Previous Hospital Admissions Research Articles

Functional decline, mortality and institutionalization after 18months in multimorbid older persons living in the community: the FUNCIPLUR longitudinal study.

Studying functional decline in multimorbidity patients is important for improving patient management. We sought to analyse long-term functional decline, mortality and institutionalization and associated factors in over-65-year-olds with multimorbidity, comparing with previous short-term results. A prospective study was conducted in three primary care centres, over 18months, in a random sample of patients (n = 241) ≥ 65years on a clinical care programme for multimorbidity. Primary outcomes were decrease in functional status category (Barthel or Lawton scales), alone and together with death and institutionalization. Other variables were sociodemographic characteristics, comorbidity, medications and hospitalisation. Patients initially included had five chronic conditions (IQR 4-6) and were on 11 (IQR 9-14) chronic medications; their median age was 82years (75th percentile 86); 38.2% had impaired function at baseline. Of the 216 patients included in the analysis, 47 died; 11 were institutionalized; and 158 completed follow-up, but of these, 81 (51.3%, 95% CI 43.5-58.9) experienced functional decline. That is, 139/216 (64.4%, 95% CI 57.8-70.4%) had outcome events and these were associated with older age (OR 1.1, 95% CI 1.0-1.1, p = 0.002) and having ≥ 1 admission during follow-up (OR 4.1, 95% CI 2.1-8.9%, p < 0.001). Considering all 241 patients, there were 234 admissions during follow-up, in 117 patients. Two-thirds of patients showed functional decline, died or were institutionalized. The factors associated with loss of function at 18months were similar to those observed at 8months, notably previous hospital admissions. These findings are important as they indicate functional decline and increasing care needs are potentially predictable/modifiable.

Determinants of coronary artery disease risk factor management across three world regions

BackgroundThe SUrvey of Risk Factors (SURF) indicated poor control of risk factors in subjects with established coronary heart disease (CHD). The present study aimed to investigate determinants of risk factor...

Alcohol-related brain injury: Improving identification and management in an acute care setting

To increase detection of alcohol-related brain injury (ARBI) in patients attending hospital with an alcohol use disorder. In April 2017, we implemented an innovative clinical pathway. We developed an electronic warning system to identify those patients at risk of ARBI. Criteria for referral were developed utilising an algorithm based on the number of previous emergency department attendances or hospital admissions and concerns raised by relatives or staff. For patients meeting criteria, an automatic referral was made to …

Complement C3 and incident hospitalization due to chronic kidney disease: a population-based cohort study

BackgroundCirculating C3 has been associated with diabetes and hypertension, which are the leading causes of chronic kidney disease (CKD). C3 activation is considered to contribute to several renal diseases. Here we examined whether elevated C3 concentration is associated with hospitalization due to CKD in the general population, and whether this relationship is mediated by factors such as diabetes and hypertension.MethodsBaseline plasma C3 was quantified in 4552 participants, without previous hospital admission due to CKD, from the Malmö Diet and Cancer cohort study. Incidence of first hospitalization due to CKD (main diagnosis) was investigated in relation to C3 levels using Cox proportional hazards regression models after a mean follow-up of 19.2 ± 4.16 years. Traditional risk factors of CKD including diabetes, blood pressure, C-reactive protein and baseline renal function were considered in adjustments and sensitivity analyses.ResultsDuring the follow-up period, 94 subjects were admitted to hospital due to CKD. After multivariate adjustment, the hazard ratios (95% confidence interval) for hospitalization from CKD across quartiles of C3 were 1.00 (reference), 1.68 (0.69, 4.13), 2.71 (1.15, 6.39), and 3.16 (1.36, 7.34) (p for trend = 0.003). Results were generally consistent across different sensitivity analyses.ConclusionsThese findings indicate that C3 is associated with incidence of first hospitalization due to CKD in the general population. The observed relationship cannot be entirely attributed to hyperglycemia and hypertension.

Ferritin and Prognosis in Elderly Patients with Heart Failure and Preserved Ejection Fraction

Background: Iron deficiency (ID) and anaemia are frequent in Heart Failure (HF) patients, but there are few data about its prevalence and prognosis in elderly HF patients with preserved ejection fraction (HF-PEF). Aim: The aim of this study is to ascertain if ID alone or associated with anaemia is related to negative clinical outcomes in elderly patients with HF-PEF. Design/Methods: 139 consecutive patients discharged from our Internal Medicine Department with a diagnosis of HF-PEF from June 2011 to June 2014 were followed up until June 2015. All demographic and clinical data, echocardiography, biochemical parameters, treatment at discharge, new hospital admissions and death were registered in a specific database. Results: Mean age was 79.1 years (SD 8.3 years), and 94 (67.6%) were women. Anaemia was present in 85 (61%), any iron deficiency in 92 (67%) and absolute iron deficiency in 67 (48%) of these patients. 33 patients (23%) died during a mean follow-up of 649 days. Increased mortality was related to age, previous hospital admissions, lower albumin level, lower Barthel score, and higher ferritin level. Using a composite endpoint of HF readmission or death during first year after index admission, 54 patients (38.8%) had this negative outcome. Lower Barthel Score and albumin values, higher NT pro-BNP and ferritin level, and absence of iron deficiency, were related to this negative outcome. Conclusion: Anaemia and Iron Deficiency are usual findings in our elderly HF-PEF patients, but only a high level of serum ferritin was associated with worse outcomes in this setting.

Prevalence and factors associated with methicillin-resistant Staphylococcus aureus colonization among clinical medical students

Background: This study was carried out to assess the prevalence and determinants of methicillin-resistant Staphylococcus aureus(MRSA) colonization among clinical clerkship medical students in Saudi Arabia. Methods: A cross-sectional study was performed at King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia. Nasal samples were obtained from 360 clinical clerkship medical students (3rd–5th years). Questionnaires were filled. MRSA identification was done using the standard laboratory procedures. Data were analyzed using SPSS Pc + 21.0 software. Results: Of 360 samples, 100 (27.7%) were positive for S. aureus and 12 (3.3%) were MRSA positive. The following variables and the outcome (MRSA+/MRSA−) showed statistically significant association; previous hospital admissions, immunocompromised status, chronic disease, and female gender. We found that our MRSA colonization prevalence rate of 3.3% predominately in female gender. Third-year medical students have the highest MRSA colonization of 4.8%, then 4th year 2.8%, and 5th year 1.2%. 17.6% of students with history of hospital admission where found to be MRSA positive, 10% of bronchial asthma sufferers, and 37.5% of immunocompromised students either due to medication or cancer were MRSA positive. Conclusion: MRSA nasal carriage among clinical medical students in KSUMC was found to be 3.3%. We recommend teaching standard practices of infection control protocols and additional precautions.

Comparison of Oral Triclofos and Oral Midazolam as Premedication in Children undergoing Elective Surgery.

Background:Children who have experienced previous hospital admission, operation, procedures, and needle pricks are more reactive to subsequent anesthetic procedures. Many sedative agents have been used for the purpose of premedication, but few of them can be given orally, thus avoiding the pricks. Midazolam, being one such choices, can be given orally, intranasally, and parenterally but has unpredictable response. Triclofos, available as sweet syrup, is a phosphorylated derivative of chloral hydrate, has been proven to be effective within 30 min in doses of 25–75 mg/kg. Hence, this study compares triclofos hydrochloride with midazolam oral to know the efficacy of both the drugs as premedication.Aim:This study aims to assess sedation score, level of anxiety/resistance, and behavior of the child in the preoperative period.Settings and Design:After parental and institutional approval, a total of 70 children were studied based on computer-generated randomization and divided into groups M and T of 35 each.Materials and Methods:Group M patients received oral midazolam 0.5 mg/kg. Group T patients received commercially available triclofos syrup containing 100 mg/ml of drug in dose of 75 mg/kg. The response of children to taste of premedication was noted, whether completely ingested or not. In case of vomiting, the child was excluded from further study.Statistical Analysis:Numerical variables were analyzed using Student's paired t-test and other variables using Mann–Whitney U-test, Fisher exact test, and Friedman ANOVA.Results:Sedation score at 5 min interval from 0 to 30 min showed P = 0.54, 0.71, 0.65, 0.92, 0.29, 0.42, and 0.15; none were statistically significant. Anxiety score during parental separation, intravenous cannulation, and mask application were also similar in both the groups.Conclusion:From data obtained, it can be concluded that parenteral formulation of either midazolam or triclofos can be safely used as premedicant in children.

Textbook Outcomes Among Medicare Patients Undergoing Hepatopancreatic Surgery.

To define and test "Textbook Outcome" (TO)-a composite measure for healthcare quality-among Medicare patients undergoing hepatopancreatic resections. Hospital variation in TO and Medicare payments were analyzed. Composite measures of quality may be superior to individual measures for the analysis of hospital performance. The Medicare Provider Analysis and Review (MEDPAR) Inpatient Files were reviewed to identify Medicare patients who underwent pancreatic and liver procedures between 2013 and 2015. TO was defined as: no postoperative surgical complications, no prolonged length of hospital stay, no readmission ≤ 90 days after discharge, and no postoperative mortality ≤ 90 days after surgery. Medicare payments were compared among patients who achieved TO versus patients who did not. Multivariable logistic regression was used to investigate patient factors associated with TO. A nomogram to predict probability of TO was developed and validated. TO was achieved in 44% (n = 5919) of 13,467 patients undergoing hepatopancreatic surgery. Adjusted TO rates at the hospital level varied from 11.1% to 69.6% for pancreatic procedures and from 16.6% to 78.7% for liver procedures. Prolonged length of hospital stay represented the major obstacle to achieve TO. Average Medicare payments were substantially higher among patients who did not have a TO. Factors associated with TO on multivariable analysis were age, sex, Charlson comorbidity score, previous hospital admissions, procedure type, and surgical approach (all P > 0.05). Less than one-half of Medicare patients achieved a TO following hepatopancreatic procedures with a wide variation in the rates of TO among hospitals. There was a discrepancy in Medicare payments for patients who achieved a TO versus patients who did not. TO could be useful for the public reporting of patient level hospital performance and hospital variation.

Program to improve the discharge process : TRANSICIONA

Introduction : High-quality coordination during transitions across different setting is especially important for older adults with multiple chronic conditions and complex needs. Evidence suggests an increased risk of decompensations of chronic conditions, hospital readmissions and death, following transitions. For example, in complex chronic patients, 30-days readmissions can reach 20-25%, according to the literature. Although several factors have been associated with “unsafe transition”, mostly uni-dimensional interventions have been designed. We implemented a multidimensional patient-centered intervention program, aimed to increase patient's empowerment on self-management and improve the coordination among the different settings of care. Objectives : Main outcome: reduction of 30-days readmissions. Intermediate outcomes: to promote early follow-up by primary care. Methods : We include all the patients admitted to our intermediate care hospital who meet at least 2 of the following criteria’s: ≥2 chronic conditions, polypharmacy ≥ 8 drugs, cognitive impairment, previous hospital admission The intervention is carried out on 5 domains: a Medication patient-center conciliation and education, b Physical activity encourage and promote the practice of physical activity, according to physical function, c Patients’ empowerment encourage and promote the incorporation of healthy habits, improve the patients’ knowledge of their disease and treatments, d Identification of other risks of hinder patients’ empowerment and confidence e Coordination of different settings primary care, nursing homes, etc. . The multidisciplinary team includes: two nurses leaders of the project, a social worker and a geriatrician. In order to improve patients’ empowerment, the two nurses have received training on motivational interview and specific techniques such as “teach-back”. We collected demographic, clinical and health process variables in order to performed quantitative analyses, as well as 30-days readmissions using the shared IS3 platform available in all Catalonia. Results : After 12 months, a total of 182 patients were included mean age 82 years and 54% females; 24 patients were missing during the intervention due to early discharge. The intervention was done mainly on the medication domain 77.1%, N=140, patients’ empowerment 78.8%, N=143 and physical activity 76%, N=138 Coordination and contact with primary care was done mainly through telephone calls, followed by email and written pre-discharge notifications. Regardless the method use for coordination, a high percentage of patients 47%, N=60 of 128 de patients from Home Care ATDOM; 67%, N= 86 de 128 patients of Primary Care of patients had a follow-up visit soon Futures steps : We plan to complete the assessment looking at patient’s adherence to recommendations pharmacological and no-pharmacological as well as to analyze qualitative feedback of patients and staff about the program implementation.

Clostridium difficile infection in Johannesburg, South Africa

ABSTRACTObjectives: The incidence of Clostridium difficile infection is increasing, resulting in significant in-patient morbidity and mortality. We describe the characteristics of Clostridium difficile infection in patients admitted to a tertiary Academic Hospital in Johannesburg, South Africa.Methods: This was a retrospective record review of 154 adult in-patients with confirmed Clostridium difficile infection undertaken between 1 January 2013 and 30 June 2014.Results: Overall, 83 (53.9%) patients were female and the median age was 39 years. The most common symptoms were watery diarrhea (92.9%) and fever (27.3%). Overall, 145 (97.9%) patients had been exposed to antibiotics in the last 30 days, 54 (35.1%) to immunosuppressives, 48 (31.2%) to gastric acid suppressants, and 65 (42.2%) patients had previous hospital admissions. Only two cases were community-acquired. In total, 73 (47.4%) patients died. There was no difference in outcomes of HIV-positive patients compared to HIV-negative patients; however, the clinical features were more marked in the HIV-negative patients. Non-survivors tended to have a greater number of severity indicators compared to the survivors.Conclusion: Patients with Clostridium difficile infection in this study were younger and had a higher mortality than that reported in the Western world. Most infections were hospital-acquired.

Population-based study of LAMA monotherapy effectiveness compared with LABA/LAMA as initial treatment for COPD in primary care

This epidemiological study aimed to describe and compare the characteristics and outcomes of COPD patients starting treatment with a long-acting anti-muscarinic (LAMA) or a combination of a long-acting beta-2 agonist (LABA)/LAMA in primary care in Catalonia (Spain) over a one-year period. Data were obtained from the Information System for the Development in Research in Primary Care (SIDIAP), a population database containing information of 5.8 million inhabitants (80% of the population of Catalonia). Patients initiating treatment with a LAMA or LABA/LAMA in 2015 were identified, and information about demographic and clinical characteristics was collected. Then, patients were matched 1:1 for age, sex, FEV1%, history of exacerbations, history of asthma and duration of treatment, and the outcomes between the two groups were compared. During 2015, 5729 individuals with COPD started treatment with a LAMA (69.8%) or LAMA/LABA (30.2%). There were no remarkable differences between groups except for a lower FEV1 and more previous hospital admissions in individuals on LABA/LAMA. The number of tests and referrals was low and decreased in both groups during follow-up. For the same severity status, the evolution was similar with a reduction in exacerbations in both groups. Treatment was changed during follow-up in up to 34.2% of patients in the LABA/LAMA and 26.3% in the LAMA group, but adherence was equally good for both. Our results suggest that initial therapy with LAMA in monotherapy may be adequate in a significant group of mild to moderate patients with COPD and a low risk of exacerbations managed in primary care.

Carbapenemase-producing Enterobacteriaceae among pregnant women and newborns in Algeria: Prevalence, molecular characterization, maternal-neonatal transmission, and risk factors for carriage

The diffusion of carbapenemase-producing Enterobacteriaceae (CPE) represents a worldwide public health problem. This study revealed that the prevalence of OXA-48-producing enterobacteria was 4.6% (19/414) and 1.6% (7/422) in mothers and newborns, respectively, from 2 maternity units in Algeria. Previous hospital admission was an independent factor associated with an increased risk of CPE carriage in the mothers (P = .021). The low birth weight was significantly associated with this carriage in the newborns (P = .008). The screening of these bacteria is essential to prevent the dissemination of CPE.

Epidemiological and genomic characterization of community-acquired Clostridium difficile infections

BackgroundClostridium difficile infection (CDI) is a major cause of morbidity and mortality in North America and Europe. The aim of this study was to identify epidemiologically-confirmed cases of community-acquired (CA)-CDI in a large North American urban center and analyze isolates using multiple genetic and phenotypic methods.MethodsSeventy-eight patients testing positive for C. difficile from outpatient clinics were further investigated by telephone questionnaire. CA-CDI isolates were characterized by antibiotic susceptibility, pulsed-field gel electrophoresis and whole genome sequencing. CA-CDI was defined as testing positive greater than 12 weeks following discharge or no previous hospital admission in conjunction with positive toxin stool testing.Results51.3% (40/78) of the patients in this study were found to have bona fide CA-CDI. The majority of patients were female (71.8% vs. 28.2%) with 50–59 years of age being most common (21.8%). Common co-morbidities included ulcerative colitis (1/40; 2.5%), Crohn’s disease (3/40; 7.5%), celiac disease (2/40; 5.0%) and irritable bowel syndrome (8/40; 20.0%). However, of 40 patients with CA-CDI, 9 (29.0%) had been hospitalized between 3 and 6 months prior and 31 (77.5%) between 6 and 12 months prior. The hypervirulent North American Pulostype (NAP) 1-like (9/40; 22.5%) strain was the most commonly identified pulsotype. Whole genome sequencing of CA-CDI isolates confirmed that NAP 1-like pulsotypes are commonplace in CA-CDI. From a therapeutic perspective, there was universal susceptibility to metronidazole and vancomycin.ConclusionsAll CA-CDI cases had some history of hospitalization if the definition were modified to health care facility exposure in the last 12 months and is supported by the genomic analysis. This raises the possibility that even CA-CDI may have nosocomial origins.

Factors influencing self-reported anxiety or depression following stroke or TIA using linked registry and hospital data

Approximately 30-50% of survivors experience problems with anxiety or depression post-stroke. It is important to understand the factors associated with post-stroke anxiety or depression to identify effective interventions. Patient-level data from the Australian Stroke Clinical Registry (years 2009-2013), from participating hospitals in Queensland (n = 23), were linked with Queensland Hospital Emergency and Admission datasets. Self-reported anxiety or depression was assessed using the EQ-5D-3L, obtained at 90-180days post-stroke. Multivariable multilevel logistic regression, with manual stepwise elimination of variables, was used to investigate the association between self-reported anxiety or depression, patient factors and acute stroke processes of care. Comorbidities, including prior mental health problems (e.g. anxiety, depression and dementia) coded in previous hospital admissions or emergency presentations using ICD-10 diagnosis codes, were identified from 5years prior to stroke event. 2853 patients were included (median age 74; 45% female; 72% stroke; 24% transient ischaemic attack). Nearly half (47%) reported some level of anxiety or depression post-stroke. The factors most strongly associated with anxiety or depression were a prior diagnosis of anxiety or depression [Adjusted Odds Ratio (aOR) 2.37, 95% confidence interval (95% CI) 1.66-3.39; p < 0.001], dementia (aOR 1.91, 95% CI 1.24-2.93; p = 0.003), being at home with support (aOR 1.41, 95% CI 1.12-1.69; p = < 0.001), and low socioeconomic advantage compared to high (aOR 1.59, 95% CI 1.21-2.10; p = 0.001). Acute stroke processes of care were not independently associated with anxiety or depression. Identification of those with prior mental health problems for early intervention and support may help reduce the prevalence of post-stroke anxiety or depression.

High nutrition risk related to dietary intake is associated with an increased risk of hospitalisation and mortality for older Māori: LiLACS NZ

ObjectivesTo investigate the association between domains of nutrition risk with hospitalisations and mortality for New Zealand Māori and non‐Māori in advanced age. MethodsWithin LiLACS NZ, 256 Māori and 399 non‐Māori octogenarians were assessed for nutrition risk using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II) questionnaire according to three domains of risk. Sociodemographic and health characteristics were established. Five years from inception, survival analyses examined associations between nutrition risk from the three domains of SCREEN II with all‐cause hospital admissions and mortality. ResultsFor Māori but not non‐Māori, lower nutrition risk in the Dietary Intake domain was associated with reduced hospitalisations and mortality (Hazard Ratios [HR] [95%CI] 0.97 [0.95–0.99], p=0.009 and 0.91 [0.86–0.98], p=0.005, respectively). The ‘Factors Affecting Intake’ domain was associated with mortality (HR, [95%CI] 0.94 [0.89–1.00], p=0.048), adjusted for age, gender, socioeconomic deprivation, education, previous hospital admissions, comorbidities and activities of daily living. ConclusionImproved dietary adequacy may reduce poor outcomes for older Māori. Implications for public healthNutrition risk among older Māori is identifiable and treatable. Effort is needed to engage relevant community and whānau (family) support to ensure older Māori have food security and cultural food practices are met.

Aerobic etiology of intraabdominal infections in a public hospital. Surveillance and antibiotic resistance

Background: The treatment of intrabdominal infections are empirically performed on the basis of existing epidemiological data. There are data in Argentine that present an increased resistance more than 30% to Ciprofloxacin and Ampicilin/sulbactam in E. coli and K. pneumoniae. The following study is performed in order to know the etiology and antimicrobial resistance in our region. Methods & Materials: Retrospective, descriptive and observational study. The patients included not only had intraabdominal infection diagnosis but also any kind of surgery in order to control the source in the “Hospital Escuela de Agudos Dr. Ramón Madariaga” with positive aerobic bacteriological results between January 1st, 2016 and December 31st, 2016. Data were analyzed by the statistical support of IBM SPSS statistics v. 19.0. Epidemic registries were done. The analysis of bacteriological samples were developed in the “Laboratorio Nacional de Referencia del Instituto Carlos Malbrán (LNR)”. Results: There were analyzed 69 intrabdominal infections, 59 acute appendicitis, male 45/69 (65.2%), middle aged 41 (15-86), comorbidities 23/69 (33%), previous use of antibiotics 10/69 (14.5%), previous hospital admission 4/69 (5.8%). The empirical treatment used was based on one drug with activity against aerobic pathogens in 68 cases (98.6%). The most frequent active drugs used were ciprofloxacin plus metronidazole 62/69 (89.9%) and ampicillin/sulbactam 4/69 (5.8%). 94 aerobic bacterias were isolated (1.4 bacterias/episodes), gram negative bacteria 82/94 (87.2%), Escherichia coli 55/94 (58.5%), Klebsiella pneumonia 10/94 (10.6%) and Pseudomonas aeruginosa 8/94 (8.5%). The resistance profile of the enterobacterias was ampicillin/sulbactam 27/69 (39%), ciprofloxacin 18/70 (26%), gentamicin 8/71 (11%), cefotaxime 4/71(6%) and piperacillin/tazobactam 3/71 (4%). In E. coli was ampicillin/sulbactam 23/55(42%), ciprofloxacin 15/55 (28%), gentamicin 6/53 (11%), amikacin 1/28 (4%), piperacillin/tazobactam 1/55 (2%) and cefotaxime 2/55(4%). In K. pneumoniae was ampicillin/sulbactam 3/10 (30%), ciprofloxacin 3/10 (30%), gentamicin 2/10(20%), piperacillin/tazobactam 2/10 (20%), cefotaxime 2/10 (20%), amikacin 0/5 (0%). There were no resistant in P. aeruginosa. Beta lactamase of extended spectrum 4/71. Conclusion: The microbiological findings of this study provide information to base the election of antibiotic empirical treatments in our hospital. This findings lead us to ask the necessity of reconsider the antibiotics schemes empirically outlined to intrabdominal infection

Dementia and Alzheimer's disease risks in patients with autoimmune disorders.

To investigate an association between autoimmune disorders (AID) and hospitalization for dementia and Alzheimer's disease, and to study whether the risk is associated with follow-up time and age. We followed up all individuals in Sweden without previous hospital admission for dementia and Alzheimer's disease, and with a primary or secondary diagnosis of an AID between 1 January 1964 and 31 December 2010, in the Swedish National Patient Register for dementia and Alzheimer's disease. The Swedish National Patient Register includes both inpatients and outpatients. We calculated standardized incidence ratios (SIR) for dementia and Alzheimer's disease, adjusted for individual variables, including age, sex and comorbidities. A total of 788 103 individuals were admitted to hospital because of an autoimmune disorder without previous dementia and Alzheimer's disease. Among a total of 42 conditions of AID, 9998 dementia and Alzheimer's disease patients were identified with a SIR of 1.28 (95% CI 1.26-1.31). A total of 17 showed an increased risk, and of those the remaining, 14 conditions were still at risk, when dementia and Alzheimer's disease diagnosed in the year of AID diagnosed were excluded. The risks depended on the age at hospitalization for dementia and Alzheimer's disease. The present large study quantified the increased risks of dementia and Alzheimer's disease in patients with many types of AID. Geriatr Gerontol Int 2018; 18: 1350-1355.

Effect of Ambulatory Transitional Care Management on 30-Day Readmission Rates

A process improvement initiative for transitional care management (TCM) was evaluated for effectiveness in reducing 30-day readmission rates in a retrospective cohort study. Regression models analyzed the association between level of TCM component implementation and readmission rates among patients discharged from a university medical center hospital. Of the 1884 patients meeting inclusion criteria, only 3.7% (70) experienced a 30-day readmission. Patients receiving the full complement of TCM had 86.6% decreased odds of readmission compared with patients who did not receive TCM ( P < .001). However, the complete package of TCM services under Medicare guidelines may not be essential. A postdischarge telephone call did not reduce readmission odds, provided a TCM office visit occurred. Important for risk assessment models targeting patients for TCM, the number of previous hospital admissions, not age, predicted 30-day readmission risk. This study provides evidence that primary care-based TCM can reduce 30-day readmissions even when overall rates are low.

Risk of infection following semi-invasive ultrasound procedures in Scotland, 2010 to 2016: A retrospective cohort study using linked national datasets.

Outbreak reports indicate a risk of cross-infection following medical procedures using semi-invasive ultrasound probes. This study aimed to evaluate the risk of infection, using microbiological reports and antibiotic prescriptions as proxy measures, associated with semi-invasive ultrasound probe procedures, including transoesophageal echocardiography, transvaginal and transrectal ultrasound. Patient records from the Electronic Communication of Surveillance in Scotland and the Prescribing Information System were linked with the Scottish Morbidity Records for cases in Scotland between 2010 and 2016. Three retrospective cohorts were created to include inpatients/day-cases and outpatients in the following specialties: Cardiology, Gynaecology and Urology. Cox regression was used to quantify the association between semi-invasive ultrasound probe procedures and the risk of positive microbiological reports and community antibiotic prescriptions in the 30-day period following the procedure. There was a greater hazard ratio of microbiological reports for patients who had undergone transoesophageal echocardiography (HR: 4.92; 95% CI: 3.17-7.63), transvaginal (HR: 1.41; 95% CI: 1.21-1.64) and transrectal ultrasound (HR: 3.40; 95% CI: 2.90-3.99), compared with unexposed cohort members after adjustment for age, co-morbidities, previous hospital admissions and past care home residence. Similarly, there was a greater hazard ratio of antibiotic prescribing for those who had received transvaginal (HR: 1.26; 95% CI: 1.20-1.32) and transrectal (HR: 1.75; 95% CI: 1.66-1.84) ultrasound, compared with unexposed patients. Analysis of linked national datasets demonstrated a greater risk of infection within 30 days of undergoing semi-invasive ultrasound probe procedures, using microbiological reports and antibiotic prescriptions as proxy measures of infection.

Prevalence of fall injuries and risk factors for fall among hospitalized children in a specialized childrens hospital in Saudi Arabia.

BACKGROUNDFall injuries among children during hospital stay is a major patient safety issue. Inpatient pediatric falls can lead to numerous negative consequences. In contrast to adults, there is a paucity of information on the prevalence and risk factors associated with children’s falls during hospitalization.OBJECTIVESIdentify the prevalence of fall injuries among hospitalized children and describe the demographic and environmental factors that could predict a higher risk of severe outcomes of fall.DESIGNDescriptive, cross-sectional prevalence study.SETTINGSpecialized children’s hospital.PATIENTS AND METHODSData was obtained through the electronic Safety Reporting System (SRS). All reported fall events during hospitalization in children ≤14 years of age for the period from 1 April 2015 to 30 April 2016 were included. Fall events that occurred in the day care unit and the outpatient clinic were excluded.MAIN OUTCOME MEASURESPrevalence and possible risk factors for fall events.SAMPLE SIZE48.RESULTSThe prevalence of falls among the 4860 admitted children was 9.9 (95% CI=7.5, 13.1) per 1000 patients (48/4860). A majority of the falls were among boys (n=26, 54%), in the age group from 1–5 years old (n=22, 46%), in children at high risk of falling (n=35, 73%), with normal mobility status (n=21, 44%), and with no history of previous falls (n=33, 69%). Severe injuries accounted for 25% of falls (n=12). However, falls among the moderate risk category (n=9, 69%) were more often severe than falls among the high risk category of children (n=12, 34%) (P=.03).CONCLUSIONRisk factor identification is required to prevent falls and their severe outcomes.LIMITATIONSUnderreporting and single-centered study.