Prevalence Of Admissions Research Articles

SAT-138 Predictors and Health Care Expenditures Associated with Recurrent Diabetic Ketoacidosis Admissions in Adults with Type 1 Diabetes

Introduction: Diabetic ketoacidosis (DKA) is a serious complication in patients with type 1 diabetes (T1D). Recurrent DKA admissions have been associated with increased mortality and substantial healthcare costs. In contrast to pediatrics, significantly less attention has been devoted to exploring and addressing recurrent DKA admissions in adults with T1D. We aimed to characterize the adult population of T1D admitted with DKA in Maryland, identify predictors of recurrent DKA admissions, and quantify their associated healthcare costs. Methods: We conducted a cross-sectional study using the Maryland Health Services Cost Review Commission's database, which collects data from all acute care hospitals in the state. We defined DKA using ICD diagnostic codes for ketoacidosis and hyperosmolality in T1D. We selected adult patients (age 20 or above) with T1D who lived in or bordering Maryland and had at least one admission with a primary diagnosis of DKA between January 1, 2012 and December 31, 2017. The predictors analyzed in this study represent patient characteristics from the first DKA admission. The primary outcome was readmission for DKA in the study period. The summation of admission charges was used to calculate DKA healthcare expenditures. Results: There were 6,147 DKA admissions by 3,368 T1D adults admitted in Maryland in the study period. Readmissions occurred in 915 (27%) patients, with 1-3 and >4 readmissions occurring in 700 (76%) and 487 (24%) of these patients, respectively. Overall, the patients admitted with DKA were predominately non-Hispanic (96%) white (45%) or black (45%) men (53%) between the ages 20-39 years old (48%) from areas of low to moderate socioeconomic status (SES). The majority of patients were insured by private (37%) and Medicaid (27%) insurance. The strongest predictors for DKA readmissions were female sex (OR 1.3; 95%CI 1.1-1.6), residing in an area of low SES (OR 1.5; 95% 1.1-2.0), being insured by Medicare (OR 1.7; 95%CI 1.3-2.2), Medicaid (OR 1.5 95%CI 1.2-1.8) or Self-pay/charity (OR 1.5; 95%CI 1.1-1.9), and discharge against medical advice (OR 1.6; 95%CI 1.2-2.3). Older and non-white patients had a reduced odds of readmission. The expenditure of all adult DKA admissions totaled 5.4 billion dollars. While patients who had DKA readmissions consisted of only 27% of those admitted with DKA, their total costs were 59% of these DKA charges at 3.2 billion dollars. Conclusion: There is a high prevalence of recurrent DKA admissions in adults with T1D. Younger patients, women, having non-private insurance and those living in areas of low SES have the highest odds for readmission. Although these patients are a minority, they account for a majority of DKA health expenditures. Further studies are needed to understand drivers of these admissions in order to intervene in this population at high risk for poor outcomes. Supported by a NIH T32 Grant T32 and Saudek Fellowship Award.

Influence of Mitroflow bioprosthesis structural valve deterioration on cardiac morbidity

BackgroundThis study investigated the extent and nature of cardiac morbidity and cause of mortality in patients with Mitroflow structural valve deterioration (SVD).MethodsA retrospective study was performed examining the medical records of patients who had received Mitroflow bioprosthesis between February 2001 and April 2014 and died during this period. A total of 211 patients were identified and included in the analyses. To determine the cause of mortality, cases were divided into three predefined groups: cardiovascular death due to SVD (group 1), cardiovascular death with no SVD (group 2) and non-cardiovascular death without SVD (group 3).ResultsOverall mortality in this study was 7.6% at 1 year, 46.4% at 5 years and 97.2% at 10 years. In group 1, 53 patients (25%) died; in group 2, 59 patients (28%) died; and in group 3, 99 patients (47%) died. Hospitalisation for congestive heart failure was observed in 49.1% in the SVD group vs. 10.2 and 13.1% in the two other groups, p < 0.001. Hospitalisation for endocarditis was also significantly higher in the SVD group (11.3%) than in the two other groups (6.8 and 0%), p < 0.05. Hospitalisation due to myocardial infarction, cerebral stroke, arrhythmia or other cardiac-related diseases was not significantly different between groups.ConclusionStructural valve deterioration in Mitroflow bioprosthesis was associated with a high prevalence of hospital admissions due to congestive heart failure and endocarditis. Patients with Mitroflow bioprosthesis should be systematically and routinely followed with echocardiography, and reoperation should be considered if SVD has developed.

Prevalence and associated factors of hospitalization for dysglycemia among elderly type 2 diabetes patients: A nationwide study.

BACKGROUNDThe prevalence of older individuals with type 2 diabetes mellitus (T2DM) is increasing due to the aging population and improved medical care. These patients are very susceptible to disease and treatment-related hospitalizations, resulting in higher health care costs, morbidity, and decreased quality of life. However, data of treatment-related complications, especially dysglycemia-related hospitalizations, are lacking.AIMTo assess the prevalence and associated factors for dysglycemia-related hospitalizations among elderly diabetic patients in Thailand using nationwide patient sample.METHODST2DM patients aged ≥ 65 years who received medical care at public hospitals in Thailand in the year 2014 were included. The prevalence of hospitalization due to dysglycemia within one year was examined. Multivariable logistic regression was performed to assess the independent factors associated with hospitalization due to hypoglycemia and hyperglycemiaRESULTSA total of 11404 elderly T2DM patients were enrolled in this study. The mean age was 72.9 ± 5.5 years. The prevalence of hospital admissions due to diabetic ketoacidosis, hyperosmolar hyperglycemic state, hyperglycemic dehydration syndrome, and hypoglycemia among elderly T2DM patients in the year 2014 was 0.1%, 0.1%, 1.7% and 3.1%, respectively. Increased hospitalization due to hypoglycemia was associated with older age, female sex, had hypertension, dementia, lower body mass index, elevated hemoglobin A1C (HbA1C), decreased kidney function, insulin use. Increased hospitalization due to hyperglycemia was associated with dementia, depression, lower body mass index, elevated HbA1C, and insulin use.CONCLUSIONThe prevalence of dysglycemia-related hospitalization in elderly T2DM patients in Thailand was 4.9%. Close monitoring of blood glucose should be provided in high-risk patients for prevention and early detection for these complications.

Trends in Hospital Admissions for Intimate Partner Violence in Australian Mothers With Children Born From 1990 to 2009.

This study aims to determine the prevalence, and trends over time, of Western Australian (WA) mothers who were victims of intimate partner violence (IPV) requiring hospital admission. The study investigated the prevalence of all mothers and the specific prevalence of Aboriginal and non-Aboriginal mothers. A population-based cohort study using de-identified linked health data of mothers of children born from 1990 to 2009 in WA was carried out. The prevalence of hospitalizations for IPV in mothers of children born in the period 1990-2009 (per 1,000 births) was calculated. Results indicate that the overall prevalence of hospital admissions for mothers assaulted 12 months prior to their child's birth month increased in the period 1990-2009, from 2.7 to 7.7 per 1,000 births. There was also an increase in the overall prevalence of hospital admissions of mothers who were assaulted 12 months prior to the birth month and 36 months after the birth month, from 8.9 per 1,000 births in 1990 to 19.4 per 1,000 births in 2009. In addition, being Aboriginal, having a mother <30 years of age, and being of low SES significantly increased the odds of having a mother with an IPV admission. This study highlights that while there has been an increase in the prevalence of IPV admissions for mothers of children born from 1990 to 2009 in WA, the level of prevalence has remained persistent for the last decade for the whole population. However, non-Aboriginal mothers have seen an increase in prevalence in the last decade. This increase is associated with the introduction of the Z63.0 code in International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM). This study highlights the importance of prioritizing groups for targeted early intervention and prevention as well as the need for culturally appropriate strategies to reduce the burden of interpersonal violence.

Regional Variability of Admission Prevalence and Mortality of Pediatric Critical Illness in Latvia

Objectives: There is only one pediatric intensive care unit (PICU) in Latvia, where all critically ill children <18 years are admitted from all regions of Latvia. The aim of this study is to ascertain regional differences in mortality and morbidity of critically ill children over a 5-year period. Materials and Methods: Descriptive retrospective study of children who were admitted to the PICU in Latvia from January 2012 to December 2016. Data on episodes were obtained from the Children's Clinical University Hospital electronic health records. Pediatric Index of Mortality (PIM2) was used for risk adjustment and calculation of standardized mortality ratio (SMR). The data were compared among the six regions of Latvia - Kurzeme, Latgale, Pieriga, Riga, Vidzeme, and Zemgale. Results: The analysis included 3651 intensive care episodes. The highest PICU admission prevalence was in Riga and the lowest in Latgale - 2.3 and 1.7 admissions per 1000 children per year, respectively. The highest emergency admission proportion was observed in Riga and Pieriga, while the lowest in Latgale - 52 and 38%, respectively. The average proportion of mechanically ventilated patients ranged from 24 to 29% of all admitted patients across the regions. SMR for the total population was 1.44 (95% CI: 1.17- 1.81). In two regions, Riga (1.51; 95% CI: 1.04- 2.14) and Latgale (2.21; 95% CI: 1.9- 3.76), it was significantly higher than 1. Conclusions: We noted excess mortality (SMR >1) in the population of critically ill children in Latvia, 2012-2016; in particular, in patients from two regions - Riga and Latgale.

Trends and determinants of Emergency Room admissions for asthma: A retrospective evaluation in Northeast Italy

BackgroundAsthma still represents a cause of death and hospital admissions worldwide. Our study aimed at analyzing the trend of Emergency Room (ER) asthma admissions in Northeast Italy in order to investigate the relevance of specific patient-related determinants and environmental triggers (pollens, mold spores, and pollutants). MethodsRetrospective data from admissions for asthma exacerbations registered between the years 2013 and 2015 in two main ERs in Northeast Italy were collected. Data about patients' age, sex and nationality were recorded. Classification of disease severity followed the current Italian ER triage scoring system (white: no need for emergency treatment; green: need for fast treatment; yellow: severe condition; red: life-threatening condition). Data on pollen/mold spore counts and pollutants were analyzed. ResultsOverall, 1745 ​ER admissions for asthma were registered, with a persistent and significant increase year by year. A slight prevalence of females and patients over 50 years old was observed. Immigrants accounted for 32%, 36% and 26% of admissions respectively in 2013, 2014 and 2015. The prevalence of immigrants' admissions was significantly higher when comparing the relative ratio of immigrant populations/Italian nationals (p ​< ​0.05). The admissions were coded as follows: white, 6.30%; green, 35.36%; yellow, 39.37%; red, 18.97%. People aged ≥50 years were more frequently admitted with a red code, but the trend was not statistically significant (p ​= ​0,0815). By contrast, amongst immigrants there was a higher prevalence of white and green codes observed in comparison with Italian nationals. Grass pollen peak and PM10 high levels represented environmental determinants of ER admissions increase. ConclusionsThe increasing rate of asthma-related ER admissions highlights the need for implementing asthma control strategies. Investigating the traits of patients referring to ER for asthma exacerbations, as well as environmental-related determinants, may help in identifying at-risk individuals and in orienting preventive strategies accordingly. Immigrants represent the most vulnerable sub-population, and their potential difficulties in accessing treatments and health services should be specifically addressed. Overall, implementing patient education in order to improve treatment adherence, as well as providing an asthma action plan to every asthmatic patient, continue to be the most urgent needs.

Prevalence and Outcome of Preterm Neonates Admitted to Neonatal Unit of a Tertiary Care Center in Western Nepal

Introduction: Preterm deliveries contribute to major morbidity and mortality in developing countries. They are a leading cause of admission in neonatal care units. Advances in the management have ensured better survival of preterm births, however cost, care and resource limitations influence the outcome.This study was conducted to determine the prevalence, risk factors, morbidity patterns and outcome of preterm admissions to a neonatal unit of a tertiary care center. Methods: This was a retrospective study where all preterm admissions over a period of two years were evaluated for maternal risk factors and morbidity pattern. Outcome was measured in terms of survival rate and case fatality rate. Mann Whitney U test and Fisher's Exact test were used to see the association between various parameters and clinical outcome. Results: Preterm admissions constituted16.48% of all neonatal unit admissions with a male to female ratio of 1.32:1. Common risk factors for preterm births were Prelabour Rupture of Membrane (31.2%) followed by Hypertensive Disorders in Pregnancy (15.1%) and Antepartum Hemorrhage (8.6%). Common morbidities were Sepsis (40.9%), Jaundice (28%) and Respiratory Distress Syndrome (RDS) (14%). Case fatality rate was significantly high in RDS (45.1%) and perinatal asphyxia (11.1%). Overall survival rate was 75.26%. Conclusion: Preterm births were an important cause for admissions in neonatal unit. Sepsis, jaundice, RDS and necrotizing enterocolitis were common morbidities observed. Since clinical outcome was related to gestational age, improving antenatal care, timely interventions and early referral of high risk pregnancies to tertiary level centers might improve the survival rate

Dental conditions associated with preventable hospital admissions in Australia: a systematic literature review

BackgroundOver the past two decades, there has been a decrease in dental diseases in Australia; however, the number of preventable dental hospital admissions has not diminished. This review reports on the factors associated with preventable dental hospital admissions in Australia.MethodsA search of five databases was conducted using Medical subject headings/Emtree terms and Index terms. All original studies, published between January1965 and March 2018 in English, based on the Australian population, and examining the prevalence of oral conditions as a cause for emergency department presentations and hospital admissions were included. The mixed method appraisal tool was used to evaluate the included studies.ResultsEleven cross-sectional studies met inclusion and exclusion criteria. All the studies, except one from Tasmania, were from Western Australia. The most common reasons for preventable dental hospital admissions were dental caries, followed by embedded or impacted teeth. Malignant neoplasms were reported as main causes of preventable dental hospital admissions in the older population.ConclusionsMost studies on preventable dental hospital admissions were from one Australian state (Western Australia). Further research is required to determine the national prevalence and incidence of preventable dental hospital admissions. A periodic audit of preventable dental hospital admission data is needed for delivery of a fair and effective dental services.

Admission prevalence of deep vein thrombosis in elderly Chinese patients with hip fracture and a new predictor based on risk factors for thrombosis screening

BackgroundElderly hip fracture (HF) patients are at very high risk of developing deep vein thrombosis (DVT), which increases their perioperative mortality. However, data focusing on the admission prevalence of DVT in elderly Chinese patients with hip fracture are limited. Venography and ultrasonography are not suitable for most elderly HF patients; there is also controversy about the prognostic value of D-dimer in elderly patients. Thus, our primary goal was to clarify the prevalence of and risk factors for DVT in elderly Chinese HF patients at admission. Our secondary goal was to evaluate the diagnostic value of a new predictor of DVT based on the risk factors for elderly HF patients.MethodsThis retrospective study was conducted in the West China Hospital, Sichuan University. Between January 2015 and January 2017, 248 elderly Chinese HF patients (> 60 years) were enrolled in this study. The subjects were diagnosed with DVT using ultrasonography or venography. All the patients’ clinical data were obtained, including demographic variables, medical history, comorbidities, and laboratory results. A stepwise multiple logistic regression analysis was used to identify the risk factors contributing to the occurrence of DVT. The value of the new DVT predictor was calculated using a formula based on the coefficient regression and independent variables. A receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic value of different factors.ResultsOf the study patients, 74 (29.8%) were diagnosed with DVT, including sixty-five (87.8%) with distal peripheral, five (6.8%) with proximal central and four (5.4%) with mixed DVT. A multivariate logistic regression analysis showed that five risk factors increased the occurrence of DVT at admission, including gender, age, time from injury to admission, fibrinogen, and D-dimer. The new DVT predictor was calculated using the following formula: 1.131× (female = 1, male = 0) + 0.071 × age (years) + 0.571 × time from injury to admission (days) + 1.028 × fibrinogen(g/L) + 0.123 × D-dimer(g/L). The diagnostic value of the new predictor was highest among those risk predictors whose AUC (area under the ROC curves) value was 0.852.ConclusionsThe results of this study revealed a high prevalence of DVT in elderly Chinese HF patients at admission. Moreover, the new predictor, based on risk factors, was a good method to improve the diagnosis of DVT.

Incidence of infections due to third generation cephalosporin-resistant Enterobacteriaceae - a prospective multicentre cohort study in six German university hospitals

BackgroundInfections caused by third generation cephalosporin-resistant Enterobacteriaceae (3GCREB) are an increasing healthcare problem. We aim to describe the 3GCREB infection incidence and compare it to prevalence upon admission. In addition, we aim to describe infections caused by 3GCREB, which are also carbapenem resistant (CRE).MethodsIn 2014–2015, we performed prospective 3GCREB surveillance in clinically relevant patient specimens (screening specimens excluded). Infections counted as hospital-acquired (HAI) when the 3GCREB was detected after the third day following admission, otherwise as community-acquired infection (CAI).ResultsOf 578,420 hospitalized patients under surveillance, 3367 had a 3GCREB infection (0.58%). We observed a similar 3GCREB CAI and HAI incidence (0.28 and 0.31 per 100 patients, respectively). The most frequent pathogen was 3GCR E. coli, in CAI and HAI (0.15 and 0.12 per 100 patients). We observed a CRE CAI incidence of 0.006 and a HAI incidence of 0.008 per 100 patients (0.014 per 1000 patient days).ConclusionsComparing the known 3GCREB admission prevalence of the participating hospitals (9.5%) with the percentage of patients with a 3GCREB infection (0.58%), we conclude the prevalence of 3GCREB in university hospitals to be about 16 times higher than suggested when only patients with 3GCREB infections are considered. Moreover, we find the HAI and CAI incidence caused by CRE in Germany to be relatively low.

An intervention to control an ICU outbreak of carbapenem-resistant Acinetobacter baumannii: long-term impact for the ICU and hospital

BackgroundFollowing a fatal intensive care unit (ICU) outbreak of carbapenem-resistant Acinetobacter baumanii (CRAB) in 2015, an aggressive infection control intervention was instituted. We outline the intervention and long-term changes in the incidence and prevalence of CRAB.MethodsThe infection control intervention included unit closure (3 days), environmental cleaning, hand hygiene interventions, and environmental culturing. CRAB acquisition and prevalence and colistin use were compared for the 1 year before and 2 years after the intervention.ResultsFollowing the intervention, ICU CRAB acquisition decreased significantly from 54.6 (preintervention) to 1.9 (year 1) to 5.6 cases (year 2)/1000 admissions (p < 0.01 for comparisons with preintervention period.). Unexpectedly, ICU CRAB admission prevalence also decreased from 56.5 to 5.8 to 13 cases/1000 admissions (p < 0.001) despite the infection control intervention’s being directed at the ICU alone. In parallel, hospital CRAB prevalence decreased from 4.4 to 2.4 to 2.5 cases/1000 admissions (p < 0.001), possibly as a result of decreased discharge of CRAB carriers from the ICU to the wards (58.5 to 1.9 to 7.4 cases/1000 admissions; p < 0.001). ICU colistin consumption decreased from 200 to 132 to 75 defined daily dose (DDD)/1000 patient-days (p < 0.05). Hospital colistin consumption decreased from 21.2 to 19.4 to 14.1 DDD/1000 patient-days (p < 0.05).ConclusionsThe ICU infection control intervention was highly effective, long-lasting, and associated with a decrease in last-line antibiotic use. The intervention was associated with the unexpected finding that hospital CRAB prevalence also decreased.

Update on Medication Use Quality and Safety in Older Adults, 2017

Improving the quality of medication use and medication safety in older adults is an important public health priority and is of paramount importance for clinicians who care for them. We selected four important articles from 2017 that address these issues to annotate and critique, and we discuss the broader implications for optimizing medication use. A longer list of articles is given in an online appendix. The first study provides national data on the prevalence of central nervous system-active medication polypharmacy in older adults and how this has changed over a 9-year period (2004-2013). The second study characterizes prevalence of and factors associated with nonadherence to antiepileptic drugs in 36,912 older adults with epilepsy, with an emphasis on minorities. The third study describes the extent of antibiotic use in residents of 381 long-term care facilities (LTCF) in British Columbia, Canada, from 2007 to 2014. Finally, we discuss a meta-analysis of 42 studies that evaluated the prevalence of hospital admissions caused by adverse drug reactions in older adults. This article is intended to provide a narrative review of important publications on medication use quality and safety for clinicians and researchers committed to optimizing medication use in older adults. J Am Geriatr Soc 66:2254-2258, 2018.

Reduction of nosocomial bloodstream infections and nosocomial vancomycin-resistant Enterococcus faecium on an intensive care unit after introduction of antiseptic octenidine-based bathing

Vancomycin-resistant Enterococcus faecium (VRE) is emerging in German intensive care units (ICUs). On a 32-bed surgical ICU at a university hospital, increasing numbers of nosocomial cases occurred despite enforcement of hand hygiene and environmental disinfection. To introduce universal octenidine-based bathing in order to reduce the burden of VRE. Between January 2012 and March 2014, patients were screened for VRE on admission and twice weekly. Active surveillance was undertaken for VRE infections and colonizations, and for bloodstream infections (BSI) with any pathogen. Intervention in this before-after study comprised of standardized octenidine-based bathing. Distinct subgroups of VRE colonizations or infections were defined and used for statistical analysis of frequency, prevalence and incidence density. In the pre-intervention period (January 2012 to April 2013), the admission prevalence of VRE was 4/100 patients and the mean incidence density of nosocomial cases was 7.55/1000 patient-days (PD). Pulsed-field gel electrophoresis analysis revealed prevalence of three vanA and two vanB clusters. In the post-intervention period (August 2013 to March 2014), the admission prevalence of VRE was 2.41/100 patients and the mean incidence density of nosocomial cases was 2.61/1000 PD [P=0.001 (pre- vs post-intervention)]. Thirteen nosocomial VRE infections were identified in the pre-intervention period, compared with one nosocomial VRE infection in the post-intervention period. Incidence densities of BSI pre- and post-intervention were 2.98 and 2.06/1000 PD (P=0.15), respectively. The epidemiology of emerging VRE appeared as a complex mix of admitted cases and transmissions in small clusters, challenging infection control measures. The implementation of universal octenidine-based bathing combined with a standardized washing regime led to a significant reduction in nosocomial VRE.

Psychosocial characteristics and complications in outpatients in a French University Hospital

Background The objectives were to describe outpatients’ psychosocial characteristics and to identify the prevalences of unanticipated hospital admission immediately following outpatient surgery and of severe complications in outpatients at one month after ambulatory surgery. Methods A prospective cohort study was conducted during one month in Rouen University Hospital in January 2017. An anonymous questionnaire was administered in outpatients before hospital discharge. After another month after discharge, data regarding unanticipated hospital admission (primary endpoint) and readmission for complication related to ambulatory surgery and risk factors of readmission depending on psychosocial level (secondary endpoint) were collected from patient medical records. Data included demographic and psychosocial characteristics information on surgery and anesthesia. Results A total of 598 outpatients were included during a month, which represented 85.7% of the outpatients of the hospital unit. The mean age was 50.8 years old (SD = 19.8), the sex ratio male/female was 0.68. Among the outpatients, 93.8% had an ASA Physical Status of I or II. There were 23.5% ophthalmic surgeries, 19.0% gynecological surgeries, 17.7% orthopedic surgeries, 8.3% plastic surgeries; 47.5% of operations were carried out under general anesthesia and 16.6% under regional anesthesia. Twenty percent of outpatients lived alone and 2.6% lived alone and socially isolated; 1.6% of outpatients returned home as a pedestrian and 3.4% used public transportation; 13.7% of outpatients were not accompanied for the first night after surgery. There were 11 (1.84%) unanticipated hospital admissions (7 for medical reasons, 1 for surgery and 3 for organizational difficulty). There were 11 (1.84%) patients that returned in hospital in the 30 days that followed the surgery with 3 readmissions. There was no difference between patients with low socioeconomic status and other patients for unanticipated hospital admission or readmission (working outpatients versus not working, P = 0.42, outpatients with primary, middle or secondary education versus higher education, P = 1.00). Conclusions In our study, the prevalence of unanticipated hospital admission and readmission was low and comparable to the literature. In this work, the psychosocial level was not a risk factor of unanticipated hospital admission or readmission after ambulatory surgery.

How frequently are hospitalized patients colonized with carbapenem-resistant Enterobacteriaceae (CRE) already on contact precautions for other indications?

Using samples collected for VRE surveillance, we evaluated unit admission prevalence of carbapenem-resistant Enterobacteriaceae (CRE) perirectal colonization and whether CRE carriers (unknown to staff) were on contact precautions for other indications. CRE colonization at unit admission was infrequent (3.9%). Most CRE carriers were not on contact precautions, representing a reservoir for healthcare-associated CRE transmission.

Prospective identification versus administrative coding of adverse drug reaction‐related hospitalizations in the elderly: A comparative analysis

To compare prospective identification of adverse drug reaction (ADR)-related hospital admissions in the elderly with administrative coding using the International Classification of Diseases 10th Revision Australian Modification (ICD-10-AM) coding system. We linked the records of 768 enrolled patients from an earlier study, where clinical pharmacists identified ADRs using prospective data collection, to hospital administrative data. We identified patients in the study whose admissions were coded as ADRs using ICD-10-AM codes. We then compared the prevalence and characteristics of ADR-related hospital admissions identified by the two approaches. According to ICD-10-AM coding, 2.7% of patients were admitted due to ADRs, while 15.0% of patients were deemed to have been admitted due to ADRs based on prospective identification by clinical pharmacists. Most (85.7%) patients coded as having an ADR-related hospital admission were also identified as such prospectively. Hematological (23.1%) and metabolic reactions (23.1%) were frequent causes of ADRs identified by coding, whereas cardiovascular ADRs (27.8%) were more common causes of ADRs identified prospectively by pharmacists. Antidepressants (16.7%) and cardiac glycosides (16.7%) were the most commonly implicated drug groups in ADRs identified by coding, whereas diuretics (28.8%) and renin-angiotensin system inhibitors (17.0%) were frequently implicated as causes of ADRs identified prospectively by pharmacists. Reliance on administrative coding potentially underestimates the extent of the problem of ADRs as a cause of hospitalization in the elderly, and more detailed prospective analysis of admissions provides additional targets for strategies to prevent ADRs. The types of ADRs identified also differ between the two approaches.

Dementia in a regional hospital setting: contextual challenges and barriers to effective care

Dementia is a growing public health problem, which may be under-recognised and poorly managed in regional hospitals. With projections of increasing dementia among older adults in regional and rural areas, knowledge about dementia and capacity of professionals to provide best-evidence care is paramount. This research investigates the challenges of dementia care in a publicly funded regional hospital in Australia. The study elucidates prevalence of dementia-related admissions, costs of treatment, length of stay and capacity for dementia care. A mixed methodology was employed in this study, including analysis of hospital records (N = 2405), dementia knowledge surveys (n = 50) and semi-structured interviews with clinical staff (n = 13). Hospital records showed that dementia-related admissions were lower than population prevalence reported in regional Australia. Dementia patients, however, attracted significantly higher treatment costs and greater length of stay than age-matched admissions who did not have a diagnosis of dementia. Clinicians reported several obstacles to effective dementia care, including staff knowledge deficits, environmental challenges, resource constraints and organisational factors.

Admission prevalence of colonization with third-generation cephalosporin-resistant Enterobacteriaceae and subsequent infection rates in a German university hospital.

BackgroundMany patients admitted to a hospital are already colonized with multi-drug resistant organisms (MDRO) including third-generation cephalosporin-resistant Enterobacteriaceae (3GCREB). The aim of our study was to determine the prevalence of rectal 3GCREB colonization at admission to a large German university hospital and to estimate infection incidences. In addition, risk factors for 3GCREB colonization were identified.Materials/MethodsIn 2014 and 2015, patients were screened for rectal colonization with 3GCREB and filled out a questionnaire on potential risk factors at admission to a non-intensive care unit (non-ICU). All patients were retrospectively monitored for bacterial infections. Descriptive, univariable and multivariable logistic regression analyses were conducted to identify risk factors for 3GCREB colonization at admission.ResultsOf 4,013 patients included, 10.3% (n = 415) were rectally colonized with 3GCREB at admission. Incidence of nosocomial infections was 3.5 (95% CI 2.0–6.1) per 100 patients rectally colonized with 3GCREB compared to 2.3 (95% CI 1.8–3.0, P = 0.213) per 100 3GCREB negative patients.Independent risk factors for 3GCREB colonization were prior colonization / infection with MDRO (OR 2.30, 95% CI 1.59–3.32), prior antimicrobial treatment (OR 1.97, 95% CI 1.59–2.45), male sex (OR 1.38, 95% CI 1.12–1.70), prior travelling outside Europe (OR 2.39, 95% CI 1.77–3.22) and places of residence in the Berlin districts Charlottenburg-Wilmersdorf (OR 1.52, 95% CI 1.06–2.18), Friedrichshain-Kreuzberg (OR 2.32, 95% CI 1.44–3.74) and Mitte (OR 1.73, 95% CI 1.26–2.36).ConclusionsAdmission prevalence of rectal colonization with 3GCREB was high, while infection incidence did not significantly differ between patients rectally colonized or not with 3GCREB at hospital admission. In consequence, hospitals should prioritize improvement of standard precautions including hand hygiene to prevent infections among all patients irrespective of their 3GCREB status at hospital admission.

“Lambda‐wave” ST‐elevation is associated with severe prognosis in stress (takotsubo) cardiomyopathy

Persistent ST-segment elevation in acute coronary syndrome is associated with both short and long-term complications. By contrast, there is limited information about ST-elevation and its evolution during takotsubo (stress) cardiomyopathy (TTC). To evaluate whether persistent downsloping ST-elevation in the early stages of TTC might correlate with short and long-term clinical events. One-hundred fifty-eight consecutive subjects with TTC were prospectively enrolled and assessed by electrocardiogram. Patients were classified in two groups according to the presence of downsloping ST-elevation ≥5mm lasting at least 24hr ("lambda-wave" ST-elevation group vs. without downsloping ST-elevation) in at least one/two contiguous leads. Five (3.2%) patients, all female with a mean left ventricular ejection fraction 32±5%, were included in the lambda-wave ST-elevation group. These patients were characterized by a higher prevalence of physical stressor (100% vs. 49%, p=0.04) and higher admission and peak levels of troponin-I levels during hospitalization. Peak of ST-elevation in the lambda-wave ST-elevation group was reached 6hr after admission and gradually decreased after 24hr. In-hospital complications were observed in all the patients presenting lambda ST-elevation (100% vs. 23%, p=0.03, OR: 29.1, p=0.04); one patient presented endoventricular thrombosis and two died of cardiogenic shock. At long-term follow-up (mean 443days), adverse events were observed in 80% of patients with lambda-wave ST-elevation (RR of adverse events at follow-up 32, p<0.01). Persistent downsloping lambda-wave ST-elevation during the acute phase of stress cardiomyopathy may be associated with a higher risk of adverse events at short and long-term follow-up.

Psychosocial characteristics and complications in outpatients in a French University Hospital

Background The objectives were to describe outpatients’ psychosocial characteristics and to identify the prevalences of unanticipated hospital admission immediately following outpatient surgery and of severe complications in outpatients at one month after ambulatory surgery. Methods A prospective cohort study was conducted during one month in Rouen University Hospital in January 2017. An anonymous questionnaire was administered in outpatients before hospital discharge. After another month after discharge, data regarding unanticipated hospital admission (primary endpoint) and readmission for complication related to ambulatory surgery and risk factors of readmission depending on psychosocial level (secondary endpoint) were collected from patient medical records. Data included demographic and psychosocial characteristics information on surgery and anesthesia. Results A total of 598 outpatients were included during a month, which represented 85.7% of the outpatients of the hospital unit. The mean age was 50.8 years old (SD = 19.8), the sex ratio male/female was 0.68. Among the outpatients, 93.8% had an ASA Physical Status of I or II. There were 23.5% ophthalmic surgeries, 19.0% gynecological surgeries, 17.7% orthopedic surgeries, 8.3% plastic surgeries; 47.5% of operations were carried out under general anesthesia and 16.6% under regional anesthesia. Twenty percent of outpatients lived alone and 2.6% lived alone and socially isolated; 1.6% of outpatients returned home as a pedestrian and 3.4% used public transportation; 13.7% of outpatients were not accompanied for the first night after surgery. There were 11 (1.84%) unanticipated hospital admissions (7 for medical reasons, 1 for surgery and 3 for organizational difficulty). There were 11 (1.84%) patients that returned in hospital in the 30 days that followed the surgery with 3 readmissions. There was no difference between patients with low socioeconomic status and other patients for unanticipated hospital admission or readmission (working outpatients versus not working, P = 0.42, outpatients with primary, middle or secondary education versus higher education, P = 1.00). Conclusions In our study, the prevalence of unanticipated hospital admission and readmission was low and comparable to the literature. In this work, the psychosocial level was not a risk factor of unanticipated hospital admission or readmission after ambulatory surgery.