Hospitalization For Acute Illness Research Articles

Acute functional decline before hospitalization in older patients

Acute diseases and related hospitalization are crucial events in the disabling process of elderly individuals. Most of the functional decline occurs in the few days before hospitalization, as a result of acute diseases in vulnerable patients. The aim of the present study was to identify determinants of prehospital components of functional decline. This was a prospective observational study carried out in three acute geriatric units and two general medicine units of three Italian hospitals. The participants were 1281 patients aged 65 years or older admitted to hospital for acute illnesses and discharged alive. Functional status 2 weeks before hospitalization (preadmission) and at hospital admission was measured by the Barthel Index to identify patients with prehospital decline. In this group of decliners, the percentage extent of prehospital decline (PEPD) was also calculated. Prehospital decline occurred in 541 (42.2%) patients, who were hospitalized mostly in geriatric wards (55.6%). Older age (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.04-1.08) and dementia (OR 2.8, 95% CI 1.4-5.4) were significant predictors of prehospital decline, whereas a high preadmission function was protective (OR 0.992, 95% CI 0.987-0.997). Pulmonary disease as primary discharge diagnosis was also associated with prehospital decline (OR 1.8, 95% CI 1.3-2.5) after adjustment for age, diagnosis of dementia and preadmission function. Amongst decliners, a low preadmission function and the origin of patients (from emergency rooms or other hospital units) were associated with larger PEPD. Using a clinically meaningful change to define decline, disease-related prehospital disability is observed mainly in persons with low preadmission function, older age and dementia.

The challenges of achieving person-centred care in acute hospitals: A qualitative study of people with dementia and their families

BackgroundPerson-centred care has been identified as the ideal approach to caring for people with dementia. Developed in relation to long stay settings, there are challenges to its implementation in acute settings. However, international policy indicates that acute care for people with dementia should be informed by the principles of person-centred care and interventions should be designed to sustain their personhood. ObjectivesUsing Kitwood's five dimensions of personhood as an a priori framework, the aim of this paper was to explore the way in which current approaches to care in acute settings had the potential to enhance personhood in older adults with dementia. DesignData collected to explore the current experiences of people with dementia, family carers and co-patients (patients sharing the ward with people with mental health problems) during hospitalisation for acute illness were analysed using a dementia framework that described core elements of person centred care for people with dementia. SettingsRecruitment was from two major hospitals within the East Midlands region of the UK, focusing on patients who were admitted to general medical, health care for older people, and orthopaedic wards. ParticipantsParticipants were people aged over 70 on the identified acute wards, identified through a screeing process as having possible mental health problems. 34 patients and their relatives were recruited: this analysis focused on the 29 patients with cognitive impairment. MethodThe study involved 72h of ward-based non-participant observations of care complemented by 30 formal interviews after discharge concerning the experiences of the 29 patients with cognitive impairment. Analysis used the five domains of Kitwood's model of personhood as an a priori framework: identity, inclusion, attachment, comfort and occupation. ResultsWhile there were examples of good practice, health care professionals in acute settings were not grasping all opportunities to sustain personhood for people with dementia. ConclusionsThere is a need for the concept of person-centred care to be valued at the level of both the individual and the organisation/team for people with dementia to have appropriate care in acute settings.

The Burgeoning Burden of Respiratory Syncytial Virus Among Children

Respiratory syncytial virus (RSV) was first isolated from infants by Chanock and colleagues in 1957. However, control of this ubiquitous agent has yet to be achieved. RSV is recognized as the primary cause of hospitalization for acute lower respiratory tract illness (LRTI) among infants worldwide. Among children < 5 years old, annual hospitalization rates in the United States (US) is 3/1000 children, and rates in Canada and European countries are similar. In the US the hospitalization rate is 3 times higher than that from influenza or parainfluenza viral infections. Much less appreciated is the clinical and economic burden from RSV outpatients, as few have specific diagnostic testing. Nevertheless, RSV in the US is estimated to cause 1 of 334 hospitalizations, 1 of 38 emergency department visits, but 1 of 13 private practice visits. These outpatient children tend to have moderate to severe illness with approximately three-fourths manifesting labored respirations. RSV burden among outpatients, therefore, is considerable both in size and severity. The global burden of RSV infection is unknown as few studies are from developing countries. Estimates indicate about one-fourth of all acute LRTI occur among children < 5 years, and the greatest burden is among children in developing countries. Currently the only approved means of RSV prophylaxis is passive immunization with humanized F protein monoclonal antibody. Such prophylaxis, however, has limited availability, is expensive, and is recommended only for infants most at risk for severe RSV disease. Only widespread immunization of children is likely to diminish the current burden of RSV infection.

Estimating age-specific influenza-related hospitalization rates during the pandemic (H1N1) 2009 in Davidson Co, TN.

Please cite this paper as: Jules et al. (2012) Estimating age‐specific influenza‐related hospitalization rates during the pandemic (H1N1) 2009 in Davidson Co, TN. Influenza and Other Respiratory Viruses 6(3), e63–e71. Background In April 2009, a pandemic caused by a novel influenza strain, the A(H1N1)pdm09 virus, started. Few age‐specific estimates of hospitalizations associated with the first year of circulation of the pandemic virus are available. Objectives To estimate age‐specific hospitalization rates associated with laboratory‐confirmed A(H1N1)pdm09 virus in Davidson County, TN, from May 2009 to March 2010. Patients/methods Two separate strategies were applied: capture–recapture and surveillance‐sampling methods. For the capture–recapture estimates, we linked data collected via two independent prospective population‐based surveillance systems: The Influenza Vaccine Effectiveness Network (Flu‐VE) tested consenting county patients hospitalized with respiratory symptoms at selected hospitals using real‐time reverse transcriptase polymerase chain reaction (rRT‐PCR); the Emerging Infections Program identified county patients with positive influenza tests in all area hospitals. For the surveillance‐sampling estimates, we applied the age‐specific proportions of influenza‐positive patients (from Flu‐VE) to the number of acute respiratory illness hospitalizations obtained from the Tennessee Hospital Discharge Data system. Results With capture–recapture, we estimated 0·89 (95% CI, 0·72–1·49), 0·62 (0·42–1·11), 1·78 (0·99–3·63), and 0·76 (0·50–1·76) hospitalizations per 1000 residents aged <5, 5–17, 18–49, and ≥50 years, respectively. Surveillance‐sampling estimated rates were 0·78 (0·46–1·22), 0·32 (0·14–0·69), 0·99 (0·64–1·52), and 1·43 (0·80–2·48) hospitalizations per 1000 residents aged <5, 5–17, 18–49, and ≥50 years, respectively. In all age‐groups combined, we estimated approximately 1 influenza‐related hospitalization per 1000 residents. Conclusions Two independent methods provided consistent results on the burden of pandemic virus in Davidson County and suggested that the overall incidence of A(H1N1)pdm09‐associated hospitalization was 1 per 1000 county residents.

Effectiveness of influenza vaccine in aging and older adults: comprehensive analysis of the evidence.

Foremost amongst the diseases preventable by vaccination is influenza. Worldwide, influenza virus infection is associated with serious adverse events leading to hospitalization, debilitating complications, and death in elderly individuals. Immunization is considered to be the cornerstone for preventing these adverse health outcomes, and vaccination programs are timed to optimize protection during the annual influenza season. Trivalent inactivated influenza virus vaccines are believed to be both effective and cost-saving; however, in spite of widespread influenza vaccination programs, rates of hospitalization for acute respiratory illness and cardiovascular diseases have been increasing in this population during recent annual influenza seasons. From meta-analyses summarizing estimates of influenza vaccine effectiveness from available observational clinical studies, this review aims to examine how effective current influenza vaccine strategies are in the aging and older adult population and to analyze which are the most important biases that interfere with measurements of influenza vaccine effectiveness. Furthermore, consideration is given to strategies that should be adopted in order to optimize influenza vaccine effectiveness in the face of immune exhaustion.

Dose-dependent effect of rehabilitation in functional recovery of older patients in the post-acute care unit

Post-acute care (PAC) is of great importance to promote functional recovery of older patients, which should be provided by the interdisciplinary team. In PAC services, rehabilitative therapy plays a key role, but the optimal intensity for rehabilitative therapy remained unclear. Between July 2007 and December 2010, all patients with functional decline after acute illness hospitalization admitted to the PAC unit of a community hospital in Taiwan were enrolled. Usual rehabilitation program, 40-min per day and five days a week, was provided to all patients before April 2009. After April 2009, the rehabilitative therapy was increased to 80min per day. Functional improvement was measured by comprehensive geriatric assessment (CGA) at admission and 4 weeks after admissions to the PAC unit. Overall, 458 patients (mean age: 83.4±5.5 years, all males) completed PAC services. Compared of all dimensions in CGA, increased dosage of rehabilitative therapy showed significantly better improvement in daily living activities (Barthel index (BI): 28.8±18.4 vs. 20.0±14.6, p<0.001), depressive mood (geriatric depression score short form (GDS): −0.5±1.0 vs. −0.1±0.5, p<0.001), and pain reduction (numerical rating scale (NRS): −2.0±2.2 vs. −0.9±2.1, p=0.01); but not in cognitive function (mini-mental status examination (MMSE): 2.9±3.3 vs. 3.3.±5.2, p=0.305), and nutritional status (body mass index (BMI): 0.3±0.9 vs. 0.3±2.5, p=0.9). In conclusion, intensive rehabilitative therapy significantly promote physical and psychological function with pain reduction, which deserves further investigations to evaluate whether there is a ceiling effect of rehabilitative therapy in PAC services.

Pilot Study Examining the Association Between Ambulatory Activity and Falls Among Hospitalized Older Adults

Fisher SR, Galloway RV, Kuo Y-F, Graham JE, Ottenbacher KJ, Ostir GV, Goodwin JS. Pilot study examining the association between ambulatory activity and falls among hospitalized older adults. Objective To examine the ambulatory activity of older patients who had a documented fall during hospitalization for acute illness. Design A retrospective case-control design was used in a pilot study of patients (n=10; ≥65y) who had a documented fall during their hospital stay and matched controls (n=25) who did not fall. Setting Acute care medical/surgical unit. Participants Men and women 65 years and older who wore a step activity monitor while hospitalized. Interventions Not applicable. Main Outcome Measures Fall incidents during the hospital stay were documented by the nurse in a standardized patient safety event report in accordance with hospital policy. The number of steps per 24-hour interval, time spent walking, and total number of activity episodes were determined for patients and controls. Results On average ± SD, patients who fell took 480.3±432.2 steps per hospital day, spent 53.8±36.9 minutes walking, and engaged in 25.8±16.9 episodes of activity. Mean daily steps, time spent walking, and number of activity episodes for patients who did not fall were 680.1±876.0, 50.1±58.6, and 21.6±23.8, respectively. Logistic regression results indicated no association between the fall outcome and mean daily steps (odds ratio=.95; 95% confidence interval, 0.84–1.06). Conclusions Ambulatory activity among patients who fell varied widely. Mean daily steps, time spent walking, and number of episodes of activity were comparable with matched controls who did not fall. Patient falls were more likely to be associated with cognitive and hospital environmental factors than actual amount of walking.

Performance measures for improving the prevention of venous thromboembolism: achievement in clinical practice

Venous thromboembolism (VTE) is a common complication during and after hospitalization for acute medical illness or surgery. Despite the existence of evidence-based guidelines for VTE prevention, real-world prescribing practices are frequently suboptimal. Specific performance measures relating to VTE prevention and treatment have been developed by US health care organizations to increase adherence with best-practice recommendations and ultimately reduce the number of preventable VTE events. Two measures developed by the Surgical Care Improvement Project have been endorsed by the National Quality Forum (NQF) and focus on VTE prevention. In addition, six measures have been developed recently by The Joint Commission in collaboration with the NQF; three measures relate to VTE prevention and three focus on treatment. To attain widespread achievement of these performance goals, it is essential to raise awareness of their existence and specifications. It is also imperative that hospitals develop and implement effective VTE protocols. The use of multiple, active strategies, such as computer decision support systems with regular audit and feedback, may be particularly valuable approaches to improve current practices within an integrated quality improvement program. During practical implementation of VTE protocols at Norton Healthcare (Kentucky's largest healthcare system), strong leadership, physician engagement, and caregiver accountability were identified as key factors influencing the process. As such, more hospitals may be able to increase adherence with guidelines, improve achievement of quality goals, and help to reduce the substantial burden associated with avoidable VTE.

The Association of Active Cancer With Venous Thromboembolism Location: A Population-Based Study

To test active cancer for an association with venous thromboembolism (VTE) location. Using the resources of the Rochester Epidemiology Project, we identified all Olmsted County, MN, residents with incident VTE during the 35-year period 1966-2000 (N = 3385). We restricted analyses to residents with objectively diagnosed VTE during the 17-year period from January 1, 1984, to December 31, 2000 (N = 1599). For each patient, we reviewed the complete medical records in the community for patient age, gender, and most recent body mass index at VTE onset; VTE event type and location; and previously identified independent VTE risk factors (ie, surgery, hospitalization for acute medical illness, active cancer, leg paresis, superficial venous thrombosis, and varicose veins). Using logistic regression we tested active cancer for an association with each of 4 symptomatic VTE locations (arm or intra-abdominal deep venous thrombosis [DVT], intra-abdominal DVT, pulmonary embolism, and bilateral leg DVT), adjusted for age, gender, body mass index, and other VTE risk factors. In multivariate analyses, active cancer was independently associated with arm or intra-abdominal DVT (odds ratio [OR], 1.76; P = .01), intra-abdominal DVT (OR, 2.22; P = .004), and bilateral leg DVT (OR, 2.09; P = .02), but not pulmonary embolism (OR, 0.93). Active cancer is associated with VTE location. Location of VTE may be useful in decision making regarding cancer screening.

Disease burden and unmet needs for prevention of venous thromboembolism in medically ill patients in Europe show underutilisation of preventive therapies

It was the aim of this review to assess the incidence of venous thromboembolism (VTE) and current practice patterns for VTE prophylaxis among medical patients with acute illness in Europe. A literature search was conducted on the epidemiology and prophylaxis practices of VTE prevention among adult patients treated in-hospital for major medical conditions. A total of 21 studies with European information published between 1999 and April 2010 were retrieved. Among patients hospitalised for an acute medical illness, the incidence of VTE varied between 3.65% (symptomatic only over 10.9 days) and 14.9% (asymptomatic and symptomatic over 14 days). While clinical guidelines recommend pharmacologic VTE prophylaxis for patients admitted to hospital with an acute medical illness who are bedridden, clear identification of specific risk groups who would benefit from VTE prophylaxis is lacking. In the majority of studies retrieved, prophylaxis was under-used among medical inpatients; 21% to 62% of all patients admitted to the hospital for acute medical illnesses did not receive VTE prophylaxis. Furthermore, among patients who did receive prophylaxis, a considerable proportion received medication that was not in accord with guidelines due to short duration, suboptimal dose, or inappropriate type of prophylaxis. In most cases, the duration of VTE prophylaxis did not exceed hospital stay, the mean duration of which varied between 5 and 11 days. In conclusion, despite demonstrated efficacy and established guidelines supporting VTE prophylaxis, utilisation rates and treatment duration remain suboptimal, leaving medical patients at continued risk for VTE. Improved guideline adherence and effective care delivery among the medically ill are stressed.

Mental Health in Haiti: A Resident's Perspective

In March, I stepped off a chartered plane onto the sweltering tarmac in Port-au-Prince to volunteer at the University of Miami Hospital in Haiti. The field hospital was created by Project Medishare and the University of Miami Miller School of Medicine’s Global Institute on January 21, 2010, just 11 days after the devastating earthquake destroyed much of the country’s infrastructure and injured and killed hundreds of thousands of Haitians (1). The hospital was a four tent facility with 240 beds located at the Port-au-Prince airport. It was arguably the most comprehensive hospital in Haiti after the earthquake, with four operating rooms, medical, pediatric and neonatal intensive care units, a pediatric ward, a medical/surgical ward, an emergency room, triage, and wound care and orthopedic clinics for follow-up care. The field hospital moved to a permanent building at the Bernard Mevs Hospital in Portau-Prince in June of 2010. It is run primarily by the University of Miami and other volunteers from around the United States who work tirelessly for 8-day stints. Project Medishare, which was founded by Barth Green, M.D., Professor and Chairman of the Department of Neurosurgery, and Arthur Fournier, M.D., Professor of Family Medicine and Associate Dean for Community Health Affairs, at the University of Miami’s Miller School of Medicine, has been working to provide sustainable health care in Haiti since 1994. As a medical student, I previously had the opportunity to volunteer in Haiti with Project Medishare on two separate occasions to provide primary care in rural villages. As a second postgraduate year (PGY-2) resident in the Department of Psychiatry and Behavioral Sciences at the University of Miami, I was eager to return to Haiti following the earthquake to provide care in any capacity needed. My faculty mentors in psychiatry warned me to avoid pathologizing patients’ normal responses to such extraordinary trauma. Haiti has suffered more than its share of disasters, but the January 12 earthquake was one of the worst natural disasters in history, with over 230,000 deaths and 1.3 million left homeless. Although I was there 8 weeks after the earthquake occurred, most Haitians affected by the catastrophe still did not have adequate access to food, water, health care, shelter, or security. Until these basic needs were met, mental health problems were, by necessity, considered secondary. I volunteered to work with the internal medicine team, partly because I had completed my intern year in internal medicine and felt comfortable ordering antibiotics and pain medications for postoperative patients. However, once my identity as a psychiatric resident was revealed, I provided much needed mental health care to Haitians as well as to some health care volunteers who were overwhelmed by the experience. The resilience and pride of the Haitian people is deeprooted. Haiti was the world’s first independent black republic, the first independent state of Latin America, and the only nation to be formed from a successful slave rebellion. Prior to its independence in 1804, Haiti was the richest French colony in the New World. Haiti’s economy was crippled when France required the small nation to pay a hefty indemnity in order to be recognized as an independent nation. Haiti has since been plagued with corrupt leadership, military uprisings, foreign occupation, and environmental devastation. Eighty percent of the population lives in poverty, half in extreme poverty. It is the least developed country in the Americas. According to the United Nation’s Human Development Index, Haiti ranks 149 of 182 countries (2). Haiti lacks a coordinated mental heath care system. There are two psychiatric hospitals in the country. Defile de Beudet in Croix-des-Bouquets is the sole hospital for the chronically mentally ill. Mars and Kline Psychiatric Center in Port-Au-Prince is the only hospital for acute mental illness. It is a 52-year-old dilapidated facility, which is severely understaffed and under-resourced (3). Received June 20, 2010; revised August 11 and September 11, 2010; accepted September 15, 2010. Dr. McShane is affiliated with the Department of Psychiatry at the University of Miami Miller School of Medicine in Miami, Florida. Address correspondence to Kathleen Molly McShane, University of Miami, Department of Psychiatry (D-29), 1695 NW 9 Ave. #3100, Miami, FL 33136; KMcShane@med.miami.edu (e-mail). Copyright © 2011 Academic Psychiatry

Association Between Acute Care and Critical Illness Hospitalization and Cognitive Function in Older Adults

Survey of Anesthesiology: December 2010 - Volume 54 - Issue 6 - p 278-279 doi: 10.1097/01.SA.0000389703.54432.18

Risk Factors for Venous Thromboembolism (VTE) Among Nursing Home Residents: A Population-Based Case Control Study

AbstractAbstract 476 Background:The burden of VTE among nursing home (NH) residents is known to be high. Yet very little data exist to help determine which NH residents to target for VTE prophylaxis. The need to characterize VTE risk in this population is especially great because the advanced age and high comorbidity that typify NH residents contribute to increased likelihood of adverse consequences from VTE prophylaxis. To compound the problem, results of our prior univariate analyses of certain factors known to contribute substantially to VTE risk in the general population (e.g., major surgery, medical hospitalization, trauma) suggest that impact of these factors on VTE may be less substantial among NH residents. Objective:To use the longitudinal population-based resources of the Rochester Epidemiology Project (REP) to investigate the contribution of multiple clinical characteristics to risk of VTE among NH residents. Methods:We took advantage of the previous identification of all Olmsted County, MN residents who met research criteria for incident VTE 1988 through 2005 (N=2,332). We then determined which individuals were resident of a local NH at time of VTE symptom onset, regardless of location of symptom onset (i.e., individuals whose VTE occurred in-hospital having been admitted from a NH were considered NH residents). For each such NH VTE case (N=269), we identified 2 same sex Olmsted County residents of similar age and duration of medical history who were also resident of a local NH at the time of the case's VTE event (i.e., index date) (N=538). We reviewed the detailed provider-linked medical records of NH VTE cases and NH non-VTE controls for 3 months before index for information on multiple characteristics identified or hypothesized as contributing to VTE risk in studies of the general population and other at-risk subgroups by our group and others (e.g., patient demographics, body mass index, major surgery, hospitalization for acute medical illness, outpatient surgical procedures, trauma/fracture, leg paresis, active cancer, superficial vein thrombosis, varicose veins, infections, diabetes mellitus, coronary artery disease, congestive heart failure, and multiple medications, including anticoagulants, statins, beta-blockers, ACE inhibitors and angiotensin II receptor antagonists). We tested and estimated the odds ratio associated with each factor using step-wise conditional logistic regression. Variables for which <10 cases or <10 controls exhibited the characteristic were excluded from analysis. Results:The first five variables to enter the model were urinary tract infection, active cancer, superficial vein thrombosis, pneumonia, and leg paresis. The respective odds ratios (95% confidence intervals) with all five in the model were 1.7 (1.2, 2.4); 2.1 (1.3, 3.5); 2.1 (1.3, 3.4); 1.9 (1.3, 2.8); 2.3 (1.3, 4.2); each p value was <0.01. Variables associated with high VTE risk in the general population (i.e., surgery, hospitalization for medical illness, trauma/fracture) were not included in the top five risk factors for NH residents. Conclusions:Infection is a potent VTE risk factor among NH residents. Our study results will help inform development of practice guidelines in the NH and stimulate future research on putative VTE mechanisms. REP data afford limited information on cognitive and physical disability, immobility, and need for NH care. Additional investigations are needed that combine information from clinical and NH assessments. Disclosures:No relevant conflicts of interest to declare.

Clinical manifestations of dengue and leptospirosis in children in Mumbai: an observational study

The aim of this study was to determine the causes of acute febrile illness in children presenting to our hospital following an extremely heavy rainfall event in the city of Mumbai in 2005. The clinical and laboratory manifestations of leptospirosis and dengue together with their outcomes are also described. This was an observational study conducted from 26 July to 30 November 2005. The diagnosis of leptospirosis was confirmed by a positive enzyme-linked immunosorbent assay (ELISA) test. The diagnosis of dengue was confirmed by a positive immunoglobulin (IgM) antibody capture ELISA test. Clinical features of patients with and without leptospirosis, respectively, and with and without dengue, respectively, were analysed. A total of 602 patients (age range 1 month to 12 years) admitted to our hospital for acute febrile illness with no obvious focus of infection were enrolled in the study. Of these, 30 had malaria, 11 had enteric fever and seven had mixed infections. Twenty-seven patients had leptospirosis. Three clinical features were significantly associated with leptospirosis: flood water contact, myalgia and conjunctival suffusion. Eighty-one children had dengue. All patients responded well to the treatment and were released to go home. Four clinical features were significantly associated with dengue, namely, giddiness, abdominal pain, rash and bleeding manifestations. Based on this review of the clinical and laboratory features of dengue fever and leptospirosis, we conclude that following the heavy rainfall event on 26 July 2005, there was a concurrent outbreak of leptospirosis and dengue among children presenting to our hospital.

Lack of prophylaxis before the onset of acute venous thromboembolism among hospitalized cancer patients: the SWIss Venous ThromboEmbolism Registry (SWIVTER)

Background: Venous thromboembolism (VTE) prophylaxis remains underutilized, particularly in cancer patients. We explored clinical predictors of prophylaxis in hospitalized cancer patients before the onset of acute VTE.Methods: In the SWiss Venous ThromboEmbolism Registry, 257 cancer patients (61 ± 15 years) with acute VTE and prior hospitalization for acute medical illness or surgery within 30 days (91% were at high risk with Geneva VTE risk score ≥3) were enrolled.Results: Overall, 153 (60%) patients received prophylaxis (49% pharmacological and 21% mechanical) before the onset of acute VTE. Outpatient status at the time of VTE diagnosis [odds ratio (OR) 0.31, 95% confidence interval (CI) 0.18–0.53], ongoing chemotherapy (OR 0.51, 95% CI 0.31–0.85), and recent chemotherapy (OR 0.53, 95% CI 0.32–0.88) were univariately associated with the absence of VTE prophylaxis. In multivariate analysis, intensive care unit admission within 30 days (OR 7.02, 95% CI 2.38–20.64), prior deep vein thrombosis (OR 3.48, 95% CI 2.14–5.64), surgery within 30 days (OR 2.43, 95% CI 1.19–4.99), bed rest >3 days (OR 2.02, 95% CI 1.08–3.78), and outpatient status (OR 0.38, 95% CI 0.19–0.76) remained the only independent predictors of thromboprophylaxis.Conclusions: Although most hospitalized cancer patients were at high risk, 40% did not receive any prophylaxis before the onset of acute VTE. There is a need to improve thromboprophylaxis in cancer patients, particularly in the presence of recent or ongoing chemotherapy.

Association Between Acute Care and Critical Illness Hospitalization and Cognitive Function in Older Adults

Studies suggest that many survivors of critical illness experience long-term cognitive impairment but have not included premorbid measures of cognitive functioning and have not evaluated risk for dementia associated with critical illness. To determine whether decline in cognitive function was greater among older individuals who experienced acute care or critical illness hospitalizations relative to those not hospitalized and to determine whether the risk for incident dementia differed by these exposures. Analysis of data from a prospective cohort study from 1994 through 2007 comprising 2929 individuals 65 years old and older without dementia at baseline residing in the community in the Seattle area and belonging to the Group Health Cooperative. Participants with 2 or more study visits were included, and those who had a hospitalization for a diagnosis of primary brain injury were censored at the time of hospitalization. Individuals were screened with the Cognitive Abilities Screening Instrument (CASI) (score range, 0-100) every 2 years at follow-up visits, and those with a score less than 86 underwent a clinical examination for dementia. Score on the CASI at follow-up study visits and incident dementia diagnosed in study participants, adjusted for baseline cognitive scores, age, and other risk factors. During a mean (SD) follow-up of 6.1 (3.2) years, 1601 participants had no hospitalization, 1287 had 1 or more noncritical illness hospitalizations, and 41 had 1 or more critical illness hospitalizations. The CASI score was assessed more than 45 days after discharge for 94.3% of participants. Adjusted CASI scores averaged 1.01 points lower for visits following acute care illness hospitalization compared with follow-up visits not following any hospitalization (95% confidence interval [CI], -1.33 to -0.70; P < .001) and 2.14 points lower on average for visits following critical illness hospitalization (95% CI, -4.24 to -0.03; P = .047). There were 146 cases of dementia among those not hospitalized, 228 cases of dementia among those with 1 or more noncritical illness hospitalizations, and 5 cases of dementia among those with 1 or more critical illness hospitalizations. The adjusted hazard ratio for incident dementia was 1.4 following a noncritical illness hospitalization (95% CI, 1.1 to 1.7; P = .001) and 2.3 following a critical illness hospitalization (95% CI, 0.9 to 5.7; P = .09). Among a cohort of older adults without dementia at baseline, those who experienced acute care hospitalization and critical illness hospitalization had a greater likelihood of cognitive decline compared with those who had no hospitalization. Noncritical illness hospitalization was significantly associated with the development of dementia.

Abnormal laboratory results: Point-of-care testing comes of age in Australia

Summary A wide range of point-of-care tests are available and being used in both hospital and community settings for acute and chronic illnesses. There have been significant improvements in device technology as well as advances in training methods, procedures to monitor analytical quality, and the electronic capture and management of test results from a central location. Various point-of-care tests have been found to be non-inferior to laboratory testing for managing chronic conditions in general practice and Aboriginal medical services. Maintaining the analytical quality of devices and ensuring that staff are properly trained are critical elements in sustaining a high quality point-of-care testing service.

Viral Etiology and Epidemiology of Outpatients with Acute Respiratory Illnesses in Busan: 2007-2008

Purpose : The purpose of this study is to identify the viral etiology of acute respiratory illnesses and to determine epidemiology in outpatients in Busan, Korea. Methods : We collected nasal wash samples from 990 patients who visited the hospital for acute respiratory illnesses between January 2007 and December 2008. Extracted DNA or RNA from specimens was used for viral detection by an RT-PCR method. Results : Of a total of 990 samples, viruses were detected in 351 cases (35.5%). The ratio of male to female was 1.6:1 and 93.7% were less than 5 years old. Rhinovirus was detected year-round in 202 cases (57.5%), respiratory syncytial virus from October to March in 57 cases (16.2%), adenovirus year-round in 37 cases (10.5%), influenza virus from December to April in 21 cases (6%), bocavirus from January to August in 15 cases (4.3%), parainfluenza virus from April to July in 9 cases (2.6%), coronavirus from January to July in 7 cases (2%), and enterovirus from June to September in 3 cases (0.9%). Conclusion : We identified the etiology and epidemiology of viruses that caused the acute respiratory diseases that were prevalent in Busan, 2007-2008. Further surveillance will be necessary.

Association Between Acute Care and Critical Illness Hospitalization and Cognitive Function in Older Adults

Association Between Acute Care and Critical Illness Hospitalization and Cognitive Function in Older Adults

Association Between Acute Care and Critical Illness Hospitalization and Cognitive Function in Older Adults

Association Between Acute Care and Critical Illness Hospitalization and Cognitive Function in Older Adults