Increase In Hospital Admissions Research Articles

Asthma control, its related factors, and impact on quality of life among pediatric patients at a tertiary center in Jordan: a cross-sectional study

Introduction Pediatric asthma is a common respiratory disease that burdens affected patients, their caregivers, and the entire healthcare system. Uncontrolled asthma ultimately impacts patients’ quality of life. There are limited studies examining the factors associated with asthma control and quality of life. Thus, this study aimed to explore factors associated with asthma control and examine the relationship between asthma control and quality of life in children with asthma. Methods A cross-sectional study was conducted from October 2023 to January 2024 at the Jordan University Hospital, including 136 children aged 7-17 diagnosed with asthma. Asthma control was assessed using the Asthma Control Test (ACT) or Childhood Asthma Control Test (C-ACT). Medication adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS), and quality of life was evaluated using the Pediatric Asthma Quality of Life Questionnaire (PAQLQ). Results Only 43.4% of patients had proper asthma control. The average quality of life and MMAS scores were 4.9 ± 1.5 and 4.2 ± 1.9, respectively. Uncontrolled asthma was associated with increased hospital admissions (p = 0.008), sensitivity to cold (p = 0.002), spring weather (p = 0.031), and infections (p = 0.001). Patients with controlled asthma had significantly higher quality of life (p < 0.001), but no significant differences in MMAS scores (p = 0.743). On multivariate analysis, QoL score was a positive predictor of control (p < 0.001), while sensitivity to infections were a negative predictor (p < 0.05). Conclusion Most pediatric patients with asthma at the Jordan University Hospital had poor asthma control. Quality of life remained a positive predictor of control irrespective of adherence to asthma treatment. This highlights the need for caregivers and physicians to focus greater attention on these cases, given the substantial clinical and social challanages they poses for affected children.

How was the impact of heatwaves on daily hospital admissions in Portugal (2000-2018)?

Abstract Background Climate change has increased the frequency, intensity, and duration of heatwaves, posing a serious threat to public health. While the link between high temperatures and premature mortality has been extensively studied, the comprehensive quantification of heatwave impacts on morbidity remains understudied. Methods We assessed the relationship between heatwaves and daily hospital admissions at a county level in Portugal, considering all major diagnostic categories and age groups, over a 19-year period from 2000 to 2018. Our nationwide study included a comprehensive geospatial analysis, integrating over 12 million hospital admission records with heatwave events indexed by the Excess Heat Factor (EHF), covering all 278 mainland counties. To estimate the impact of heatwaves on hospital admissions, we applied negative binomial regression models at both national and county levels. Results A statistically significant overall 18·9% increase in daily hospital admissions was found during heatwave days (IRR=1·189, 95% CI: 1·179-1·198). This impact affected all age groups, with pediatric ages being the most affected (21·7%), followed by the working-age (19·7%) and elderly individuals (17·2%). All 25 Major Disease Diagnostic Categories experienced significant increases, particularly Burns (34·3%), Multiple Significant Trauma (26·8%), and Infectious and Parasitic Diseases (25·4%). Notable rises were also observed in Endocrine, Nutritional, and Metabolic (25·1%), Mental (23%), Respiratory (22·4%), and Circulatory (15·8%) diseases. Conclusions Our results provide statistically significant evidence of the association between heatwaves and increased hospitalizations across all age groups and for all major causes of disease. This is the first study to estimate the full extent of heatwaves’ impact on hospitalizations using the EHF index over a comprehensive 19-year period, encompassing an entire country, and spanning 25 disease categories during multiple heatwave events. Key messages • There is a clear association between heatwaves and increased hospital admissions across all age groups and Major Diagnostic Categories. • Our data offer crucial information to guide policymakers in effectively and efficiently allocating resources to address the profound healthcare consequences resulting from climate change.

Empowering health literacy: Turkiye’s Health Literacy Action Plan 2022-2026

Abstract Issue/Problem The ‘Health Literacy Action Plan 2022-2026’ of the Turkish Ministry of Health addresses the critical public health issue of limited health literacy, leading to increased hospital admissions, inappropriate emergency department use, and poor health outcomes. This underscores a significant challenge in individual health self-management and higher healthcare expenditure within the country. Description of the Problem The Health Literacy Action Plan aims to tackle disparities in health literacy levels among people. It employs customized teaching schemes, digital communication, and inclusive healthcare practices to reach every demographic group. The plan seeks to enhance health knowledge and empowerment among Turkish people by increasing access to medical information, simplifying clinician instructions, and promoting closer communication between patients and healthcare professionals. Results Comparative evaluation of nationwide surveys conducted in 2017 and 2023 with 15,000 participants shows remarkable improvements. Despite delays due to the pandemic, the action plan led to a notable increase in adequate health literacy levels from 31.9% in 2017 to 46.1% in 2023. Additionally, significant improvements were observed in ailment prevention and health promotion, with health literacy levels in disease prevention increasing from 28.4% to 45.7%. Lessons The Health Literacy Action Plan plays a crucial role in developing and implementing multifaceted public health strategies based on data and stakeholder participation. These interventions, requiring continuous monitoring and adjustment, are essential steps toward achieving high-level health literacy. Key messages • Strategic health literacy interventions are essential for improving health outcomes and optimizing the use of public resources. • Evidence-based interventions and ongoing evaluation are key to promoting health literacy.

The effectiveness of COVID-19 vaccination in preventing hospitalisation and mortality: A nationwide cross-sectional study in Iran.

The pandemic of the coronavirus disease 2019 (COVID-19) led to a global health crisis, prompting widespread vaccination efforts to reduce severe outcomes. In this study, we assessed the impact of mass COVID-19 vaccination on hospitalisation and mortality rates in Iran, where over 83% of the vaccinated population received inactivated virus vaccines. Using retrospective, cross-sectional analysis, we examined data from the Iran Health Insurance Organisation, covering 41 million individuals from 20 February 2020 to 20 March 2022. We analysed hospital records from 956 Iranian hospitals, focusing on inpatient stays, short-term hospitalisations, and emergency department visits. Study outcomes included COVID-19 hospital admissions and associated mortality. We used negative binomial regression to compare hospital admission rates between periods, while we used a poison regression model with a log link to assess mortality risks before and after vaccination. Among 806 076 hospital admissions, 57 599 deaths were recorded. COVID-19 hospitalisations increased with age, and women had slightly higher admission rates than men. Advanced age and male sex correlated with higher mortality rates. Hospital admissions rose to 1178.66 per million population per month post-vaccination compared to 459.78 pre-vaccination. The incidence rate ratio was 2.09 (95% confidence interval (CI) = 1.90-2.32, P < 0.001), mainly due to the Delta variant. In contrast, post-vaccination mortality rates decreased from 111.33 to 51.66 per 1000 admissions per month. Post-vaccination, COVID-19 mortality significantly decreased, with a relative risk being 0.61 (95% CI = 0.60-0.62, P < 0.001) across all age groups and sexes. The Delta variant increased hospital admissions among vaccinated individuals, but widespread vaccination significantly reduced COVID-19-related mortality.

The Intersection between Frailty, Diabetes, and Hypertension: The Critical Role of Community Geriatricians and Pharmacists in Deprescribing.

Background: Frailty is a clinical syndrome prevalent among the elderly, characterised by a decline in physiological reserves and increased susceptibility to stressors, resulting in higher morbidity and mortality. Diabetes and hypertension are common in frail older individuals, often leading to polypharmacy. In this narrative review, we aimed to evaluate the relationship between frailty, diabetes, and hypertension and to identify effective management strategies and future research directions. Methods: This narrative review was conducted using the Scopus, Medline, PubMed, Cochrane Library, and Google Scholar databases. Results: Frailty significantly impacts the management and prognosis of diabetes and hypertension, which, in turn, affects the progression of frailty. Managing these conditions often involves multiple drugs to achieve strict glycaemic control and blood pressure targets, leading to polypharmacy and associated morbidities, including orthostatic hypotension, falls, fractures, hypoglycaemia, and reduced medication adherence. Identifying frailty and implementing strategies like deprescribing can mitigate the adverse effects of polypharmacy and improve outcomes and quality of life. Despite the availability of effective tools for identifying frailty, many frail individuals continue to be exposed to complex treatment regimens for diabetes and hypertension, leading to increased hospital admissions, morbidity, and mortality. Conclusions: Managing diabetes and hypertension in the frail ageing population requires a multidisciplinary approach involving hospital and community geriatricians and pharmacists. This is important due to the lack of sufficient clinical trials dedicated to diabetes and hypertension in the context of frailty. Future large population studies are needed to assess the best approaches for managing diabetes and hypertension in frail individuals.

Clinical Impacts of Pseudomonas aeruginosa Isolation in Patients with Bronchiectasis: Findings from KMBARC Registry.

Background:Pseudomonas aeruginosa isolation in bronchiectasis is associated with a poor prognosis, including increased hospital admissions, exacerbation, and mortality. In this study, we aimed to evaluate the clinical characteristics and outcomes of P. aeruginosa isolation from patients with bronchiectasis in South Korea. Methods: This multicenter prospective cohort study analyzed 936 patients with bronchiectasis. We examined the prevalence of P. aeruginosa isolates and other microbiological characteristics. Additionally, the clinical characteristics related to disease severity and 1-year prognosis were compared between patients with and without P. aeruginosa isolation. Propensity score matching was used to mitigate confounding biases. Results: Of the 936 patients with bronchiectasis, P. aeruginosa was isolated from 89. A total of 445 matched patients-356 patients without (non-Pseudomonas group) and 89 with (Pseudomonas group) P. aeruginosa isolation-were analyzed. The Pseudomonas group showed poorer lung function, greater involvement of radiographic bronchiectasis, and a higher proportion of cystic bronchiectasis than the non-Pseudomonas group. After one year, more patients in the Pseudomonas group were admitted for bronchiectasis than in the non-Pseudomonas group. Moreover, the Bronchiectasis Health Questionnaire scores were significantly lower in the Pseudomonas group than in the non-Pseudomonas group. Conclusions: The isolation of P. aeruginosa was independently associated with increased disease severity and poor clinical outcomes in Korean patients with bronchiectasis.

The potential burden from urbanisation on heat-related mortality in São Paulo, Brazil

Heatwave events are associated with increased hospital admissions and mortality rates worldwide. Heat exposure is often exacerbated by the Urban Heat Island (UHI) effect, especially in large cities. However, an accurate quantification of the additional burden related to heat from urbanisation is understudied in Latin American cities. Therefore, we used advanced meteorological modelling to simulate 2 m air temperature at 1 km spatial resolution across São Paulo, estimating UHI intensity attributing of all-cause mortality to heat and UHI during the 2014 heatwave. The Local Climate Zone classification system provided input land use parameters. Our model was validated against 31 weather stations and bias-corrected using linear regression. We calculated heat-related all-cause mortality, stratified by age, using the modelled temperature data, estimating 394 heat-related deaths. A counterfactual experiment, replacing urban areas with natural land, quantified the additional UHI burden. We found that the UHI may contribute to 69–70% of heat-related mortality (modelled temperature scenario). This work motivates the use of appropriate urban climate data, including careful model validation and bias correction, when assessing heat exposure and health risk assessment. It also highlights the health impacts from heatwaves in cities such as São Paulo, which are likely to increase due to climate change.

Oxidative potential of particulate matter and its association to respiratory health endpoints in high-altitude cities in Bolivia

Exposure to particulate matter (PM) pollution is a significant health risk, driving the search for innovative metrics that more accurately reflect the potential harm to human health. Among these, oxidative potential (OP) has emerged as a promising health-based metric, yet its application and relevance across different environments remain to be further explored. This study, set in two high-altitude Bolivian cities, aims to identify the most significant sources of PM-induced oxidation in the lungs and assess the utility of OP in assessing PM health impacts. Utilizing two distinct assays, OPDTT and OPDCFH, we measured the OP of PM samples, while also examining the associations between PM mass, OP, and black carbon (BC) concentrations with hospital visits for acute respiratory infections (ARI) and pneumonia over a range of exposure lags (0–2 weeks) using a Poisson regression model adjusted for meteorological conditions. The analysis also leveraged Positive Matrix Factorization (PMF) to link these health outcomes to specific PM sources, building on a prior source apportionment study utilizing the same dataset. Our findings highlight anthropogenic combustion, particularly from traffic and biomass burning, as the primary contributors to OP in these urban sites. Significant correlations were observed between both OPDTT and PM2.5 concentration exposure and ARI hospital visits, alongside a notable association with pneumonia cases and OPDTT levels. Furthermore, PMF analysis demonstrated a clear link between traffic-related pollution and increased hospital admissions for respiratory issues, affirming the health impact of these sources. These results underscore the potential of OPDTT as a valuable metric for assessing the health risks associated with acute PM exposure, showcasing its broader application in environmental health studies.

Comprehensive atrial fibrillation package of care to minimise unnecessary hospital admission and improve patient outcome: a quality improvement project

Abstract Funding Acknowledgements None. Introduction Recent studies have highlighted an increasing rate of hospitalisation among atrial fibrillation (AF) patients, despite a relatively low in-hospital mortality rate. This trend carries significant financial implications, with a twofold increase in AF-related expenditures, over 50% of which are associated with inpatient care. Purpose A Quality Improvement Project (QIP) was conducted to enhance AF care, reduce unnecessary admissions, and address the root causes driving increased hospitalisations. Methods The root cause analysis, illustrated in Figure 1, revealed four factors contributing to the increased hospital admission rate of newly diagnosed AF patients: systemic issues, the nature of the disease itself, patient and physician-related factors. The driver diagram (Figure 2) visually presented the primary and secondary drivers with corresponding interventions targeting potential areas for improvement. Plan, Do, Study, Act (PDSA) cycle was conducted using four-pronged approach: 1. Updating local guidelines and designing a stepwise algorithm to align with contemporary standards of care. 2. Establishing an ambulatory care/arrhythmia clinic referral pathway for follow-up of stable AF patients to ensure continuity of care, thus minimizing unnecessary admissions. 3. Implementing a safe discharge toolkit comprising patient education materials, a poster for stroke and bleeding risk assessment tools, and an anticoagulation checklist. 4. Incorporating AF management teaching sessions into the doctors’ induction curriculum to enhance their knowledge and confidence in managing newly diagnosed AF patients and ensuring safe discharges. Results Lack of an ambulatory care or arrhythmia clinic referral pathway, inadequate educational resources, insufficient clinician training were key factors contributing to unwarranted hospitalization of newly diagnosed AF patients. The comprehensive guideline revision process, requiring substantial resources and the support of stakeholders and a multidisciplinary team comprising cardiologists and emergency and acute medical physicians, facilitated the successful implementation of the new AF referral pathway. This QIP resulted in a 16% reduction in avoidable admissions, 24% increase in clinician confidence, and 18% improvement in adherence to stroke and bleeding risk assessment protocols, in addition to reducing the hospital stay duration. Conclusions The collaboration among diverse medical disciplines, evidence-based guideline revision, and the implementation of a streamlined AF referral pathway demonstrated the potential to reduce healthcare resource utilization and financial burdens. This approach aligns with national standards, enhances healthcare providers' knowledge and confidence, ensuring standardised clinical practices. It underscores its potential for implementation of similar pathways to improve patient care. Continuous evaluation to evolving guidelines are recommended for sustainability.Figure 1.Ishikawa fishbone diagramFigure 2.Driver diagram for AF care

Virtual ward: The future in the management of neutropenic sepsis in the NHS

Virtual ward offers patients with neutropenic sepsis a unique opportunity to receive hospital level of care in the comfort of their home, especially for patients who would otherwise be admitted to hospital because of their acute treatment. On the virtual ward, patients can receive hospital level of care with a significant opportunity to mitigate any risk of hospital-acquired infection in this subset of patients who are already immunocompromised amongst other benefits. Additionally, hospital length of stay can be shortened leading to reduced admission pressure in hospitals, increasing hospital admission avoidance, and encouraging safe discharge from hospital while still providing the best care for the patients. We report a case of a 76-year-old cancer patient who presented with neutropenic sepsis and was successfully managed on the virtual ward in a district hospital. This case highlights the importance of virtual wards an evolving innovation that can define the future management of cancer patients in NHS. It is safe and reduces the cost of inpatient care in healthcare.

What We Do and What We Should Do Against Malnutrition in Spinal Cord Injury: A Position Paper From Italian Spinal Cord Injury Network Rehabilitation Centers.

Spinal cord injury (SCI) is a traumatic event that significantly impacts body composition and alters energy and nutritional needs. This places patients with SCI at a high risk of malnutrition, which can hinder optimal functional recovery, prolong hospital stays, increase hospital admissions, and contribute to the development of obesity and cardiovascular and metabolic ailments in chronic patients. Consequently, there is an urgent need for clear guidance to support clinicians in managing the nutritional needs of patients with SCI at different stages of the disease, including the acute (0 - 4 months after injury), post-acute (4 - 26 months after injury), and post-discharge phases. This study utilized a cross-sectional survey to assess the strategies employed in seven spinal units across Italy to address the nutritional needs of patients with SCI during the acute, post-acute, and post-discharge phases of the condition. Eight clinicians (five physiatrists, two internists, and one urologist) and one nurse participated in the survey. Following the survey completion, the participants were invited to partake in a round table session to delve deeper into the questionnaire results to gather their opinions and gain insights into clinical practices related to the various challenges surrounding the management of malnutrition in patients with SCI. We here review the available evidence on the energy needs and nutritional requirements of patients with SCI, highlighting the clinical aspects that deserve more attention throughout the distinct phases of the disease. We additionally provide an overview of the scenario regarding the management of malnutrition in patients with SCI across various spinal units in Italy. Through this comprehensive analysis, we aimed to enhance understanding and provide valuable insights for clinicians working with patients with SCI, equipping them with the knowledge and confidence to provide nutritional support to patients with SCI efficiently. By addressing the challenges of defining nutritional needs and presenting a practical guide, we aspire to contribute to the overall management and care of individuals with SCI and the prevention of malnutrition and its associated complications, thereby improving patient outcomes.

IJCM_240A: A cross sectional study to assess the health literacy among adults attending outpatient clinics at a government tertiary care hospital in urban Bangalore.

Background: WHO defines health literacy as cognitive and social skills that determine the motivation and ability of people to understand, gain access and use the information to obtain good health. Inadequate health literacy has been linked to increased hospital admissions, poorer physical and mental health, lower use of preventive health services like vaccinations and screening tests. These ultimately lead to higher healthcare costs. This study was conducted to assess health literacy among adults attending outpatient clinics at a government tertiary care hospital in urban Bangalore. Objectives: To estimate proportion of inadequate health literacy and its associated factors among adults attending outpatient clinics at a government tertiary care hospital in urban Bangalore. Methodology: A cross-sectional study was conducted among adult attendees (i.e., patients and companions) of outpatient clinics of a government tertiary care hospital in urban Bangalore. Based on a study done by Almaleh. R et al. (P = 34.3%) with 7% absolute precision, the sample size was calculated as 200. A total of 200 adults attending outpatient clinics at the government tertiary care hospital were selected using simple random sampling. Data was collected using a pre-tested, semi-structured questionnaire for sociodemographic factors and HLS-EU-Q16 (European Health Literacy Survey Questionnaire short version) for assessing health literacy. The data collected was entered in MS Excel and analysed using SPSS 21.0. Results: The proportion of inadequate health literacy among study participants was observed to be 38%. Factors like educational status, age, and gender were found to have an association with it. Health literacy was found to be least in lower-educated individuals. Conclusion: From the present study, it was found that a large part of adult population had limited health literacy. It should be addressed through proper interventions, like ensuring basic education and health awareness programmes.

Approach to Decompensated Right Heart Failure in the Acute Setting

Acute right heart failure (ARHF) arises when the right ventricle fails to pump blood efficiently to the pulmonary circulation. This inefficiency leads to a decreased blood supply to various organs. ARHF is a significant health concern, often leading to increased hospital admissions and being associated with a higher risk of mortality. This condition underscores the importance of effective cardiac care and timely intervention to manage its complications and improve patient outcomes. Diagnosing ARHF involves a comprehensive approach that includes a physical examination to evaluate the patient’s fluid status and heart-lung function, blood tests to identify potential triggers and help forecast patient outcomes and various imaging techniques. These imaging techniques include electrocardiograms, point-of-care ultrasounds, computed tomography, cardiac magnetic resonance imaging, and other advanced monitoring methods. These diagnostic tools collectively aid in a detailed assessment of the patient’s cardiac and pulmonary health, essential for effective management of ARHF. The management of ARHF focuses on addressing the underlying causes, regulating fluid balance, and enhancing cardiac function through pharmacological treatments or mechanical support aimed at boosting right heart performance. This management strategy includes the use of medications that modulate preload, afterload, and inotropy; vasopressors; anti-arrhythmic drugs; ensuring proper oxygenation and ventilation; and the utilization of heart and lung assist devices as a bridge to potential transplantation. This review article is dedicated to exploring the pathophysiology of ARHF, examining its associated morbidity and mortality, evaluating the various diagnostic tools available, and discussing the diverse treatment modalities. The article seeks to provide a comprehensive understanding of ARHF, its impact on health, and the current strategies for its management.

Assessing Safety of Anticoagulation for Atrial Fibrillation in Patients with Cirrhosis: A Real-World Outcomes Study.

In patients with atrial fibrillation (AF) and stroke risk factors, randomized trials have demonstrated that anticoagulation decreases the risk of ischemic stroke. However, all trials to date have excluded patients with significant liver disease, leaving guidelines to extrapolate recommendations. We aim to evaluate the impact of anticoagulation on safety events in patients with AF and cirrhosis. In this retrospective cohort study, we obtained de-identified health record data to extract anticoagulation strategy, comorbidities, prescriptions, lab values, and procedures for a cohort of patients with cirrhosis who develop AF. After selecting a propensity matched population to match patients with various anticoagulation strategies, we tracked data on outcomes for death, transfusion requirements, hospital and ICU admissions. After propensity score weighting and multivariable adjustment, anticoagulation strategy was associated with increased hospital admission count (OR = 1.74 per admission, P < .001), binary risk of hospital admission (OR = 1.54, P = .010) and risk of ICU admission (OR = 1.41, P = .047). We detected no significant differences in mortality, transfusion of blood products, or average length of stay. Direct oral anticoagulant (DOAC) prescriptions were associated with increased binary risk of hospital admission compared to warfarin prescriptions. In a third comparison, DOAC strategy alone was associated with increased hospital admission count (OR = 1.41 per admission, P < .001) and binary risk of hospital admission (OR = 1.52, P = .038) compared to no anticoagulation strategy. Anticoagulation strategy in patients with cirrhosis and AF was associated with increased rate of hospital admission and ICU admission but not associated with increased risk of mortality or transfusion requirement.

The impact of COVID-19 on surgical cases at a large quaternary referral hospital

Introduction Coronavirus-19 (COVID) stressed healthcare systems by increasing hospital admissions and in-hospital mortality. The impact of COVID on surgical patients is unknown. The purpose of this study was to evaluate how the COVID pandemic affected surgical patients at a large quaternary referral hospital. Methods A retrospective review of patients undergoing surgical procedures was performed to evaluate patients undergoing surgery. The impact of COVID on surgical patients was divided into four timeframes based on government regulations: pre-COVID (January 1, 2020 to March 15, 2020), suspended (March 16, 2020 to May 4, 2020), backlogged cases (May 5, 2020 to June 14, 2020), and restoration (June 15, 2020 to September 30, 2020). Differences between patient characteristics and outcomes during these timeframes were evaluated. Results A total of 21,424 surgical cases were performed between January 1, 2020 and September 30, 2020. During the suspended timeframe (when all elective cases were cancelled), the percentage of surgeries increased in men (53.8% compared to 49.2% pre-COVID; P < 0.01), in Black and Hispanic patients (23.1% and 15.3%, respectively; P < 0.05), and in Medicaid and self-pay patients (16.3% compared to 9.9% pre-COVID; P < 0.01). All service lines experienced similar trends in overall case volume except obstetrics (constant), trauma, vascular, and thoracic (which increased during the suspended timeframe). Conclusions COVID-19 induced stresses in surgical patients, altering payor mix and impacting minority groups at a large quaternary referral hospital.

Bushfire-smoke trigger hospital admissions with cerebrovascular diseases: Evidence from 2019-20 bushfire in Australia.

Exposure to ambient air pollution is strongly associated with increased cerebrovascular diseases. The 2019-20 bushfire season in Australia burnt 5.4 million hectares of land in New South Wales alone, with smoke so severe it affected cities in Argentina, 11,000 km away. The smoke emitted by bushfires consists of both gaseous and particle components. It is important to note that exposure to particulate matter has been shown to be linked to a heightened risk of stroke, which is the primary kind of cerebrovascular illness, as well as an increased likelihood of hospitalisations and mortality. However, the available data is inadequate in terms of documenting the response of patients diagnosed with a proven cerebrovascular illness to bushfire smoke. Additionally, there is a lack of information about the health effects associated with particulate matter throughout the bushfire season and on days when smoke was present in 2019 and 2020.Therefore, we aimed to determine the effects of (i) short-term air pollution triggered by bushfires and (ii) high smoke days in increasing the daily number of hospital admissions with cerebrovascular diseases. Hospitalisation data were accessed from the admitted patient dataset from seven local Government areas of Hunter New England Local Health District. The bushfire period was defined from 1 October 2019 to 10 February 2020, and a same period from 2018-19 as the control. High bushfire smoke days were days when the average daily concentration of particulate matter was higher than the 95th percentile of the control period. Poisson regression models and fixed effect meta-analysis were used to analyse the data. In total, 275 patients with cerebrovascular admissions were identified, with 147 (53.5%) during the bushfire (2019-20) and 128 (46.5%) in the control period (2018-19). There was no significant increase in daily admissions for cerebrovascular disease (Incidence Rate Ratio, IRR: 1.04; 95% CI: 0.81-1.34; p-value: 0.73), acute stroke (IRR: 1.15; 95% CI: 0.88-1.50; p-value: 0.29) or acute ischaemic stroke (IRR: 1.18; 95% CI: 0.87-1.59; p-value: 0.28), over the entire bushfire period. However, the high bushfire smoke days were associated with increased acute ischaemic stroke-related hospital admissions across lead 0-3 and the highest cumulative effect was observed with lead 0 (IRR:1.52; 95% CI: 1.01-2.29; p-value: 0.04). In addition, during the bushfire period, particulate matter, both PM10 and PM2.5 (defined as particulates that have an effective aerodynamic diameter of 10, and 2.5 microns, respectively), were also associated with increased acute ischaemic stroke admissions with a lag of 0-3 days. The results suggested a possible association between particulate matter and high smoke days with increased hospital admissions due to acute ischaemic stroke during the recent Australian bushfire season.

Air quality and health impacts of the 2020 wildfires in California

Abstract Background Wildfires in 2020 ravaged California to set the annual record of area burned to date. Clusters of wildfires in Northern California surrounded the Bay Area covering the skies with smoke and raising the air pollutant concentrations to hazardous levels. This study uses the Fire Inventory from the National Center for Atmospheric Research database and the Community Multiscale Air Quality model to estimate the effects of wildfire emissions on air quality during the period from August 16 to October 28 of 2020. In addition, low-cost sensor data for fine particulate matter (PM2.5) from the PurpleAir network is used to enhance modeled PM2.5 concentrations. The resulting impacts on ozone and PM2.5 are used to quantify the health impacts caused by wildfires using the Benefits Mapping and Analysis Program – Community Edition. Results Wildfire activity significantly increased direct PM2.5 emissions and emissions of PM2.5 and ozone precursors. Direct PM2.5 emissions surged up to 38 times compared to an average day. Modeling results indicated that wildfires alone led to a rise in ozone daily maximum 8-h average by up to 10 ppb and exceeded PM2.5 air quality standards in numerous locations by up to 10 times. While modeled PM2.5 concentrations were lower than measurements, correcting these with PurpleAir data improved the accuracy. The correction using PurpleAir data increased estimates of wildfire-induced mortality due to PM2.5 exposure by up to 16%. Conclusions The increased hospital admissions and premature mortality attributed to wildfires were found to be comparable to the health impacts avoided by strategies aimed at meeting ozone and PM2.5 air quality standards. This suggests that widespread wildfire emissions can negate years of efforts dedicated to controlling air pollution. The integration of low-cost sensor data proved invaluable in refining the estimates of health impacts from PM2.5 resulting from wildfires.

Hand-Held Echocardiography by Advanced Practice Providers in Patients with Congestive Heart Failure.

The performed hand-held echocardiography (HHE) was evaluated and interpreted by trained advanced practice providers (APPs) on hospitalized CHF patients for image quality and interpretation by comparing with expert echocardiographer and SE findings. Congestive heart failure (CHF) is associated with increased hospital admissions and mortality. While a standard echocardiogram (SE) is the gold standard for cardiac assessment, it is not readily available. Hospitalized CHF patients require rapid assessment for expedited treatment. Over 6 months, five trained APPs performed HHE on hospitalized CHF patients and interpreted: (a) left ventricular (LV) size, (b) LV ejection fraction (LVEF), and (c) right atrial pressure (RAP). The study echocardiographer reviewed and blindly interpreted the HHE images and compared them with APPs and SE findings. Kappa statistics determined the degree of agreement between APPs and the study echocardiographer's interpretation of the HHE images and SE. A total of 80 CHF patients (age 73 ± 14 years, 58% males; LVEF (by SE) 45 ± 19%; 36.3% body mass indexes ≥ 30 kg/m2) were enrolled. HHE interpretation by APPs had a good agreement for LVEF (kappa 0.79) with the study echocardiographer and SE (kappa 0.74) and a good agreement for RAP (kappa 0.67) with the study echocardiographer. The correlation between the absolute LVEF interpretation by the study echocardiographer on HHE and SE was r = 0.88 (p < 0.0001). Trained APPs obtained diagnostic-quality HHE images and interpreted the LV function and RAP in CHF patients in good agreement with the study echocardiographer. LVEF by HHE correlated with LVEF by SE. Our study suggests trained APPs can use HHE to evaluate LVEF and RAP in CHF patients, leading to expedited and optimized treatment.

An observational study to determine the category and causes of the drug-related problems among geriatric inpatients

Background: Geriatric patients are at a higher risk of drug-related problems (DRPs) because of age-related chronic diseases leading to the use of numerous therapeutic regimens, and pharmacokinetic and pharmacodynamic changes. DRPs are associated with reduced quality of life, increased hospital admissions, prolonged hospital stays, and increased health-care costs. Aims and Objectives: This study aimed at identifying the category and causes of DRPs so that better strategies can be framed, thereby improving the quality of health care. Materials and Methods: The observational study was conducted among geriatric inpatients in a tertiary care hospital. The DRPs were identified using national and international standard guidelines. The Pharmaceutical Care Network of Europe (PCNE) classification version 9.01 was used to determine the category and causes of DRPs in the patients. Results: Seventy patients were enrolled in the study. A total of 102 DRPs were detected among these patients. The mean number of DRPs per patient was 1.45. According to the PCNE classification, 36 DRPs were related to treatment effectiveness, 27 were related to treatment safety, 25 were unnecessary drug treatments and 14 were related to cost effectiveness of the treatment. One hundred and fifty-one causes of DRPs were identified. The most commonly involved class of drugs in DRPs was antimicrobials. Conclusion: The number of DRPs noted in the present study was lower than those in the other studies. Majority of DRPs were treatment effectiveness-associated and caused due to errors in drug selection and use.

One response: Global Outbreak Alert and Response Network supporting the COVID-19 response, Kiribati.

In January 2022, Kiribati experienced widespread community transmission of COVID-19, leading to high rates of infection among health-care workers (HCWs), which reduced essential HCWs during a period of increased hospital admissions. Kiribati, a Pacific island country made up of a remote group of 33 low-lying atolls in the Pacific Ocean, experienced its first surge of COVID-19 cases beginning on 24 January 2022. Reports of increasing numbers of COVID-19 cases in South Tarawa prompted the Kiribati Ministry of Health and Medical Services to request assistance from the international community, including the World Health Organization's Global Outbreak Alert and Response Network (GOARN), to support national COVID-19 response operations. Specialists in infection prevention and control (IPC) were deployed to Kiribati in February 2022 to assist the Ministry's National COVID-19 Taskforce in collaboration with national partners. These specialists helped review and strengthen IPC capacities to accommodate a potential patient surge and consequent demands for medical consumables in health-care facilities in South Tarawa. Strengthened knowledge about and processes for IPC among HCWs prevented health care-associated infections and reduced community disease transmission during the first surge of COVID-19 cases in Kiribati. GOARN has the capacity and ability to rapidly deploy experts to support requests for assistance. Outbreak response activities can be enhanced and sustained by using GOARN's resources and collaborating with all partners, as necessary.