished at January 2016. The mandatory screening and the validation of the nutritional and social intervention plan will be implemented during 2016. Conclusion : The results of the prevalence study of DRM in CPCHN could be extrapolated to the rest of Catalonia, allowing us to manage effectively the health and social policies. It will also allow us to analyze the impact of different health care quality indicators linked to the strategy to approach to DRM. Nutritional and social community intervention can be cost-efficient, as demonstrated in the hospital setting, and probably will allow reducing unnecessary admissions, readmissions, complications, need for social resources and will help improve the quality of life in CPCHN. The impact of this strategy is based in detecting and treating in an integrated and collaborative manner DRM in CPCHN.

Diabetes care in Austria and England: what causes the fivefold higher hospital admission rates?

Background This study tries to identify differences in the structure and processes of primary care related to diabetes care in Graz (Austria) and Tower Hamlets (London, United Kingdom). It tries to assess if these observed differences can explain the five-fold higher hospital admission rates due to diabetes in Austria compared with England. Methods The study implemented a mixed-method …

Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: an observational study.

BackgroundThis study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance.MethodsThis was a planned sub-study of a prospective, interrupted time series cohort study conducted at three time points in 2014 and which included consecutive adult patients presenting to the ED with dyspnoea as a main symptom. For this sub-study, additional inclusion criteria were presentation to an ED in Australia or New Zealand and transport by ambulance. The primary outcomes of interest are the epidemiology and outcome of these patients. Analysis was by descriptive statistics and comparisons of proportions.ResultsOne thousand seven patients met inclusion criteria. Median age was 74 years (IQR 61-68) and 46.1 % were male. There was a high rate of co-morbidity and chronic medication use. The most common ED diagnoses were lower respiratory tract infection (including pneumonia, 22.7 %), cardiac failure (20.5%) and exacerbation of chronic obstructive pulmonary disease (19.7 %). ED disposition was hospital admission (including ICU) for 76.4 %, ICU admission for 5.6 % and death in ED in 0.9 %. Overall in-hospital mortality among admitted patients was 6.5 %.DiscussionPatients transported by ambulance with shortness of breath make up a significant proportion of ambulance caseload and have high comorbidity and high hospital admission rate. In this study, >60 % were accounted for by patients with heart failure, lower respiratory tract infection or COPD, but there were a wide range of diagnoses. This has implications for service planning, models of care and paramedic training.ConclusionThis study shows that patients transported to hospital by ambulance with shortness of breath are a complex and seriously ill group with a broad range of diagnoses. Understanding the characteristics of these patients, the range of diagnoses and their outcome can help inform training and planning of services.

Risk of bipolar disorder in patients with COPD: a population-based cohort study.

Few studies have investigated the relationship between chronic obstructive pulmonary disease (COPD) and bipolar outcomes in the world. We sought to investigate the association between COPD and risk of bipolar disorder in a large national sample. The insured aged 15years or more with a new primary diagnosis of COPD (ICD-9: 491, 492, 494 and 496) between 2000 and 2007 were identified from Taiwan's National Health Insurance Research Database. We included individuals with an inpatient diagnosis of COPD and/or at least 1year of two diagnoses of COPD in outpatient services. These 35,558 cases were compared to 35,558 sex-, age-, residence- and insurance premium-matched controls. We followed both groups until the end of 2008 for incidence of bipolar disorder, defined as ICD-9 codes 296.0-296.16, 296.4-296.81 and 296.89. Competing risk-adjusted Cox regression analyses were applied with adjusting for sex, age, residence, insurance premium, prednisone use, Charlson comorbidity index, diabetes, hypertension, hyperlipidemia, cardiovascular diseases, hospital admission days, outpatients' visits and mortality. Of the total 71,116 subjects, 202 were newly diagnosed with bipolar disorder during the study period. The mean follow-up time was 6.0(SD=2.2)years. COPD, younger age, lower economic status, lower dose of prednisone use, higher hospital admission days and higher outpatient visits were independent predictors of bipolar disorder. COPD was associated with increased risk of bipolar disorder independent of a number of potential confounding factors in this study.

Hospital Utilisation in Indigenous and Non-Indigenous Infants under 12 Months of Age in Western Australia, Prospective Population Based Data Linkage Study.

BackgroundIndigenous infants (infants aged under 12 months) have the highest hospital admission and emergency department presentation risks in Australia. However, there have been no recent reports comparing hospital utilisation between Indigenous and non-Indigenous infants.MethodsOur primary objective was to use a large prospective population-based linked dataset to assess the risk of all-cause hospital admission and emergency department presentation in Indigenous compared to non-Indigenous infants in Western Australia (WA). Secondary objectives were to assess the effect of socio-economic status (Index of Relative Socio-Economic Disadvantage [IRSD]) on hospital utilisation and to understand the causes of hospital utilisation.FindingsThere were 3,382 (5.4%) Indigenous and 59,583 (94.6%) non-Indigenous live births in WA from 1 January 2010 to 31 December 2011. Indigenous infants had a greater risk of hospital admission (adjusted odds ratio [aOR] 1.90, 95% confidence interval [95% CI] 1.77–2.04, p = <0.001) and emergency department presentation (aOR 2.15, 95% CI 1.98–2.33, p = <0.001) compared to non-Indigenous infants. Fifty nine percent (59.0%) of admissions in Indigenous children were classified as preventable compared to 31.2% of admissions in non-Indigenous infants (aOR 2.12, 95% CI 1.88–2.39). The risk of hospital admission in the most disadvantaged (IRSD 1) infants in the total cohort (35.7%) was similar to the risk in the least disadvantaged (IRSD 5) infants (30.6%) (aOR 1.04, 95% CI 0.96–1.13, p = 0.356).InterpretationWA Indigenous infants have much higher hospital utilisation than non Indigenous infants. WA health services should prioritise Indigenous infants regardless of their socio economic status or where they live.

First-episode psychosis: What does it mean?

IntroductionFirst-Episode Psychosis (FEP) is a variable condition, characterized by the emergence of new psychotic features for a period of at least 1 week. The majority of existing studies about FEP only address schizophrenia spectrum psychosis (SSP), which may limit the capacity to fully characterize this entity.Objectives/AimsReport the clinical and socio-demographic characteristics of patients with FEP in real-world setting, and compare the differences among SSP and affective FEP.MethodsRetrospective analysis of clinical files of patients admitted to our hospital unit with FEP diagnosis from January/2012 to April/2015. Clinician-rated dimensions of psychosis symptom severity scales (DSM-5) were applied.ResultsAnnual incidence of FEP was 11,3/100,000. From a total of 755 patients, 57 (7,5%) corresponded to FEP; 38 (66,7%) were diagnosed with SSP, 11 (19,3%) affective psychosis, 3 (5,2%) toxic psychosis and 5 (8,8%) organic psychosis. Most were female (61,4%), with a mean age of 49 years. The majority were unemployed (66,7%), lived with family (57,9%), and presented with moderate-severe delusions (80,1%), but without hallucinations (57,8%), disorganized speech (59,6%) or negative symptoms (85,9%). Affective FEP patients were older (61 vs 45 years), presented with less severe psychotic symptoms (7,2 vs 8,3 points), but with higher hospital admission (26,1 vs 21,1 days).ConclusionsRegardless the growing interest concerning FEP, its conceptualization and characterization remains controversial. Our results differ from pre-existing literature data, especially concerning gender and age. By including all the possible etiologies of FEP, we aimed to obtain a more realistic characterization of this entity in a real-world setting.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Identifying and prioritising areas of child dental service need: a GIS-based approach.

To identify and prioritise areas of high need for dental services among the child population in metropolitan Western Australia. All children hospitalised due to an oral-condition from 2000 to 2009, at metropolitan areas of Perth were included in the analysis of a 10-year data set. QGIS tools mapped the residential location of each child and socioeconomic data in relation to existing services (School Dental Service clinics). The tables and maps provide a clear indication of specific geographical areas, where no services are located, but where high hospital-admission rates are occurring, especially among school-age children. The least-disadvantaged areas and areas of high rates of school-age child hospital-admissions were more likely to be within 2km of the clinics than not. More of high-risk-areas (socio-economically deprived areas combined with high oral-related hospital admissions rates), were found within 2km of the clinics than elsewhere. The application of GIS methodology has identified a community's current service access needs, and assisted evidence based decision making for planning and implementing changes to increase access based on risk.

Public funding of uterine transplantation.

A retrospective survey of acute hospital admissions from nursing homes over a year to a district hospital revealed high overall hospital admission rates and wide variations of admission rates from similar homes. Medical admissions dominated, infections and poorly controlled heart failure being notably common. A significant proportion of admissions may have been avoided by active chronic disease management, together with better information for doctors responding to emergency calls and specialist support programmes facilitating in situ treatment.

Implementing a "free" tuberculosis (TB) care policy under the integrated model in Jiangsu, China: practices and costs in the real world.

BackgroundIn the 1990s, China introduced a “free” tuberculosis (TB) care policy under the national TB control program. Recently, as a part of a new TB diagnosis and treatment model, it has been recommended that the integrated model scale up. This paper examines whether or not TB designated hospitals in the selected project sites have provided TB care according to the national and local guidelines, and analyzes the actual practices and expenditures involved in completing TB treatment. It also explores the reasons why “free” TB care in China cannot be effectively implemented under the integrated model.MethodsThis study was conducted in three counties of Zhenjiang city, Jiangsu province. Mixed methods were used, which comprised reviewing the national and local TB control guidelines, conducting TB patient surveys, collecting TB inpatient and outpatient hospital records, and conducting qualitative interviews with stakeholders. Descriptive statistics were used for quantitative data analysis across counties and in order to compare patients who received only outpatient care and those who received both outpatient and inpatient care. The chi-square test and analysis of variance were performed where necessary. Qualitative data were analyzed using the framework approach.ResultsAlthough the national TB care guidelines recommend outpatient care as a basis for TB treatment in China, we found high hospital admission rates for TB patients ranging from 39 % in Yangzhong county to 83 % in Dantu county. Almost all outpatient TB patients paid for lab tests and over 80 % paid for liver protection drugs and around 70 % paid for image examinations. These three components accounted for three-quarters of the total outpatient expenditure. For patients who received only outpatient care, the total expenditure upon completion of TB treatment was on average 1,135 Chinese yuan. For patients who received outpatient and inpatient care, the total expenditure upon completion of TB treatment was 11,117 Chinese yuan.ConclusionThe “free” TB care policy under the integrated model has not been effectively implemented in China. There has been substantial spending on non-recommended services, examinations, and drugs for TB treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0099-8) contains supplementary material, which is available to authorized users.

Effects of socioeconomic disadvantage on renal failure hospital admissions in Victoria.

5 years of age. RFAs had the sixth highest 30-day readmission (15%). One-tenth of the patients died in hospital. The RFA rates varied inversely with SED (r=–0.51, P <0.01).Thecoefficientofvariationwas0.44and0.16forRFA andalladmissions,respectively,indicatingthatRFAshadgreater variability by LGA than all admissions. The mean RFA rate for the top percentile LGAs was 2.4-fold greater than that of the bottom percentile LGA (13.21 (95% CI 11.44–14.93) vs 5.62 (95% CI 4.43–6.95), respectively). The top percentile group was the most disadvantaged, including Central Goldfields, Loddon and Mildura. The bottom percentile group include Bayside, Boroondara and Nillumbik. LGAs with high RFA rates also had high hospital admission ratesforotherconditions,suchasheartfailure(r=0.58,P <0.01) and chronic obstructive pulmonary disease (r=0.49, P <0.01), and prevalence of hypertension (r=0.32, P <0.01) and obesity (r=0.26,P <0.05). Residents of disadvantaged communities are significantly more likely (r=0.45, P <0.01) to be on a Disability Support Pension (Table 1). Inconclusion,thevariationsinRFAratesmayreflectmultiple factors, particularly access to adequate care, delayed referral to Table 1. Inter-correlation coefficients for age-standardised renal failure hospitalisation rates and key variables *P <0.05, **P <0.01 (two-tailed). SED, socioeconomic disadvantage; REN, age-adjusted renal failure admissions per 10 000 population; HRF, age-adjusted heartfailureadmissionsper10 000population;COP,age-adjustedchronicobstructivepulmonarydiseaseadmissionsper10 000population;OCA,proportionof thepopulationundertakingmostlyheavylabourorphysicallydemandingactivity;HYP,prevalence(%)ofhypertension;OBE,prevalence(%)ofoverweightand obesity;HLS,prevalence(%)offairorpoorself-reportedhealthstatus;CAN,prevalence(%)ofcancer;DSP,proportionofthepopulationonDisabilitySupport

Vaccinating against influenza in children without needles: A new initiative

Young children are of the highest hospital admission rate of all influenza cases. A broad and effective rollout of influenza vaccines for children is hindered by the current most common method of administration: the needle and syringe. Limitations include: reduced compliance due to needle-phobia; increased costs due to maintaining refrigeration due to transportation and storage (the cold chain); the need for qualified medical/nursing practitioners - to help reduce risk of unsafe injections and needle-stick injuries; and potentially impeded immunity - by delivery to muscle and not accessing the abundant antigen presenting cell populations resident in skin and mucosal surfaces. This paper explores needle-free routes to improved childhood influenza vaccines rollout, by being a practical device for self-Administration that has also generated significantly-improved immunogenicity and also the removal of the cold chain (through dry-formulation). Marketed devices targeting the mucosa through intranasal delivery (of liquid vaccine) are analysed, together with skin-targeting approaches currently in development - offering both improved immunogenicity and cold-chain removal by formulating the vaccine in a solid form.

Neurological Manifestations in Falciparum Malaria: A Study in Tribal Community of Hill Tracts

Objectives The aim of this study is to find out the prevalence and outcome of falciparum malaria with neurological manifestations.&#x0D; Materials and Methods A prospective cross-sectional hospital-based study of 318 falciparum malaria patients using simple, direct, standardized questionnaire with history, lab investigations and neurological examination from January 2014 to December 2014.&#x0D; Results July was the most vulnerable month for falciparum malaria causing the highest hospital admission (48.8%) and death (29.3%). The commonest age group affected was 15-30 years (49.2%). Prevalence of neurological manifestations was 41.2%. Altered sensorium (48.7%) was the most frequent neurological manifestation, followed by abnormal behavior (19.8%) and convulsions (15.5%). Case fatality rate was very high with neurological manifestations, highest with altered sensorium (31.3%). Perception of neurological manifestations among tribal was very poor. Primary health care providers also failed to diagnose most of the cases (69%) which presented with neurological features.&#x0D; Conclusion Falciparum malaria with neurological involvement is associated with increased mortality. By documenting different neurological patterns of falciparum malaria and by trained health care personnel, mortality and morbidity rates can be reduced by early diagnosis and management.&#x0D; CBMJ 2015 January: Vol. 04 No. 01 P: 18-21

Multisite analysis of the timing and outcomes of unplanned transfers from subacute to acute care.

The aim of the present study was to examine the timing and outcomes of patients requiring an unplanned transfer from subacute to acute care. Subacute care in-patients requiring unplanned transfer to an acute care facility within four Victorian health services from 1 January to 31 December 2010 were included in the study. Data were collected using retrospective audit. The primary outcome was transfer within 24 h of subacute care admission. In all, 431 patients (median age 81 years) had unplanned transfers; of these, 37.8% had a limitation of medical treatment (LOMT) order. The median subacute care length of stay was 43 h: 29.0% of patients were transferred within 24 h and 83.5% were transferred within 72 h of subacute care admission. Predictors of transfer within 24 h were comorbidity weighting (odds ratio (OR) 1.1, P = 0.02) and LOMT order (OR 2.1, P < 0.01). Hospital admission occurred in 87.2% of patients and 15.4% died in hospital. Predictors of in-hospital mortality were comorbidity weighting (OR 1.2, P < 0.01) and the number of physiological abnormalities in the 24 h preceding transfer (OR 1.3, P < 0.01). There is a high rate of unplanned transfers to acute care within 24h of admission to subacute care. Unplanned transfers are associated with high hospital admission and in-hospital mortality rates.

Trend of urban-rural disparities in hospital admissions and medical expenditure in China from 2003 to 2011.

ObjectivesTo assess the trend of urban-rural disparities in hospital admissions and medical expenditure between 2003 and 2011 in the context of Chinese health-care system reform.MethodsThe data were from three different national surveys: the Third National Health Services Survey in 2003, the Fourth National Health Services Survey in 2008 and the national health-care reform phased assessment survey in 2011. There were 151421, 143380 and 48356 respondents aged 15 years or older in 2003, 2008 and 2011, respectively.ResultsThe health insurance coverage expanded considerably from 27.7% in 2003 to 96.4% in 2011 among respondents aged 15 years or older. Hospitalization rate increased rapidly from 4.1% in 2003 to 9.6% in 2011. Urban respondents had higher hospital admissions than rural respondents, and the RR (95% CI) of hospitalization was 1.23 (1.17–1.30), 1.06 (1.02–1.10) and 1.16 (1.10–1.23) in 2003, 2008 and 2011, respectively. The urban-rural disparity in hospital admissions significantly narrowed over time. Urban respondents had a higher admission rate if insured and a lower admission if not insured than their rural counterparts. Of the six medical expenditure measures, the disparities in reimbursement rate and the proportion of hospitalization direct cost to the total consumer spending significantly narrowed.ConclusionsThe health insurance coverage has been continually expanding and health service utilization has been substantially improved. Urban-rural disparities have been narrowed but still exist. Therefore, policy-makers should focus on increasing investment and reimbursement levels, developing a uniform standard health insurance system for urban and rural residents and improving the medical assistance system.

Costs of surviving meningococcal disease in Spain: Evaluation for two cases of severe meningitis and septicaemia

ObjectivesThe aim of this study was to count the lifelong rehabilitation costs associated with surviving meningococcal disease with major sequelae from the perspective of the Spanish National Healthcare System (NHS) and the national government. MethodsTwo severe scenarios describing meningococcal disease were developed, one case that represented meningococcal septicaemia and another case for meningococcal meningitis. The scenarios were developed based on a literature review on severe sequelae of meningococcal disease, and discussions with paediatricians who have been responsible for the treatment of children with this disease in Spain. Second, a detailed list of all health, educational and social care resources used by survivors during their acute illness and during the rest of their lives and by family members was obtained by interviewing survivors and their families. Professionals in health and social care were also interviewed to complete the list of resources and ensure the scenario's were accurate. The costs attributed to these resources were obtained from tariff lists, catalogues and published information by the national authorities. All costs were based on a life expectancy of a survivor of 70 years and expressed in EUR 2012. ResultsIn this study it was estimated that the lifelong discounted rehabilitation costs associated with the treatment of long-term sequelae due to meningococcal disease are approximately €1180,000–€1400,000. Medical care and social care were the main cost drivers for both septicaemia and meningitis. Annual costs showed to be the largest in the first year after diagnosis of the disease for both cases, due to high hospital admission and medical care costs during this period and decreased significantly over the years. ConclusionThis study shows that the lifelong rehabilitation costs associated with the survival of meningococcal disease with severe sequelae place an important burden on the NHS budget and governmental resources in Spain.

Effect of Influenza Vaccination on Acute Respiratory Symptoms in Malaysian Hajj Pilgrims

Respiratory illness were a major problem and caused high hospital admission during hajj seasons. One of the contributing cause to this illness is infection. Various measures had been implemented to reduce respiratory infections. The aim on the study is to determine the effect of influenza vaccination against acute respiratory illness among Malaysian Hajj pilgrims. This is an observational cohort study. Influenza vaccination was given to pilgrims at least 2weeks prior to departure. The occurrence of symptoms for respiratory illness such as cough, fever, sore throat and runny nose was monitored daily for 6weeks during pilgrimage using a health diary. A total of 65 vaccinated hajj pilgrims and 41 controls were analyzed. There was no significant difference in pattern of occurrence of symptoms of respiratory illness by duration of pilgrimage as well as the number of symptoms between both groups. Hajj pilgrims have frequent respiratory symptoms. We were unable to document benefit from influenza vaccination, but our study was limited by a small sample size and lack of laboratory testing for influenza.