Hospital Admission Status Research Articles

Achromobacter Species: An Emerging Cause of Community-Onset Bloodstream Infections.

Background: Case reports and small series indicate that Achromobacter species bloodstream infection (BSI) is most commonly a complication of hospitalization among patients with chronic lung disease. The aim of the present study was to determine the incidence, risk factors, and outcomes of Achromobacter sp. BSI in an Australian population. Methods: Retrospective, laboratory-based surveillance was conducted in Queensland, Australia (population ≈ 5 million) during 2000–2019. Clinical and outcome data were obtained by linkage to state hospital admissions and vital statistics databases. BSI diagnosed within the community or within the first two calendar days of stay in hospital were classified as community-onset. Community-onset BSIs were grouped into community-associated and healthcare-associated. Results: During more than 86 million person-years of surveillance, 210 incidents of Achromobacter sp. BSI occurred among 195 individuals for an overall age-and sex-standardized annual incidence of 2.6 per million residents. Older individuals and males were at highest risk (2.9 vs. 2.0 per million, IRR for males 1.5; 95% CI, 1.1–1.9; p = 0.008). Most (153; 73%) cases were of community-onset of which 100 (48%) and 53 (25%) were healthcare- and community-associated, respectively. An increasing proportion of community-onset cases were observed during twenty years of surveillance. Underlying medical illnesses were common with median (interquartile range) Charlson Comorbidity Index (CCI) scores of 3 (1–5). CCI scores of 0, 1, 2, and 3+ were observed in 37 (18%), 27 (13%), 40 (19%), and 105 (50%) of cases, respectively. All but one of the cases were admitted to hospital for a median (interquartile range) length of stay of 12 (5–34) days. All-cause case–fatality rates in hospital by day 30 and by day 90 were 30 (14%), 28 (13%), and 42 (20%), respectively. The 90-day case–fatality rate increased with increasing comorbidity and was 3% (1/37), 11% (3/27), 25% (10/40), and 27% (28/105) among those with Charlson Comorbidity Indices of 0, 1, 2, and 3+, respectively (p = 0.004). Conclusions: Although comorbidity is an important determinant of risk, most Achromobacter sp. BSI are of community-onset and one-fifth of cases occur in patients without significant underlying chronic co-morbidities. This study highlights the value of population-based methodologies to define the epidemiology of an infectious disease.

Physiologic profile associated with severe multisystem inflammatory syndrome in children: a retrospective study.

ObjectiveThe purpose of this study was to describe the clinical presentation and physiologic profile of individuals with varying degrees of severity of multisystem inflammatory syndrome in children (MIS-C).MethodsWe performed a retrospective study of children diagnosed with MIS-C admitted to a single quaternary children’s hospital from May 2020 to April 2021. We created an MIS-C severity score using the following parameters: hospital admission status (e.g., floor vs intensive care unit), need for inotropic or vasoactive medications, and need for mechanical ventilation. Univariate and multivariate analyses were performed to associate risk factors corresponding to the MIS-C severity score.ResultsThe study included 152 children who were followed for 14 days post hospital admission. A stepwise forward selection process identified seven physiologic variables associated with “severe” MIS-C according to a logistic regression. Specifically, a combination of elevated creatinine (p = 0.013), international normalized ratio (p = 0.002), brain natriuretic peptide (p = 0.001), white blood cell count (p = 0.009), ferritin (p = 0.041), respiratory rate (p = 0.047), and decreased albumin (p = 0.047) led to an excellent discrimination between mild versus severe MIS-C (AUC = 0.915).ConclusionThis study derived a physiologic profile associated with the stratification of MIS-C severity.Impact Based on a cohort of 152 individuals diagnosed with MIS-C, this study derived a nomenclature that stratifies the severity of MIS-C.Investigated demographic, presentational vital signs, and blood analytes associated with severity of illness.Identification of a multivariate physiologic profile that strongly associates with MIS-C severity.This model allows the care team to recognize patients likely to require a higher level of intensive care.

Pasteurella species bloodstream infections in Queensland, Australia, 2000\u20132019

Pasteurella species are infrequent but potentially severe causes of bloodstream infection (BSI). The objective of this study was to determine the incidence, risk factors, and outcomes of Pasteurella species BSI in a large Australian population. Retrospective, laboratory-based surveillance was conducted in Queensland, Australia (population ≈ 5 million) during 2000–2019, and clinical and outcome information was established by linkage to state hospital admissions and vital statistics databases. During more than 86 million person-years of surveillance, 272 incident Pasteurella species BSI occurred for an overall age- and sex-standardized annual incidence of 3.3 per million residents. The incidence of Pasteurella species BSI was highest in recent years and older individuals were at greatest risk. The median (interquartile range) Charlson Comorbidity Index was 2 (0–4) with scores of zero, 1, 2, and 3 + observed in 81 (30%), 37 (14%), 44 (16%), and 110 (40%) of cases. The 30-day all-cause case fatality was 9% (24/272) and patients who died had more comorbidities and were less likely to have community-associated disease. Although Pasteurella species are infrequent causes of BSI, older individuals and those with comorbidities are at highest risk. The burden of this disease may be expected to increase with an aging and more comorbid population.

Mendelian randomization analysis of the causal impact of body mass index and waist-hip ratio on rates of hospital admission

We analyze how measures of adiposity – body mass index (BMI) and waist hip ratio (WHR) – causally influence rates of hospital admission. Conventional analyses of this relationship are susceptible to omitted variable bias from variables that jointly influence both hospital admission and adipose status. We implement a novel quasi-Poisson instrumental variable model in a Mendelian randomization framework, identifying causal effects from random perturbations to germline genetic variation. We estimate the individual and joint effects of BMI, WHR, and WHR adjusted for BMI. We also implement multivariable instrumental variable methods in which the causal effect of one exposure is estimated conditionally on the causal effect of another exposure. Data on 310,471 participants and over 550,000 inpatient admissions in the UK Biobank were used to perform one-sample and two-sample Mendelian randomization analyses. The results supported a causal role of adiposity on hospital admissions, with consistency across all estimates and sensitivity analyses. Point estimates were generally larger than estimates from comparable observational specifications. We observed an attenuation of the BMI effect when adjusting for WHR in the multivariable Mendelian randomization analyses, suggesting that an adverse fat distribution, rather than a higher BMI itself, may drive the relationship between adiposity and risk of hospital admission.

Increased Risk of Thrombosis in Patients with Myeloproliferative Neoplasms Compared with the General Population Hospitalized with COVID-19

Increased Risk of Thrombosis in Patients with Myeloproliferative Neoplasms Compared with the General Population Hospitalized with COVID-19

Adolescent trauma

Introduction: Adolescence is the transitional stage of physical and psychological changes that occur from puberty to adulthood, and disruption in growth at this stage can have long-lasting effects. Our main aim was to profile these injuries treated in the emergency department (ED) and describe the etiology, patterns, and outcomes in such patients. Materials and Methods: We conducted a retrospective descriptive analysis of these victims who presented to us from January 2017 to December 2018. Among key factors studied were patient demographics, mechanism of trauma, injury severity, hospital admission status. In addition to descriptive statistics, we utilized univariate and multivariate analyses to help elucidate factors associated with severe injuries. Results: The data for a total of 693 patients were analyzed. Among these, 84.5% were male. The mean age was 17.2 ± 1.33 years. Based on their hemodynamic stability, the majority were triaged as priority 2 (49.6%). The most common causes of trauma were road traffic accidents (RTAs) (63.3%), followed by sports related injury (13.7%). Two-wheeler-related incidents accounted for 82.5% of RTA-related injuries. Extremities, face, and head were injured in 51.3%, 25.8%, and 13.5%, respectively. New injury severity score of more than 14 was noted in 82 (13.2%) cases. Approximately half of the study population, 374 (54%), were discharged stable from the ED, whereas 254 (37%) were admitted with 194 (28%) requiring major surgical intervention. Conclusions: Most of the traumas related to adolescents are RTAs, followed by sports-related injuries. Male gender and pedestrian-related injuries are independent predictors for high severity of injuries. The following core competencies are addressed in this article: Patient care, Systems-based practice, Medical knowledge, Practice-based learning and improvement.

77 Insurance Status Plays a Role in Burn Patient Disposition Following Burn Injury

Abstract Introduction According to the Emergency Medical Treatment and Labor Act (EMTALA), patient insurance status has no role in stabilization and treatment of patients brought into the emergency department. However, uninsured patients with burn injuries are more likely than insured patients to face early hospital discharge, and less likely to receive care in skilled facilities for post-hospital rehabilitation. Following trauma, insured patients are more likely to have longer hospital lengths of stay (LOS) compared to uninsured patients, resulting in a loss of clinical equipoise. The purpose of this study was to evaluate whether insurance status affects morbidity, mortality, LOS, and post-discharge care for patients with burn injuries. We hypothesized that insured patients would experience fewer complications but would more frequently be referred to skilled facilities for extended post-discharge care. Methods We retrospectively queried our prospectively collected burn database for all patients suffering from burn trauma and admitted to our burn facility from July 2015-December 2015. Patients under the age of 18 years and those without documented insurance status were excluded. Our primary outcome was any complication. Secondary outcomes included LOS, ICU days, mortality, and disposition. Chi-square and multivariate logistic regression analyses were performed using Stata. Results A total of 451 patients were included (74% male, median age 51 years, TBSA 20% ± 1.1, 27% were uninsured). Univariate analysis showed that uninsured patients were less likely to have complications following burn injury, as well as less likely to have any comorbidities (28.5% vs. 40.6%, p=0.02; 55.3% vs. 72.3%, p=0.001, respectively). After controlling for confounding variables (Baux score, comorbidities, gender, and smoking) we found there was no association between complications and insurance status (OR 1.45, 95% CI 0.91–2.33). Using the same regression model, we secondarily found that there was a significant association between disposition after hospital admission and insurance status (OR 1.94, 95% CI 1.04–3.62) as well as an association between mortality and insurance status (OR 0.35, 95% CI 0.17–0.72). Conclusions At our institution, insurance status for burn patients was not associated with differences in length of stay or complications. Despite this, insured patients were more likely to be discharged to skilled facilities and less likely to die from burn injury. Disparate outcomes between insured and un-insured burn patients remain a significant concern, and more studies are needed to understand underlying etiologies.

Post-traumatic stress disorder symptoms in COVID-19 survivors: online population survey.

This study examined post-traumatic stress disorder (PTSD) symptoms in 13 049 survivors of suspected or confirmed COVID-19, from the UK general population, as a function of severity and hospital admission status. Compared with mild COVID-19, significantly elevated rates of PTSD symptoms were identified in those requiring medical support at home (effect size 0.178 s.d., P = 0.0316), those requiring hospital admission without ventilation (effect size 0.234 s.d., P = 0.0064) and those requiring hospital admission with ventilator support (effect size 0.454 s.d., P < 0.001). Intrusive images were the most prominent elevated symptom. Adequate psychiatric provision for such individuals will be of paramount importance.

Comorbidity of posttraumatic stress disorder and addiction from a biopsychosocial perspective

Posttraumatische Belastungsstörung und Substanzkonsumstörungen treten im medizinischen Versorgungssystem häufig koexistent auf. Ihre Komorbidität geht mit schwerwiegenderen akuten klinischen Symptombildern, mit zahlreichen, oft notfallmäßigen Hospitalisierungen und geringeren Behandlungserfolgen einher. Ihre Komorbidität trägt zu dramatisch ungünstigeren Verläufen auf allen biopsychosozialen Ebenen bei. Das Thema Komorbidität von PTBS und Sucht wird auf mehreren Ebenen untersucht: in den Perspektiven von Epidemiologie, Substanzkonsumstörung als Risikofaktor für Trauma und PTBS, Trauma und PTBS als Risikofaktor für Substanzkonsumstörung, neurobiologischen Konsequenzen einer Substanzkonsumstörung für die Neurobiologie von PTBS, gemeinsam geteilten Faktoren der Genetik/Epigenetik, Persönlichkeitsdimensionen und aversiven/traumatogenen Einflüssen in der frühen Entwicklung. Der Hauptfokus der Analyse liegt auf den wechselseitig sich verstärkenden Mechanismen, die der Entwicklung und dem Verlauf beider Störungsbilder inhärent sind.

An early experience on the effect of solid organ transplant status on hospitalized COVID-19 patients.

We compared the outcome of COVID-19 in immunosuppressed solid organ transplant (SOT) patients to a transplant naïve population. In total, 10356 adult hospital admissions for COVID-19 from March 1, 2020 to April 27, 2020 were analyzed. Data were collected on demographics, baseline clinical conditions, medications, immunosuppression, and COVID-19 course. Primary outcome was combined death or mechanical ventilation. We assessed the association between primary outcome and prognostic variables using bivariate and multivariate regression models. We also compared the primary endpoint in SOT patients to an age, gender, and comorbidity-matched control group. Bivariate analysis found transplant status, age, gender, race/ethnicity, body mass index, diabetes, hypertension, cardiovascular disease, COPD, and GFR <60mL/min/1.73m2 to be significant predictors of combined death or mechanical ventilation. After multivariate logistic regression analysis, SOT status had a trend toward significance (odds ratio [OR] 1.29; 95% CI 0.99-1.69, p=.06). Compared to an age, gender, and comorbidity-matched control group, SOT patients had a higher combined risk of death or mechanical ventilation (OR 1.34; 95% CI 1.03-1.74, p=.027).

Evaluation of Hospital Admission Status for Emergency Department Patients Seen for Chronic Obstructive Pulmonary Disease Exacerbation: A Retrospective Observational Study.

Background: Chronic obstructive pulmonary disease (COPD) is a common and preventable condition. The disease accounts for a large economic burden in the US health care system. Better control and prevention of COPD exacerbations can help prevent presentations to already-crowded emergency departments (EDs) and hospitals. The objective of our study was to identify variables associated with hospital admission status in ED patients presenting with COPD exacerbation.Methods: We conducted a retrospective observational study of patients seen at 1 of 3 US EDs from 2012 to 2014 with a primary diagnosis related to COPD exacerbation. Hospital admission status was modeled using patient characteristic data via adaptive least absolute shrinkage and selection operator logistic regression. Study results are presented as adjusted odds ratios with 95% CIs. Planned post hoc model dependency and external data sensitivity analyses were conducted.Results: The study sample included 1,165 unique patients with COPD with an ED encounter related to exacerbation at 1 of the 3 reviewed hospitals. Approximately half of these patients had a hospital admission. Variables inversely associated with an admission included oxygen saturation and number of prior ED encounters for COPD exacerbation. Variables positively associated with admission were initial ED heart rate, patient age, and documented comorbidities of anxiety and/or depression. These mental health comorbidities had the strongest association with admission status.Conclusion: Understanding the characteristics of admitted patients may help direct resources and outpatient services to prevent encounters. Of note, the study revealed mental health variables as being strongly associated with admission status.

Injury Severity of Ambulatory Patients Following Motor Vehicle Crash.

On-scene ambulatory status following a motor vehicle crash (MVC) serves as an informal marker of physiologic stability. The influence of ambulatory status after an MVC on trauma team activation and injury severity is infrequently studied, yet may alter the clinician's index of suspicion for injury. The purpose of this study is to describe the injury burden of ambulatory on-scene patients following an MVC. This is a prospective descriptive study of MVC patients arriving by emergency medical services (EMS), with trauma team activation, to a Midwestern Level I trauma center from July through December 2018. The EMS records were reviewed for wording that indicated the patient's ambulatory status following an MVC. Those denoted as "ambulatory on-scene" were included in this study. Of this subset, Injury Severity Score (ISS), hospital admission status, safety mechanisms utilized, crash scene description, and demographics were collected. A total of 648 MVC patients with trauma activations were reviewed, of which 308 met criteria for study inclusion. The average ISS was 2.8, with a range of 0 to 30. The cohort was 51.3% male, with a hospital admission rate of 25.9%. Of the 308 trauma activations, six were total, and 302 were partial. This study of MVC patients with documented on-scene ambulation found that, although the average ISS was low, injuries and hospital admission were present in up to one-quarter of patients. Ambulatory status following an MVC while informative should not be used as a triage mechanism.

Decline in Racial Disparities for United States Hospital Admissions After Anterior Cruciate Ligament Reconstruction From 2007 to 2015.

Background:Racial disparities in perioperative complications have been shown to exist for many procedures in orthopaedic surgery. Although anterior cruciate ligament reconstruction (ACLR) is commonly performed as an outpatient procedure, the rate of admission to the hospital postoperatively is not insignificant. Hispanic patients have been shown to have higher odds of admission compared with non-Hispanic patients.Hypothesis:We hypothesized that racial disparities would decrease from 2007 to 2015, resulting in lower rates of hospital admission for Black and Hispanic patients.Study Design:Descriptive epidemiology study.Methods:This study represents a retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) database for patients undergoing ACLR between 2007 and 2015. We performed bivariate analysis as well as binary logistic regression, with postoperative admission as the primary outcome. Previously identified risk factors for admission were used as predictors in addition to a term for the statistical interaction between year of surgery and ethnicity.Results:A total of 7542 patients undergoing ACLR were assessed. The logistic regression model showed that Hispanic patients had higher overall odds of admission (odds ratio [OR], 3.320; P < .001) than White patients; Black patients also had higher odds compared with White patients (OR, 1.929; P = .009). However, there was a significant interaction between year of surgery and both Black ethnicity (OR, 0.907; P = .026) and Hispanic ethnicity (OR, 0.835; P = .002), indicating a significant decrease in the admission rates for these minority patients compared with White patients over time. Other risk factors for admission were the use of regional anesthesia (OR, 3.482; P < .001), bleeding disorders (OR, 5.064; P = .002), a higher body mass index (OR, 1.029; P < .001), and longer operative times (OR, 1.012; P < .001). More recent surgery was associated with lower odds of admission (OR, 0.826; P < .001).Conclusion:Admission rates after ACLR declined from 2007 to 2015. Black and Hispanic patients were more likely to be admitted overall, but they also saw a greater decrease in the odds of admission than White patients. This represents a reduction in disparity between the 2 groups and is a reassuring improvement in racial disparity trends after a common sports procedure.

Ethnic differences in mortality and hospital admission rates between Māori, Pacific, and European New Zealanders with type 2 diabetes between 1994 and 2018: a retrospective, population-based, longitudinal cohort study

Type 2 diabetes affects Indigenous and non-European populations disproportionately, including in New Zealand, where long-term temporal trends in cause-specific clinical outcomes between Māori, Pacific, and European people remain unclear. We aimed to compare the rates of mortality and hospital admission between Māori, Pacific, and European patients with type 2 diabetes in Auckland, New Zealand, over a period of 24 years. In this retrospective, population-based, longitudinal cohort study, we identified a cohort of patients (aged 35-84 years) with type 2 diabetes enrolled between Jan 1, 1994, and July 31, 2018, to the primary care audit programme, the Diabetes Care Support Service (DCSS) in Auckland, New Zealand. Patients with type 1 diabetes, prediabetes, and gestational diabetes were excluded. We linked data from the DCSS with national death registration, hospital admission, pharmaceutical claim, and socioeconomic status databases. Patients were followed up until death or July 31, 2018 (date of last enrolment to the DCSS). Incident clinical events (all-cause mortality, cardiovascular mortality, cancer mortality, cardiovascular hospital admission, cancer hospital admission, and end-stage renal disease hospital admission) were identified. Event rates were stratified by ethnic group, age group, sex, socioeconomic status, and time period (<1998, 1999-2013, 2004-08, 2009-13, and 2014-18). Incidence rate ratios (IRRs) and absolute risk differences were adjusted for sex, age, smoking status, obesity, socioeconomic status, and time period by use of age-period-cohort modelling. Between Jan 1, 1994, and July 31, 2018, 45 072 patients with type 2 diabetes (21 936 [48·7%] female; mean age 56·7 years [SD 13·8]) were enrolled in the DCSS and followed up for a median of 9·7 years (IQR 5·8-13·6). 16 755 (37·2%) were European, 7093 (15·7%) were Māori, and 12 044 (26·7%) were Pacific patients. Despite a similar temporal trend (decreasing mortality and increasing hospital admissions) across the three ethnic groups, Māori and Pacific patients had consistently higher hospital admission rates than European patients. Māori but not Pacific patients had higher adjusted IRRs for all-cause mortality (1·96 [95% CI 1·80-2·14]), cardiovascular mortality (1·93 [1·63-2·29]) and cancer mortality (1·64 [1·40-1·93]) rates compared with European patients. Compared with European patients, poorer health outcomes have persisted among Māori and Pacific people with type 2 diabetes for more than 20 years. New policies supporting prevention and more intensive management of type 2 diabetes are urgently needed. Research into the biological and societal mechanisms underlying these disparities, and the associated differences between Māori and Pacific patients is also needed. Counties Manukau Health and Middlemore Foundation.

High Lung Transplant Center Volume Is Associated With Increased Survival in Hospitalized Patients

The lung allocation score (LAS) was designed to optimize the use of pulmonary allografts based on anticipated pretransplant survival and posttransplant outcome. Hospital admission status, not included in the LAS, has not been comprehensively investigated with regard to organ allocation. The objective of this study was to determine whether pretransplant hospital admission status was independently associated with posttransplant mortality and whether high center volume was associated with improved survival in that cohort. All consecutive adult lung transplants provided by the Scientific Registry of Transplant Recipients were retrospectively reviewed (from 2007 to 2017). Group stratification was performed based on admission status at the time of transplantation. A Cox proportional hazard regression was used to determine independent associations with posttransplant mortality. During the study period, 3747 of 18,416 recipients (20%) were admitted to the hospital at the time of transplantation. Compared with nonadmitted recipients, LAS were significantly higher and waitlist times significantly shorter. Admitted recipients had higher rates of prolonged mechanical ventilation, higher rates of posttransplant dialysis, and longer posttransplant lengths of stay. Pretransplant admission to a low-volume center conferred significantly worse survival compared with nonadmitted patients, and high-volume centers were independently associated with improved survival compared with low-volume centers. Hospital admission status is associated with increased posttransplant mortality independent of the LAS and the factors from which it is calculated. However, adjusted survival analysis demonstrates that admission to a high-volume center appears to be independently associated with improved survival compared with low-volume centers.

Length of stay for inpatient incompetent to stand trial patients: importance of clinical and demographic variables

We investigated clinical and demographic variables to better understand their relationship to hospital length of stay for patients involuntarily committed to California state psychiatric hospitals under the state's incompetent to stand trial (IST) statutes. Additionally, we determined the most important variables in the model that influenced patient length of stay. We retrospectively studied all patients admitted as IST to California state psychiatric hospitals during the period January 1, 2010 through June 30, 2018 (N = 20 041). Primary diagnosis, total number of violent acts while hospitalized, age at admission, treating hospital, level of functioning at admission, ethnicity, sex, and having had a previous state hospital admission were evaluated using a parametric survival model. The analysis showed that the most important variables related to length of stay were (1) diagnosis, (2) number of violent acts while hospitalized, and (3) age of admission. Specifically, longer length of stay was associated with (1) having a diagnosis of schizophrenia or neurocognitive disorder, (2) one or more violent acts, and (3) older age at admission. The other variables studied were also statistically significant, but not as influential in the model. We found significant relations between length of stay and the variables studied, with the most important variables being (1) diagnosis, (2) number of physically violent acts, and (3) age at admission. These findings emphasize the need for treatments to target cognitive issues in the seriously mentally ill as well as treatment of violence and early identification of violence risk factors.

Correction:Seasonality of ventricular fibrillation at first myocardial infarction and association with viral exposure.

[This corrects the article DOI: 10.1371/journal.pone.0226936.].

Predictors of Seclusion and Restraint Following Injurious Assaults on Psychiatric Units.

The aim of this study was to describe use of seclusion and restraint after injurious assaults by psychiatric inpatients in U.S. hospitals, including examination of hospital, unit, assaultive patient, and assault characteristics as predictors of seclusion/restraint use. Data from 2004 to 2017 on 23,630 injurious assaults reported by 747 psychiatric units in 482 general hospitals were analyzed. Odds of seclusion, odds of three restraint types (device, hold, pharmacological), and duration of seclusion and device restraint were modeled as functions of hospital, unit, assaultive patient, and assault characteristics. Compared with teaching hospitals, nonteaching hospitals had lower rates of seclusion but higher rates of all three types of restraint. Seclusion and restraint rates were lower in government hospitals and hospitals in metropolitan settings. Pharmacological restraint was most common in for-profit hospitals; seclusion was most common in nonprofit hospitals. Episodes of seclusion and device restraint were approximately 20% shorter in teaching hospitals than in nonteaching hospitals and lasted markedly longer in federal government hospitals. Hospitals in metropolitan settings reported 30% longer time spent in seclusion, on average. Involuntary admission was associated with higher odds of seclusion, device restraint, and hold. Female patients were less likely than males to be restrained with a device, and their seclusion and device restraint episodes tended to be shorter. The number of persons injured in an assault predicted odds of seclusion and all three types of restraint. The maximum level of injury sustained predicted odds of seclusion, device restraint, and hold, as well as duration of both seclusion and device restraint. Odds of seclusion/restraint were lower when the most severely injured person was a patient rather than a clinical health care worker. Inconsistencies were observed in seclusion and restraint use, which varied by hospital type, patient sex and admission status, maximum level of injury sustained, and type of person most severely injured. Thus, there may be room for improvement in hospital and unit policies and practices. More comprehensive data are needed for further research on use of seclusion and restraint in response to incidents other than injurious assault.

Development and Evaluation of the Supportive Needs Assessment Tool for Cirrhosis (SNAC).

BackgroundWe report the development and psychometric testing of a Supportive Needs Assessment tool for Cirrhosis (SNAC).MethodsThe 50-item SNAC was administered to patients (n=465) diagnosed with cirrhosis recruited from five metropolitan hospitals in Queensland, Australia. Items were assessed for ceiling and floor effects, and exploratory factor analysis was used to assess the factor structure. Identified factors were assessed for internal consistency and convergent validity to validated psychosocial tools.ResultsExploratory factor analysis identified 4 factors (39 items), which together accounted for 49.2% of the total variance. The 39-item SNAC met the requirements of a needs assessment tool and identified a range of needs important to patients with cirrhosis that were grouped in four subscales: “Psychosocial issues”, “Practical and physical needs”, “Information needs”, and “Lifestyle changes”. Cronbach's alpha values for the four subscales ranged from 0.64 to 0.92. Convergent validity was supported by a strong correlation between the total SNAC score and that of the Chronic Liver Disease Questionnaire (CLDQ; Spearman rho −0.68; p<0.001), and moderate correlations with the Distress Thermometer (Spearman rho 0.53; p<0.001) and seven subscales of a generic health-related quality of life instrument (Short Form 36; Spearman rho ranged from −0.48 to −0.57; p<0.001). The SNAC discriminated patient groups with respect to sex (p=0.013), age group (p<0.001), and hospital admission status (admitted vs not; p<0.001).ConclusionThese data provide initial evidence for the validity and reliability of the SNAC, an instrument designed to measure type and amount of perceived unmet practical and psychological needs of people diagnosed with cirrhosis.

Seasonality of ventricular fibrillation at first myocardial infarction and association with viral exposure.

To investigate seasonality and association of increased enterovirus and influenza activity in the community with ventricular fibrillation (VF) risk during first ST-elevation myocardial infarction (STEMI). This study comprised all consecutive patients with first STEMI (n = 4,659; aged 18-80 years) admitted to the invasive catheterization laboratory between 2010-2016, at Copenhagen University Hospital, Rigshospitalet, covering eastern Denmark (2.6 million inhabitants, 45% of the Danish population). Hospital admission, prescription, and vital status data were assessed using Danish nationwide registries. We utilized monthly/weekly surveillance data for enterovirus and influenza from the Danish National Microbiology Database (2010-2016) that receives copies of laboratory tests from all Danish departments of clinical microbiology. Of the 4,659 consecutively enrolled STEMI patients, 581 (12%) had VF before primary percutaneous coronary intervention. In a subset (n = 807), we found that VF patients experienced more generalized fatigue and flu-like symptoms within 7 days before STEMI compared with the patients without VF (OR 3.39, 95% CI 1.76-6.54). During the study period, 2,704 individuals were diagnosed with enterovirus and 19,742 with influenza. No significant association between enterovirus and VF (OR 1.00, 95% CI 0.99-1.02), influenza and VF (OR 1.00, 95% CI 1.00-1.00), or week number and VF (p-value 0.94 for enterovirus and 0.89 for influenza) was found. We found no clear seasonality of VF during first STEMI. Even though VF patients had experienced more generalized fatigue and flu-like symptoms within 7 days before STEMI compared with patients without VF, no relationship was found between enterovirus or influenza exposure and occurrence of VF.