Number Of Hospitalizations In Patients Research Articles

Clinical impact of Achromobacter xylosoxidans colonization/infection in patients with cystic fibrosis.

The rate of diagnosis of colonization/infection of the airways with Achromobacter xylosoxidans has increased in cystic fibrosis patients, but its clinical significance is still controversial. This retrospective, case-control study aimed to evaluate the clinical impact of A. xylosoxidans colonization/infection in cystic fibrosis patients. Individuals who were chronically colonized/infected (n=10), intermittently colonized/infected (n=15), and never colonized/infected with A. xylosoxidans (n=18) were retrospectively evaluated during two periods that were 2 years apart. Demographic characteristics, clinical data, lung function, and chronic bacterial co-colonization data were evaluated. Of the total study population, 87% were pediatric patients and 65.1% were female. Individuals chronically colonized/infected with A. xylosoxidans had decreased forced expiratory volume in 1 s (51.7% in the chronic colonization/infection group vs 82.7% in the intermittent colonization/infection group vs 76% in the never colonized/infected group). Compared with the other two groups, the rate of co-colonization with methicillin-resistant Staphylococcus aureus was higher in individuals chronically colonized/infected with A. xylosoxidans (P=0.002). Changes in lung function over 2 years in the three groups were not significant, although a trend toward a greater decrease in lung function was observed in the chronically colonized/infected group. Compared with the other two groups, there was a greater number of annual hospitalizations in patients chronically colonized/infected with A. xylosoxidans (P=0.033). In cystic fibrosis patients, there was an increased frequency of A. xylosoxidans colonization/infection in children, and lung function was reduced in patients who were chronically colonized/infected with A. xylosoxidans. Additionally, there were no differences in clinical outcomes during the 2-year period, except for an increased number of hospitalizations in patients with A. xylosoxidans.

Inpatient Burden of Abdominal Pain in United States: An Analysis of Time Trends

Introduction: Abdominal pain is a common gastrointestinal disorder and accounts for substantial number of outpatient visits. There is limited data on the inpatient burden of abdominal pain in the United States. The aim of this study was to evaluate inpatient admission rates, length of stay, and associated costs related to abdominal pain. Methods: Using data from the Nationwide Inpatient Sample we examined the characteristics of hospitalization for abdominal pain (ICD-9 code 789) and evaluated the time trends of resource utilization from 1997 to 2012. Fisher's exact test and two-sample t-test were used where appropriate. Results: In 2012, abdominal pain was the primary discharge diagnosis for 45,840 hospitalizations. Majority of these patients were females (63.95%) and aged between 18 and 64 (64.71%). The mean charges per hospitalization were $21,302 and resulted in a national bill of $978,260,696. The mean cost was $6058 and the aggregate cost was $278,123,672. Based on regions defined by bureau of census, southern states accounted for majority (42.67%) of these hospitalizations. Only 9.62% patients were uninsured and median income for zip code was not low (>25 percentile) for majority of the hospitalizations (63.31%). Mean charges were significantly higher for zip codes with median income greater than 25 percentile when compared to low (≤25 percentile) median income zip codes (21,961 vs 19,921, p= 0.027). Readmission rate with abdominal pain as the primary diagnosis was 2.2%. Whereas, all cause readmission rate was 17%. Between 1997 and 2010, the number of hospitalizations for patients with a primary discharge diagnosis of abdominal pain increased from 21,190 patients to 48,450 (p < .001; relative risk 1.19, 95% CI: 1.18, 1.21). Despite, no change in mean duration (2.9 days) of hospital stay the mean charges increased from $5,671 to $21,302, p < 0.001 and the aggregate charges increased 4.92 folds from $198,728,026 to $978,260,696. Conclusion: Abdominal pain is a common reason for hospitalization. There are gender and regional differences with females and southern states accounting for majority of admissions. Patient's socioeconomic status affects the charges of hospitalization as suggested by lower charges for hospitalization in low median income zip codes. The number of inpatient discharges and associated cost has increased since 1997 to 2012. Additionally, readmission rate in patients presenting with abdominal pain is high and adds to the economic burden.Figure 1

Efficacy of Long-acting, Injectable Antipsychotics in the Treatment of Bipolar Disorders

Objective: Long-acting injectable (LAI) antipsychotic drugs have been used to treat bipolar disorders, especially in patients with poor medication adherence. We used copies of a questionnaire and chart reviews to investigate the outcome of long-term use of LAI antipsychotic drugs in bipolar patients. Methods: In this study, the use of LAI antipsychotics, including first-generation LAI (FLAI) antipsychotic drugs and second-generation LAI (SLAI) antipsychotic drugs were studied, to determine their efficacy and side effects. The study group comprised patients with bipolar disorder who were recruited from outpatient clinics at Taipei City Psychiatric Center: 27 patients who received FLAI antipsychotics and 14 patients who received risperidone one of the SLAI antipsychotics. Self-report copies of the questionnaire were gathered, and information from patients' medical records was reviewed and analyzed (n ¼ 41). Results: The frequencies (number of times per year) of mood episodes were found to be significantly different before and after the administration of LAI antipsychotic drugs (0.71 ± 0.65 and 0.23 ± 0.43, respectively, p < 0.001). The frequency of hospitalizations was also significantly different (0.57 ± 0.69 and 0.11 ± 0.26, respectively, p < 0.001). Conclusion: LAI treatment may decrease the frequency of mood episodes and number of hospitalizations in patients with bipolar disorder.

Inpatient Burden of Constipation in the United States: An Analysis of National Trends in the United States from 1997 to 2010

Constipation is one of the most common outpatient diagnoses in primary care and gastroenterology clinics; however, there is limited data on the inpatient burden of constipation in the United States. The aim of this study was to evaluate inpatient admission rates, length of stay, and associated costs related to constipation from 1997 to 2010. We analyzed the National Inpatient Sample Database for all patients in which constipation (ICD-9 codes: 564.0-564.09) was the principal discharge diagnosis from 1997 to 2010. The statistical significance of the difference in the number of hospital discharges, length of stay, and hospital costs over the study period was determined by utilizing the Spearman's coefficient to describe various trends. Between 1997 and 2010, the number of hospitalizations for patients with a primary discharge diagnosis of constipation increased from 21,190 patients to 48,450 (P<0.001, GoF test), whereas the mean length of hospital stay increased only slightly from 3.0 days to 3.1 days (b=0.008 (0.003-0.014); P=0.004). The mean charges per hospital discharge for constipation increased from $8869 in 1997 (adjusted for long-term inflation) to $17,518 in 2010 (b=745.4 (685.3-805.6); P<0.001)), whereas the total costs increased from $188,109,249 (adjusted for inflation) in 1997 to $851,713,263 in 2010. Although the elderly (65-84 years) accounted for the largest percentage of constipation discharges, patients in the 1-17 years age group had the highest frequency of constipation per 10,000 discharges. The number of inpatient discharges for constipation and associated costs has significantly increased between 1997 and 2010.

Noninvasive home telemonitoring for patients with heart failure: A review of medical consensuses

Heart Failure (HF) is the leading cause of death in Western World, producing the highest number of hospitalizations in patients over 65 years. These continuous hospitalizations generate high costs to the health system. Studies point out that multidisciplinary post-discharge treatment programs, i.e. telemonitoring or structured telephone support, can avoid a large portion of readmissions related to HF, with benefit also in mortality, length of hospital stay and quality of life. Considering the impact of telemonitoring in HF, this paper aims to identifying the different world opinions and recommendations of the participants in the management, treatment and monitoring of HF. This purpose is achieved by studying the different HF consensuses. From this study it was possible to detect a number of aspects (parameters to be monitored, health education) that should be considered when a telemonitoring system for HF patients is designed.

A new model for integrated heart failure and palliative advanced homecare − rationale and design of a prospective randomized study

Guidelines have concluded that there is a great need for new models of integrated care, e.g., heart failure and palliative care, in order to facilitate equality of care for dying patients, regardless of diagnosis. We found no evidence in the literature concerning the advantages and effects of integrated heart failure and palliative advanced home care for patients with severe chronic heart failure. The primary aim is to study the effects of integrated Palliative advanced homecarRE and heart FailurE caRE (PREFER) on patients' symptom burden, quality of life, and activities of daily living (ADL) as compared to usual care. Prospective, randomized study with an open-evaluation PROBE design. Optimally treated outpatients with chronic heart failure of varying aetiologies in New York Heart Association classes III-IV will be eligible to participate. The PREFER study is designed to investigate whether a new concept of managing patients with severe chronic heart failure by integrating palliative homecare and active heart failure treatment will reduce symptom burden, increase quality of life and ADL, and reduce the number of hospitalizations in patients with severe chronic heart failure.

Abstract 17294: Medication Discrepancies in Heart Failure: an Independent Predictor of Hospitalizations

Background: One advantage of the recent mandate by the U.S. government for electronic medical records (EMR) is the ability to reconcile medications in order to limit adverse effects of polypharmacy, thereby potentially improving outcomes. High-risk patients on multiple medications, such as those with heart failure (HF), stand to benefit greatly from the EMR. While medication discrepancies still occur in the EMR, their association with adverse outcomes in HF has not previously been examined. Hypothesis: The number of medication discrepancies in the EMR of HF patients is associated with adverse outcomes. Methods: We prospectively studied 99 HF patients and compared medications lists in the EMR with patient-reported medications to determine the number of medication discrepancies. We dichotomized patients into 2 groups: “Low Discrepancies” (0-1) and “High Discrepancies” (2 or greater). Multivariable linear regression was performed to determine whether increased number of medication discrepancies was independently associated with increased number of hospitalizations over a 1-year period. Results: Patients with increased medication discrepancies (≥ 2) were more symptomatic based on NYHA class, had a higher number of health care providers, and had more hospitalizations over a 1 year period (Table). On multivariable linear regression analysis, the number of medication discrepancies was independently associated with the number of hospitalizations (beta-coefficient 0.17, 95% CI 0.08-0.25), p&lt;0.0001 per each medication discrepancy after adjusting for age, sex, ethnicity, NYHA class, and total number of medications. Conclusion: Despite the use of a well-established EMR in HF patients, medication discrepancies still exist. The number of medications discrepancies is an independent predictor of number of hospitalizations in patients with HF. Improving EMR medication reconciliation, especially in HF patients who have multiple providers, is critical.

Old-age inflammatory bowel disease onset: A different problem?

Inflammatory bowel disease (IBD) in patients aged > 60 accounts for 10%-15% of cases of the disease. Diganostic methods are the same as for other age groups. Care has to be taken to distinguish an IBD colitis from other forms of colitis that can mimick clinically, endoscopically and even histologically the IBD entity. The clinical pattern in ulcerative colitis (UC) is proctitis and left-sided UC, while granulomatous colitis with an inflammatory pattern is more common in Crohn's disease (CD). The treatment options are those used in younger patients, but a series of considerations related to potential pharmacological interactions and side effects of the drugs must be taken into account. The safety profile of conventional immunomodulators and biological therapy is acceptable but more data are required on the safety of use of these drugs in the elderly population. Biological therapy has risen question on the possibility of increased side effects, however this needs to be confirmed. Adherence to performing all the test prior to biologic treatment administration is very important. The overall response to treatment is similar in the different patient age groups but elderly patients have fewer recurrences. The number of hospitalizations in patients > 65 years is greater than in younger group, accounting for 25% of all admissions for IBD. Mortality is similar in UC and slightly higher in CD, but significantly increased in hospitalized patients. Failure of medical treatment continues to be the most common indication for surgery in patients aged > 60 years. Age is not considered a contraindication for performing restorative proctocolectomy with an ileal pouch-anal anastomosis. However, incontinence evaluation should be taken into account an individualized options should be considered.

A Nationwide Analysis of Changes in Severity and Outcomes of Inflammatory Bowel Disease Hospitalizations

IntroductionThe past decade has seen a change in inflammatory bowel disease (IBD; Crohn's disease (CD) and ulcerative colitis (UC)) treatment, with increasing use of immunomodulators and biologics. The impact of this on IBD hospitalization outcomes is unknown. MethodsWe identified hospitalizations with a diagnosis of IBD using data from the Nationwide Inpatient Sample, a national US discharge database. We compared the proportion of hospitalizations resulting in surgery in the entire cohort and within each disease severity stratum for the years 1998, 2004, and 2007. ResultsThere were an estimated 89,673 hospitalizations for CD in 1998 increasing to 150,593 hospitalizations in 2007. UC hospitalizations increased from 56,911 in 1998 to 86,611 in 2007. This increase was primarily among low or intermediate severity hospitalizations not requiring surgery. For CD, the proportion of bowel surgeries during hospitalization decreased from 17.3% in 1998 to 12.4% in 2007 (p < 0.001) while for UC, the proportion of colectomy decreased from 9.5% in 1998 to 6.2% in 2007 (p < 0.001). For both diagnoses, this reduction was significant in those with a low severity of disease but not with in those with the highest severity stratum. ConclusionsThere continues to be an increase in the number of hospitalizations in patients with IBD. The numbers of non-elective bowel surgeries among those with the highest severity of disease continues to increase suggesting need for further research into improving outcomes in this cohort at high risk for adverse outcome.

Factors Associated With Stigma Among Caregivers of Patients With Bipolar Disorder in the STEP-BD Study

Factors Associated With Stigma Among Caregivers of Patients With Bipolar Disorder in the STEP-BD Study

Factors Associated With Stigma Among Caregivers of Patients With Bipolar Disorder in the STEP-BD Study

Little is known about the factors contributing to mental illness stigma among caregivers of people with bipolar disorder. A total of 500 caregivers of patients participating in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study were interviewed in a cross-sectional design on measures of stigma, mood, burden, and coping. Relatives and friends with bipolar disorder were assessed on measures of diagnosis and clinical status, determined by a days-well measure derived from psychiatrist ratings of DSM-IV episode status. Because patients' clinical status varied widely, separate models were run for patients who were euthymic for at least three-fourths of the past year (well group) and for those who met criteria for an affective episode for at least one-fourth of the previous year (unwell group). Stepwise multiple regression was used to identify patient, illness, and caregiver characteristics associated with caregiver stigma. In the unwell group, greater mental illness stigma was associated with bipolar I (versus II) disorder, less social support for the caregiver, fewer caregiver social interactions, and being a caregiver of Hispanic descent. In the well group, greater stigma was associated with being a caregiver who is the adult child of a parent with bipolar disorder, who has a college education, who has fewer social interactions, and who cares for a female bipolar patient. Mental illness stigma was found to be prevalent among caregivers of persons with bipolar disorder who have active symptoms as well as for caregivers of those who have remitted symptoms. Stigma is typically associated with factors identifying patients as "different" during symptomatic periods. Research is needed to understand how the stigma experienced by caregivers during stable phases of illness differs from the stigma experienced during patients' illness states.

Increased Continuity of Care Associated with Decreased Hospital Care and Emergency Department Visits for Patients with Asthma

The objective of this study was to determine the association between continuity of care and emergency room visits/hospital care for patients with asthma. A population-based study was conducted using administrative healthcare datasets obtained from Alberta Health and Wellness, Alberta, Canada. The 4-year study period extended from April 1, 1996 to March 31, 2000, and took place at the Palliser Health Region in Alberta, Canada, which has a population of 88,000 people. A population-based sample of 2774 patients, diagnosed with asthma between ages 5 and 45 with two or more office visits for asthma and who lived in the Palliser Health Region for 2 consecutive years during the study period, was studied. The main outcome measure was the association of continuity of care with hospitalizations and emergency room visits for patients with asthma. Continuity of care was the proportion of total physician visits made to the most frequently visited physician. High continuity of care was associated with a decreased risk of an emergency visit (OR = 0.24: 95% CI 0.19-0.29), number of emergency visits (RR = 0.37; 95% CI 0.32-0.42), decreased risk of number of hospitalizations (RR = 0.69; 95% CI 0.54-0.89), and total days in hospital (average difference = 0.77; 95% CI 0.63-0.95), but not with ever hospitalized. High continuity of care was associated with a 60%-75% reduction in emergency room visits and an approximate 25% reduction in number of hospitalizations in patients with asthma. Interventions to improve continuity of care could have the potential to improve care and reduce cost.

Intravenous Quetiapine Abuse

Back to table of contents Previous article Next article Letter to the EditorFull AccessIntravenous Quetiapine AbuseM.Z. HUSSAIN, M.D., , WAQAR WAHEED, M.D., and SEEMA HUSSAIN, M.D., M.Z. HUSSAINSearch for more papers by this author, M.D., Prince Albert, Sask., Canada, WAQAR WAHEEDSearch for more papers by this author, M.D., and SEEMA HUSSAINSearch for more papers by this author, M.D., Calgary, Alta., CanadaPublished Online:1 Sep 2005https://doi.org/10.1176/appi.ajp.162.9.1755-aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: There are recent reports in the literature describing the intranasal abuse of quetiapine among jail inmates, who may obtain it by reporting malingering psychotic symptoms and who refer to it as “quell” (1).Ms. A was a 34-year-old woman with a history of polysubstance dependence (alcohol, cannabis, and cocaine), depressive episodes associated with multiple suicide attempts, and borderline personality disorder who was incarcerated after conviction on charges of physical assault and possession of controlled substances. She had a history of incarceration on multiple occasions for similar charges. She complained of difficulty sleeping, poor impulse control, irritability, and depressed mood. For these symptoms, she was given oral quetiapine, 600 mg at bedtime. On one occasion, she took the pills provided to her but did not ingest them. Instead, she crushed the two 300-mg tablets, dissolved them in water, boiled them, drew the solution through a cotton swab, and while lying in bed, covered by blankets, intravenously injected the solution.Twelve hours later, she was awoken by facility guards who found the syringe she used still in place on her arm. She informed the guards that she had intravenously injected herself with quetiapine the previous evening and became rapidly sedated, falling asleep before she could remove the syringe. She additionally admitted to previous intranasal abuse of crushed quetiapine tablets. Apart from “the best sleep I ever had,” she described no dysphoric, euphoric, or other effects.This description lends support to findings by other investigators of an increased risk of abuse of prescription medication in individuals who have a history of substance abuse or dependence (2). It is conceivable that such a progression from the use of quetiapine to its abuse either intranasally or intravenously is more prevalent than is currently assumed. This may be particularly apt in settings in which the prescription of sedative agents, such as benzodiazepines, barbiturates, and stimulants, is decreasing secondary to concerns of abuse and resale, e.g., prison settings and substance abuse treatment programs and among school-age children. The calming and sedating effects of quetiapine, which make it useful in clinical practice, also make it a substance of abuse and confer “street value” on it by the same token.Quetiapine treatment has been demonstrated to be associated with prolonging abstinence and decreasing the number of hospitalizations in patients with alcohol dependence and posttraumatic stress disorder (3). This is hypothesized to be related to the impact of quetiapine on improving disturbed sleep but may also be related to a direct action of quetiapine in reducing the use of alcohol. The awareness of the “extra-antipsychotic” effects of quetiapine provides potential areas for further clinical research for understanding the treatment of substance abuse and anxiety disorders.

Do dialysis- and transplantation-related medical factors affect perceived health status?

Quality of life and perceived health status (PHS) are important indicators of patient care together with morbidity, mortality and health-care resource utilization. The aim of this study is to explore how various medical conditions might influence perceived health status. The study sample consisted of 128 kidney transplant recipients. PHS was measured using the self-administered SF-36 questionnaire. Stepwise linear regression analysis of 17 demographic, dialysis-, transplantation- and co-morbidity-related factors was performed in order to explore predictors of worse PHS. Older age, female gender, lower education, increased number of hospitalizations during the dialysis period and diabetes mellitus were identified as significant predictors of worse PHS. Age was the most important predictor of PHS, explaining 23.3% of variance in the SF-36 physical component and 4.4% in the SF-36 mental component. Between age groups, major differences were found in predictors of perceived health status-serum creatinine was the most important for patients younger than 45 years and the number of hospitalizations for patients of 45 years and over. Biological and medical factors are significant predictors of the physical component of PHS, although they can explain only up to one-third of its variance. Other dimensions of PHS are weakly influenced by these medical parameters. It seems important to evaluate perceived health status separately among the age groups because they differ in their predictors.

Risks and benefits of rate control versus maintenance of sinus rhythm

There are 2 fundamental approaches to managing patients with recurrent atrial fibrillation (AF): to restore and maintain sinus rhythm with cardioversion and/or antiarrhythmic drugs, or to control the ventricular rate only. Over the past few years, there have been several important prospective clinical trials comparing rate control with rhythm control in patients with recurrent AF. The Pharmacological Intervention in Atrial Fibrillation (PIAF) trial was the first prospective randomized study to test the hypothesis of equivalency between the 2 management strategies for AF. The trial demonstrated that rate control was not inferior to rhythm control with respect to symptoms, quality of life, or number of hospitalizations in patients with persistent AF. The Strategies of Treatment in Atrial Fibrillation (STAF) trial was a pilot study that enrolled approximately 200 patients with AF who were randomized to either ventricular rate control or cardioversion and maintenance of sinus rhythm. The results showed that over a 1-year period there was little difference in outcome in terms of morbidity or symptoms. In the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, patients with AF and risk factors for stroke were randomized to either rhythm control or rate control, with both groups receiving anticoagulation with warfarin. There was no difference in the composite end point of death, disabling stroke or anoxic encephalopathy, major bleeding, or cardiac arrest between the 2 arms. In addition, no major differences were noted in functional status or quality of life. The Rate Control Versus Electrical Cardioversion (RACE) trial also reached a similar conclusion. Thus, rate control is an acceptable primary strategy for management of patients with recurrent AF.

Hydroxyurea for Treatment of Severe Sickle Cell Anemia: A Pediatric Clinical Trial

Hydroxyurea (HU) enhances the synthesis of fetal hemoglobin (HbF) and can improve the clinical course of some adult patients with sickle cell anemia (SCA). In a randomized trial, we studied the biologic effects and the clinical benefit of HU in children and young adults with severe SCA. Twenty-five patients (median age, 9 years) were randomized to receive either HU (at the initial dosage of 20 mg/kg/d) or a placebo for 6 months and were then switched to the other arm for the next 6 months. Among the 22 evaluable patients (median age, 8 years), significant increases in HbF and mean corpuscular volume occurred during the HU treatment period. The white blood cell and reticulocytes counts decreased significantly, but these changes were not clinically relevant. Sixteen of 22 patients (73%) experienced a complete disappearance of events requiring hospitalization. The number of days of hospitalization as well as the number of hospitalizations for patients on HU, as compared with those for the patients receiving placebo, were significantly reduced. We conclude that treatment with HU in children and young adults is feasible, well-tolerated, and improves the clinical course of SCA. The long-term effects of HU require further investigation.