Admission Rates Research Articles

Mental health professionals’ beliefs and attitudes towards compulsory admission in Athens: a token of social stigma or good faith in psychiatry?—a cross-sectional study

BackgroundMental health professionals’ (MHPs) attitudes towards involuntary admissions have not received adequate attention in efforts to curb their rates. Thus, the present study set out to (i) explore MHP attitudes regarding involuntary hospitalisation, (ii) describe their perceived dangerousness of people with severe mental illness (SMI) and their trust in psychiatry, (iii) identify the predictors of attitudes towards compulsory admissions and (iv) gauge the contribution of perceived dangerousness versus trust in psychiatry to explaining them.MethodsA random sample of 300 mental health professionals working in public mental health services located in the Northern part of Athens and in the two psychiatric hospitals of Attica participated in the study. Respondents had to complete a self-reported instrument garnering information about participants’ attitudes towards involuntary hospitalisation (original scale), the perceived dangerousness of people with SMI (Perceived Dangerousness Scale) and their trust in psychiatry (based on the Attitudes to Mental Illness scale) as well as various socio-demographic and work-related variables.ResultsRespondents largely accepted involuntary hospitalisations, considering them to be beneficial (72.96%) and disagreeing with the view that they adversely influence the course of illness (54.85%). Nonetheless, they believe that people with SMI should be treated in the community (89.93%), that compulsory admission should be the last therapeutic resort (84.01%) and that people with SMI should not be placed in psychiatric hospitals against their will in order to be under surveillance (90.64%). However, they acknowledge that involuntary admission is often the only treatment options(61.19%). Concomitantly, they report moderate levels of perceived dangerousness and high levels of trust in psychiatry. Trust in psychiatry had the strongest positive association with acceptance of involuntary hospitalisation among mental health professionals whereas postgraduate studies and working in outpatient settings were linked to less favourable attitudes. Interestingly, perceived dangerousness did not yield an independent effect; rather, it weakened the association between trust in psychiatry and acceptance of involuntary admissions.ConclusionsMental health professionals hold complex attitudes towards involuntary hospitalisation, which are largely explained by their trust in psychiatry. Efforts to reduce the rates of involuntary admissions should address both them and their determinants.

Impact of alcohol use disorder on inpatient hospitalizations: A comparison of outcomes between urban and rural Veterans Affairs hospitals.

Alcohol use disorder (AUD) is a leading cause of morbidity and mortality that disproportionately affects rural residents and Veterans. To evaluate the burden of AUD in admissions at rural and urban hospitals within the Veterans Health Administration (VHA) comparing patient characteristics, clinical outcomes, and 1-, 3-, and 5-year mortality rates. Retrospective cross-sectional study of patients admitted to VHA hospitals from 2016 to 2020, with a primary or secondary diagnosis related to AUD. Follow-up mortality data was collected through September 30, 2023. From 2.9 million qualifying admissions, AUD-related diagnoses were present in 14.3% of admitted patients (427,375 admissions among 190,152 unique patients in 129 facilities). Rural hospitals (n = 22) had a significantly higher overall admission rate for AUD-related diagnoses (21.6% vs. 14.8%, p = .011), higher 30-day readmission rates (17.8% vs. 15.3%, p < .001), but lower hospital-level average length of stay (median = 4.3 vs. 5.6, p < .001). Mortality in rural hospitals was lower than urban at 1 year (9.6% vs. 11.4%, p < .001), 3 years (20.7% vs. 23.1%, p < .001), and 5 years (30.4% vs. 32.9%, p < .001). Rural VHA hospitals have a higher proportion of patients admitted with AUD-related diagnoses and higher readmission rates, but lower mortality rates. Approximately, one in three patients admitted with an AUD-related diagnosis died within the 5-year follow-up period. The mortality rates observed are extraordinary and deserve urgent attention. A comprehensive plan to address AUD in the Veteran population, including how we approach and engage patients in treatment during hospitalizations with any primary or secondary AUD diagnoses, is needed.

A Comparison of Scoring Systems to Identify Patients at Increased Risk From Traumatic Rib Fractures

IntroductionPatients with rib fractures from traumatic injuries may suffer increased morbidity, an increased hospital stay, an increased length of time in the intensive care unit (ICU), pulmonary complications resulting in the need for mechanical ventilation, and increased mortality. Some studies have focused on developing specific scoring systems to triage and to help identify patients most at risk for the most severe complications. One such protocol is the RibScore. At our institution, we use and modified the Pain, Inspiratory Effort, Cough score (mPIC score) to help stratify patients most likely to require ICU admission. This study compared our protocol with the previously published and validated RibScore. MethodsThis was a retrospective review of patients with traumatic rib fractures presenting to our trauma center between 2018 and 2022. The primary outcomes evaluated were overall length of stay (LOS) and ICU LOS, with a secondary outcome of rates of intubation. We collected basic patient demographics, as well as data on methods to control analgesia, whether a nerve block was performed, and if the patient was mobilized. We calculated an mPIC score and a RibScore for these patients. We used an initial mPIC score of <5 to indicate the need for ICU admission. Statistical analysis was performed with a value of a P value of <0.05 deemed statistically significant. ResultsThrough Cox regression analysis we found that an mPIC score <5 is associated with a doubling of both the risk to remain in ICU, and in hospital, compared to an mPIC score of ≥5. The overall LOS was also significantly higher in the former (median 4 d versus 6 d, P = 0.037). It was also associated with higher rates of intubation (14% versus 2.3%, P = 0.021) and ICU admission (82% versus 51%, P = 0.007). Similarly, a RibScore of 4-6 was associated with a statistically significant increase in the median overall LOS (2 d; P = 0.008) and ICU LOS (2 d; P < 0.001), as well as a statistically significant increase in the rates of intubation (14% versus 2.1%, P < 0.006) and ICU admission (83% versus 51%), when compared to a RibScore of 0-3. ConclusionsPatients with rib fractures are at an increased risk of morbidity and mortality. The use of radiographic signs has been used to aid clinicians in accurately stratifying patients with traumatic rib fractures who are at increased risk. Here, we utilize two methods of stratifying patients, the previously described RibScore, which we used as our gold standard and our institutional mPIC score. As has been previously published, we found that a RibScore>3 is associated with significant increases in the rates of intubation. We also found an increase in overall and ICU LOS; this correlates with our mPIC score of <5. Comparing the two scores, we found a percentage agreement of 88.7%. One advantage of our mPIC score over the RibScore is its ability to be easily and rapidly scored at the bedside upon initial patient presentation and throughout the patient's stay by both physicians and nurses, triaging patients upon admission and at later times, during their stay. To our knowledge this is the first time another method of stratifying patients has been compared to the RibScore, and using the mPIC score may give the clinician an opportunity to identify patients most at risk, aiding in their disposition and management.

Evaluating Disparities in COVID-19 Clinical Outcomes Among Patients With Cirrhosis in North America and Europe-An International Registry Study.

Patients with decompensated cirrhosis have a higher risk of hospitalization, ICU admission, and death from COVID-19. The impact of demographics on these outcomes remains uncertain. The SECURE-Liver and COVID-Hep databases were utilized to evaluate disparities in COVID-19 outcomes. Patients were stratified by North American and European cohorts. Bivariate and multivariable logistic regression was performed. A total of 718 cirrhosis patients with COVID-19 were evaluated. In the North American cohort, Black patients had more comorbidities (CI: 1.86 vs. 1.83, p < 0.01), higher rates of hospitalization (77% vs. 85%, p < 0.01), ICU admission (27% vs. 40%, p = 0.05), and death (18% vs. 28%, p = 0.07). Hispanic patients had the lowest adverse outcome rates. In the European cohort, White patients had more comorbidities (CI; 1.63 vs. 1.31, p = 0.02), but non-White patients had higher hospitalization rates (82% vs. 67%, p = 0.01), ICU admissions (15% vs. 18%, p = 0.04), and lower mortality rates (28% vs. 34%, p = 0.01). Black patients in North America had higher hospitalization, ICU admission, and death rates. In the European subgroup, White patients had higher death rates than non-White patients. These disparities became statistically insignificant after adjusting for confounders, suggesting that non-liver-related comorbidities might increase the risk of adverse outcomes.

Associations between obesity and severity of coronavirus disease 2019 in Brazilian inpatients: A 2021 secondary data analysis.

In the backdrop of the global obesity pandemic, recognized as a notable risk factor for coronavirus disease 2019 (COVID-19) complications, the study aims to explore clinical and epidemiological attributes of hospitalized COVID-19 patients throughout 2021 in Brazil. Focused on four distinct age cohorts, the investigation scrutinizes parameters such as intensive care unit (ICU) admission frequency, invasive mechanical ventilation (IMV) usage, and in-hospital mortality among individuals with and without obesity. Using a comprehensive cross-sectional study methodology, encompassing adult COVID-19 cases, data sourced from the Influenza Epidemiological Surveillance Information System comprises 329 206 hospitalized patients. Of these individuals, 26.3% were affected by obesity. Analysis reveals elevated rates of ICU admissions, increased dependence on IMV, and heightened in-hospital mortality among the individuals with obesity across all age groups (p < .001). Logistic regression, adjusting for confounding variables, underscores a progressively rising odds ratio for mortality in younger age brackets: 1.2 (95%CI 1.1-1.3) for those under 50 years, 1.1 (95%CI 1.0-1.2) for the 50-59 age group, and 1.1 (95%CI 1.0-1.2) for the 60-69 age group. Conversely, no significant mortality difference is observed for patients over 70 years (OR: 0.972, 95%CI 0.9-1.1). In summary, hospitalized COVID-19 patients with obesity, particularly in younger age groups, exhibit elevated rates of ICU admission, IMV requirement, and in-hospital mortality compared with the control group. Notably, the 'obesity paradox' is not evident among hospitalized COVID-19 patients in 2021.

Helmet c-PAP Versus NIPPV in Association with Early Respiratory Physiotherapy and Mobilization for Treating SARS-CoV-2 ARDS: A Case-control Prospective Single-center Study.

Introduction: Early noninvasive respiratory support (NIRS) is correlated with a success rate of 60-75% in patients experiencing SARS-CoV-2 ARDS. We conducted a prospective case-control study to assess differences in outcomes between Helmet c-PAP (H-c-PAP) and noninvasive positive pressure ventilation (NIPPV). Methods: All patients with SARS-CoV-2 ARDS, treated with H-c-PAP or NIPPV between October 2021 and April 2022 were sampled. We recorded: demographics, comorbidities, clinical, respiratory, sepsis, NIRS parameters, and outcomes. A "NIRS team" followed the patients in respiratory support supplying them with early and timely intensive physiotherapy i-PKT as well. The Cox's proportional hazard model was applied for multivariate analyses. Results: 368 patients were admitted to our hospital medical ward. 85 patients were treated with H-c-PAP and 145 underwent NIPPV. 138 patients needing oxygen supplementation alone were excluded. The two groups were homogeneously distributed and ICU admission rates were lower in the H-c-PAP one (9.4 vs 11% P = .001) while mortality was higher in the NIPPV group (22.7 vs 9.4%, P = .001). The two multivariate models, that had overall mortality as primary outcome, identified age, H-c-PAP daily, i-PKT and ICU admission as independent variables impacting on the outcome. Age was no longer a significant independent predictor after the inclusion of elderly patients (age >80). The third model showed daily i-PKT could prevent ICU admission whereas the length of NIRS was inversely proportional to outcome. Conclusions: A "NIRS multidisciplinary team" made it possible to adopt an early and timely combination of NIRS and i-PKT resulting in the saving of both patient lives and ICU resources.

Burden of community acquired pneumonia in medically admitted patients with positive past admission history

Aims: The study examined the correlation between Community-Acquired Pneumonia (CAP) burden in hospitalized geriatric patients and their history of admission frequency, revealing a correlation between previous admissions and CAP burden in newly admitted patients. Methods: This study analyzed geriatric patients aged 65 and above admitted to King Hussein Medical Centre in Amman, Jordan. The patients were divided into two age groups and assessed for prognostic factors such as frequency of prior admissions, CURB-65 assessment score, comorbidity burden, and composite outcomes of interest (cOI). The study found that positive cOI was associated with adverse outcomes such as high admission rates, transfers to critical care units, oxygen desaturation, and mortality. Patients were divided into two groups based on Community-Acquired Pneumonia (CAP) diagnosis, with improved cOI indicating the absence of adverse outcomes. The study conducted multiple linear regression analysis to investigate the relationship between past admission frequencies and CAP severity. The results showed significant correlations between factors such as age, gender, and comorbidity burden. Results: This retrospective observational study evaluated 641 geriatric patients who were medically admitted for community-acquired pneumonia (CAP). The results showed that approximately 52.73% (338 patients) experienced a negative diagnosis of CAP, while 47.27% (303 patients) experienced a positive diagnosis. The study found a statistically significant difference in the tested gender between the dichotomised outcome groups (Groups I-II). The odds ratio for a positive CAP in elderly geriatric patients admitted for medical reasons was found to be 3.441. The CAP positivity group had a distribution rate for poorer outcomes of approximately 74.9% (227 patients) compared to 29.0% (98 patients) in the CAP negativity group. The study also found a statistically significant association between comorbidity burden and frailty among geriatric patients. The highest distribution rates were observed in geriatric patients with a CURB-65 score of 3, followed by those with a score of 4, with frequencies of 171 (56.4%) and 124 (40.9%), respectively. The study performed a multiple linear regression analysis, focusing on the assessment of CURB-65 scores in geriatric patients diagnosed with community-acquired pneumonia who were medically admitted. The constructed regression model accounted for approximately 86.4% of the variability in the target variable, as explained by the four independent variables tested. Conclusion: The study found a significant correlation between geriatric patients' prior admission history and the diagnosis of community-acquired pneumonia, indicating an increased severity of CAP with a higher frequency of past admission days.

Association between thoracic epidural anesthesia and driving pressure in adult patients undergoing elective major upper abdominal surgery: a randomized controlled trial

BackgroundThoracic epidural anesthesia (TEA) is associated with a knowledge gap regarding its mechanisms in lung protection and reduction of postoperative pulmonary complications (PPCs). Driving pressure (ΔP), an alternative indicator of alveolar strain, is closely linked to reduced PPCs with lower ΔP values. We aim to investigate whether TEA contributes to lung protection by lowering ΔP during mechanical ventilation.MethodsIn this prospective, randomized, patient and evaluator-blinded parallel study, adult patients scheduled for elective major upper abdominal surgery were assigned to either the TEA group with combined thoracic epidural anesthesia and general anesthesia (TEA-GA) (n = 30) or the control group with only general anesthesia (GA) (n = 30).MeasurementsThe primary outcome was the minimum ΔP determined based on positive end-expiratory pressure (PEEP) after intubation. Secondary outcomes included the incidence of PPCs within seven days, the minimum ΔP at various time points, blood gas analysis, intensive care unit (ICU) admission rates, length of hospital stay, and 30-day mortality rate.ResultsThe TEA group had a significantly lower minimum ΔP titrated based on PEEP compared to the control group (11.23 ± 2.19 cmH2O vs. 12.67 ± 2.70 cmH2O; P = 0.028). Multivariate linear regression analysis showed that intraoperative TEA application (compared with its absence; unstandardized beta coefficient (B) = -1.289; P = 0.008) significantly correlated with ΔP. The incidence of PPCs did not differ significantly between the two groups (8 of 30 [26.7%] vs. 12 of 30 [40%]; P = 0.273), but the incidence of atelectasis in the TEA group was significantly lower than in the control group (5 of 30 [16.7%] vs. 12 of 30 [40.7%]; P = 0.012). Multivariate logistic regression analysis indicated that ΔP was the only variable significantly associated with PPCs (Adjusted Odds Ratio [OR] = 2.190; 95% Confidence Interval [CI]: 1.300 to 3.689; P = 0.003).ConclusionCompared to GA, TEA-GA can reduce intraoperative ΔP in patients undergoing major upper abdominal surgery, especially those undergoing laparoscopic surgery. However, compared to GA combined with ΔP-guided ventilation, TEA-GA combined with ΔP-guided ventilation does not reduce the risk of PPCs. There was no significant difference in the total use of various vasoactive drugs between the two groups.Trial registrationThis study was registered in the Chinese Clinical Trial Registry (registration number ChiCTR2300068778 date of registration February 28, 2023).

Risk factors for hemocoagulase-associated hypofibrinogenemia in patients with gastrointestinal bleeding

BACKGROUND With the widespread use of hemocoagulase in patients with gastrointestinal bleeding, clinicians have become increasingly concerned about coagulation disorders associated with this medication. Risk factors for hypofibrinogenemia associated with hemocoagulase are poorly understood. AIM To determine risk factors for hemocoagulase-associated hypofibrinogenemia in patients with gastrointestinal bleeding. METHODS We performed a retrospective analysis of the medical documentation of hospitalized patients treated with hemocoagulase for gastrointestinal bleeding. Hypofibrinogenemia was defined as a decrease in plasma fibrinogen concentration to less than 2.0 g/L. The included patients were divided into two groups: acquired hypofibrinogenemia group and non-hypofibrinogenemia group. We used logistic regression analysis to identify potential risk factors and established risk assessment criteria by employing a receiver operating characteristic curve. RESULTS There were 36 patients in the acquired hypofibrinogenemia group and 73 patients in the non-hypofibrinogenemia group. The hypofibrinogenemia group showed higher rates of intensive care unit admissions (P = 0.021), more female patients (P = 0.005), higher in-hospital mortality (P = 0.027), larger hemocoagulase doses (P = 0.026), more Packed Red Cells transfusions (P = 0.024), and lower baseline fibrinogen levels (P &lt; 0.000). Binary logistic regression was employed to examine the risk factors associated with acquired hypofibrinogenemia. The analysis revealed that baseline fibrinogen [odds ratio (OR) 0.252, 95%CI: 0.137-0.464, P &lt; 0.000], total hemocoagulase doses (OR 1.074, 95%CI: 1.015-1.137, P = 0.014), and female gender (OR 2.856, 95%CI: 1.015–8.037, P = 0.047) were statistically significant risk factors. CONCLUSION Higher doses of total hemocoagulase, female gender, and a lower baseline fibrinogen level were risk factors for hemocoagulase-associated hypofibrinogenemia in patients with gastrointestinal bleeding.

Hospitalisation patterns for respiratory diseases in Australia: an ecological study

ObjectivesThe objective of this study is to examine the hospitalisation profile for respiratory diseases in Australia between 1998 and 2019.DesignAn ecological study.SettingA population study that involved all private and public...

Microbiological trends, in-hospital outcomes, and mortality in infective endocarditis: a Swiss-nationwide cohort study.

The epidemiology of infective endocarditis (IE) is evolving, driven by an aging population and increased use of endovascular devices, and is associated with significant morbidity and mortality. This study aims to evaluate changes in microbiological trends and clinical outcomes in patients with IE over the past decade in Switzerland. This nationwide cohort study analyzed in-hospital claims data from patients hospitalized with IE in Switzerland between 2012 and 2021. We assessed incidence rates per 100,000 hospitalizations, categorizing them by common pathogens. The outcomes included in-hospital and 6-month mortality, admission to the intensive care unit (ICU), and length of hospital stay (LOS). Among 15,255 hospitalizations with IE, the annual number of cases increased from 1,361 in 2012 to 1,636 in 2021. The most frequently diagnosed pathogens were Staphylococcus aureus (increasing from 19.8% to 30.0%, ptrend <0.01) and Streptococcus species (from 17.6% to 24.4%, ptrend <0.01). Infective endocarditis caused by Staphylococcus aureus was associated with the highest in-hospital (19.9%) and 6-month mortality (30.3%), and ICU admission rates (44.2%), with no relevant changes over time. The longest LOS was observed in hospitalizations with IE caused by Enterococcus species (mean 23.9 days) and Staphylococcus aureus (23.8 days). This nationwide cohort study showed an increase in IE hospitalizations from 2012 to 2021, primarily due to Staphylococcus aureus and Streptococcus species. Predominantly, Staphylococcus aureus was associated with adverse outcomes that remained consistently high over time compared to other or unidentified pathogens.

A Retrospective Review of Ambulatory Oral and Maxillofacial Surgery in a Suburban Tertiary Hospital in Nigeria

Background Ambulatory surgical procedures are integral aspects of oral and maxillofacial surgical (OMS) practice. Objective The aim of this study is to report the scope of ambulatory OMS procedures in a Nigerian suburban teaching hospital. Method A retrospective review of ambulatory OMS procedures performed at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, between March 2021 and February 2022 was conducted. Sociodemographic data, diagnoses, procedures, type of anesthesia, and immediate postoperative complications were retrieved from patients' records. Data were analyzed using the Statistical Package of Social Sciences (SPSS) version 22. Results Two hundred and fifty-two ambulatory OMS procedures were performed during the 12-month study period. This accounted for 80.3% (252/314) of elective surgeries. The patients' mean (standard deviation [SD]) age was 32.2 (10.4) years, while a slight male preponderance (51.6%) was recorded. Third molar surgery was the commonest (48.0%) procedure undertaken in ambulatory setting. Most (90.9%) of them were performed under local anesthesia. Satisfactory postoperative pain control was achieved with the use of oral nonsteroidal anti-inflammatory analgesics in most patients (81.7%). However, owing to a failed ambulatory session, there was an eventual admission rate of 0.4% (1/252). Conclusion Ambulatory surgical procedures constitute the majority of the OMS elective cases, with third molar surgery being the commonest procedure. Judicious prescription and administration of oral analgesics were effective in managing postoperative pain in our day case OMS patients. We recommend a prospective study to determine an intermediate/long-term outcome of care in ambulatory settings.

Obstetric Intensive Care Admissions and Neonatal Outcomes: 15 Years of Experience from a Single Center

Background and Objectives: Maternal severe morbidity and mortality are measures for assessing maternal healthcare, and admissions to the intensive care unit (ICU) can be used to study these metrics. Here, we analyze ICU admissions of pregnant or postpartum women in a tertiary hospital. Materials and Methods: This is a retrospective, single-center, observational cohort study of obstetric intensive care admissions at a Portuguese hospital spanning 15 years. We analyzed maternal, admission-related, and neonatal variables from women admitted during pregnancy and up to 42 days post-delivery. Results: We identified 150 obstetric ICU admissions (0.9% of all ICU admissions, with an admission rate of 4.4 per 1000 deliveries). The mean age was 34 years, with most women being multiparous and 16.7% utilizing assisted reproductive technology. Notably, 45% of the women were above 35 years old. Most (86.7%) were admitted during the early postpartum period after undergoing a cesarean section (74%). The most frequent reasons for ICU admission were postpartum hemorrhage and hypertensive disorders of pregnancy. The mortality rate was 1.3%. The mean gestational age of newborns was 36 weeks and 6 days, and 46.4% were admitted to the neonatal ICU. We recorded one fetal death at 25 weeks and no neonatal deaths. Conclusions: The unique needs of obstetric ICU patients emphasize the need for specialized training of multidisciplinary teams. Severe postpartum hemorrhage was responsible for significant morbidity and disability, prompting a reassessment of delivery practices.

Resting heart rate assessed within clinical practice demonstrates no prognostic relevance for defibrillator recipients in the German DEVICE registry

Resting heart rate (RHR) has prognostic implications in heart failure with reduced ejection fraction, where ≤ 70 bpm is targeted. Whether a RHR > 70 bpm assessed within clinical practice goes along with elevated cardiovascular risk in implantable cardioverter-defibrillator (ICD) / cardiac resynchronization therapy-defibrillator (CRT-D) recipients remains incompletely understood. A total of 1589 patients (ICD n = 1172 / CRT-D n = 417, median age 65 years, 22.6% female) undergoing ICD/CRT-D implantation or revision in the prospective German DEVICE multicenter registry were analyzed. RHR was assessed via a 12-channel electrocardiogram at enrollment. 1-year outcomes (all-cause mortality, major cardio- and cerebrovascular events (MACCE), all-cause hospital admission) were compared between patients with a RHR ≤ 70 bpm and > 70 bpm. 733 patients (46.1%) showed a RHR > 70 bpm. Median RHR was 63 (interquartile range 59; 68) bpm (≤ 70 bpm group) and 80 (75; 89) bpm (> 70 bpm group). Heart failure with reduced ejection fraction was present in 76.3%, a prior myocardial infarction in 32.4% and non-ischemic heart disease in 44.9%. One-year all-cause mortality was similar between RHR groups (≤ 70 bpm 5.4% vs. > 70 bpm 5.4%, p = 0.96), and subgroup analysis regarding patient characteristics and comorbidities revealed only a significantly higher rate of patients with dual chamber ICD in the > 70 bpm group (0.8% vs. 9.2%, p = 0.003). MACCE (5.9% vs. 6.1%, p = 0.87) and defibrillator shock rates (9.9% vs. 9.8%, p = 1.0) were similar. Higher all-cause hospital admission rates were observed in patients with > 70 bpm RHR (23.1% vs. 29.0%, p = 0.027) driven by non-cardiovascular events (6.0% vs. 11.7%, p = 0.001). In conclusion, in ICD and CRT-D recipients a RHR at admission > 70 bpm may indicate patients at increased risk of all-cause hospital admission but not of other adverse cardiovascular events or death at 1-year follow-up.

Obstetric and neonatal outcomes in the management of twin pregnancies with gestational diabetes using the IADPSG criteria for singleton pregnancies

BackgroundThis study evaluates the effectiveness of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, typically applied to singleton pregnancies, in managing gestational diabetes mellitus (GDM) in twin pregnancies. Focusing on a Chinese cohort, it contrasts the clinical outcomes and complications in twin pregnancies with and without GDM.MethodsWe conducted a retrospective cohort study at our hospital from January 2019 to December 2021, including all twin deliveries except those before 28 weeks of gestation, with prior diabetes, or unknown GDM status. GDM was diagnosed using a 75 g oral glucose tolerance test based on the IADPSG criteria, and management involved dietary or insulin interventions. We assessed outcomes such as hypertensive disorders (gestational hypertension, preeclampsia, and eclampsia), membrane rupture, preterm birth, small for gestational age (SGA), large for gestational age (LGA), and neonatal intensive care unit (NICU) admissions.ResultsAmong 1003 twin pregnancies, 21.7% had GDM, with 11.5% receiving insulin. GDM was associated with older maternal age, higher BMI, and a family history of diabetes. Pregnant women with GDM had lower weekly weight gain (0.44 kg/week vs. 0.58 kg/week, p < 0.001) and experienced a higher risk of SGA neonates (aOR = 1.68, 95% CI: 1.06–2.67) and increased NICU admissions (aOR = 1.30, 95% CI: 1.00-1.69) compared to those without GDM. Additionally, dichorionic twins with GDM showed higher risks of SGA and NICU admissions, while monochorionic twins had no significant differences. A U-shaped relationship was identified between weekly weight gain and the rates of SGA and NICU admissions, with the lowest risk observed at a weekly weight gain of 0.75 kg for SGA and 0.57 kg for NICU admissions.ConclusionsApplying singleton-derived IADPSG criteria to twin pregnancies may mitigate some maternal risks but elevates the risk for SGA neonates, suggesting a need for tailored diagnostic and management strategies for twin pregnancies.Trial registrationRetrospectively registered.

Trend Analysis of Admission, Enrolment, Completion, and Transition Rates in Primary Education in Ghana

The purpose of this study was to investigate trends in primary education admission, enrolment, completion rates, and transition rates to junior high school in the Bongo District from 2012 to 2021. A descriptive exploratory design was used. This study used secondary data from the Ghana Education Office of the Bongo District in the Upper East region of Ghana to analyse trends in access to and participation in primary education within the district during the period studied. Findings revealed that a significant number of children enrolled in primary education were not in the appropriate grade for their age; the majority were either below or above the age range of 6 to 11 years for primary education in Ghana. Additionally, the percentage of the out-of-school population within the appropriate age range for primary education (NER) increased by 1.1 percentage points, from 15.4% in 2012 to 16.5% in 2021. This study recommends community outreach programmes by the district education office to address sociocultural factors affecting pupils’ participation in primary education. Received: 28 August 2024 / Accepted: 11 November 2024 / Published: 20 November 2024

Trends in syncope testing and admissions in the USA from 2006 through 2019.

Syncope is common, with bimodal distribution through life, peaking in adolescence and in the elderly, and overall increases in incidence with age among both men and women. In this context, syncope-related visits to emergency departments (ED), hospitalizations, and testing are a significant healthcare cost burden. Ultimately, understanding the volume of testing types and settings of syncope encounters may aid in more effective healthcare utilization and high value care for this patient population. Data for this study were collected from the Truven Health Analytics MarketScan Database from 2006 to 2019. This database contains both commercially insured patients and those with Medicare coverage. Patients with the diagnosis of syncope were identified using International Classification of Diseases (ICD)-9 and -10 codes. We assessed the incidence of various tests for syncope evaluation and ED disposition for the study period. The incidence of syncope among the study cohort rose from nine per 1000 patients to 13 per 1000 patients during the study period. The incidence of testing for syncope among multiple domains (neurologic, cardiac, blood testing) decreased in some categories, but routine testing remained prevalent. Women had a significantly lower incidence of testing in most testing domains. Discharge rate from the ED for patients presenting with syncope remained stable during the study period. However, admission rate to the hospital for those aged > 65 years increased during the study time. Testing and admissions for syncope remain prevalent and are drivers of healthcare-associated costs. There is a clear need for further work in developing a focused approach in the evaluation of syncope patients in order to mitigate healthcare costs and improve outcomes.

Urban–rural disparities in hospital admissions for depression in Austria: A spatial panel data analysis

Medical practice variation in mental healthcare is a useful indicator for policymakers aiming to improve the efficiency of healthcare delivery. Previous studies have shown strong regional variation in healthcare utilisation in Austria, which seems to be a by-product of regionalised institutional rules and healthcare service mix rather than epidemiology. We use a set of routine municipality-level healthcare data on hospital admissions for depressive episodes of adult Austrian patients from 2009 to 2014 to examine spatial patterns in healthcare utilisation in mental health. Our data contains 93,302 hospital episodes by 65,908 adult patients across 2114 municipalities. We estimate a random-effects spatial autoregressive combined model to regress log hospital admission rates on hospital supply and urbanicity as proxies for municipality healthcare service mix alongside demographic and socioeconomic controls. We find that admissions for depression are substantially higher in suburban municipalities compared to rural areas and in municipalities with hospitals compared to those without. The spatial structure suggests positive spatial spillovers between neighbouring municipalities. Our main results are stable across virtually all model specifications used for robustness and show that healthcare service mix and supply of hospital services strongly correlate with spatial patterns of hospital admission rates in the population. Promoting timely access to high-quality primary care and early-stage treatments may reduce the burden of avoidable depression-related hospitalisations for patients and public budgets, and close a gap of unmet need for care of vulnerable populations.

Impact of COVID-19 pandemic on accesses for seizures in the pediatric emergency department

BackgroundSeveral studies reported a reduced rate of accesses to pediatric emergency department (ED) for seizures during COVID-19 pandemic. The aim of our study is to evaluate the attendance to pediatric ED for seizures, as well as the influence of seizure type and personal history of seizures on the rate of admissions during the pandemic period. MethodsThe number and clinical features of patients admitted to the pediatric ED because of seizures were collected at a single hospital in Milan, Italy, between January 2017 and December 2021. The impact of COVID-19 on the rate of admissions was quantified by using the incidence rate ratio (IRR), comparing the pandemic period (March 2020 to December 2021) to the pre-pandemic (January 2017 to February 2020). ResultsDuring the study period, 1091 patients with seizures were evaluated, 776 (71.1 %) before the pandemic and 315 (28.9 %) during the pandemic. Mean age at evaluation was 3.9 years (range: 1 month to 17 years). During the pandemic, we found a 30 % decrease in evaluation rates per month (IRR, 0.70; 95 % CI, 0.58–0.84), as well as an increased rate of unprovoked seizures (44.8 %, vs 26.5 %, p < 0.001) and focal seizures (29.5 % vs 13.1 %, p < 0.001). ConclusionsOur study showed a reduction in the number of emergency evaluations for seizures during the COVID-19 pandemic. The rate of evaluations was influenced by seizure type and previous history of seizures.

Forecasting heart failure: Seasonal alignment of heart failure outcomes in New York.

Seasonal variations have been observed in heart failure (HF) hospitalization. Numerous explanatory mechanisms have been proposed, but no prior studies have examined potential contributors directly. Our objective was to identify specific factors that could contribute to seasonal variability using a large longitudinal dataset of HF hospitalizations. Hospital discharge data were obtained for all hospitals in the state of New York from 1994 to 2007. Records with a primary diagnosis of HF by the International Classification of Diseases-9 Clinical Modification (ICD-9-CM) code (428.xx and 425.xx) were included. Year and month of admission were used as predictors to evaluate outcomes of in-hospital mortality, population-adjusted daily rate of hospital admissions and length of stay (LOS) using univariable regression including a sinusoidal model to assess the seasonality of HF outcomes. Observations were then adjusted for multiple medical covariables as well as the average local monthly temperature and humidity at each hospital using data from the Global Historical Climate Network to identify potential modifiers of seasonal variability. Among 949907 records, the median age was 76 [inter-quartile range (IQR) 65-84years old], and the cohort was 54% female (510945 records). The population-adjusted rate of HF admissions per day increased by 1.1 admissions/day/year between 1994 and 2007, whereas in-hospital mortality and LOS decreased by -0.3%/year and -0.3days/year, respectively (P<0.001 for all). Seasonal trends were identified for daily HF admissions (February peak, P<0.0001), mortality (January peak, P<0.001) and LOS (January peak, P<0.01). Cosinor analysis revealed significant periodicity for HF admission rate (amplitude=±0.9 admissions/day/100000 people, P<0.001), in-hospital mortality (amplitude=±0.47%, P<0.001) and LOS (amplitude=±0.23days, P<0.01). No other patient characteristics were significant modifiers of seasonality. Odds of mortality were highest in July rather than January when adjusted for average local temperature but not humidity. Adverse outcomes in patients hospitalized with HF were significantly worse in the winter months even when adjusted for patient characteristics and concurrent acute diagnoses such as pneumonia. Local ambient temperature was the strongest modifier of the observed seasonality. Given the increasing frequency of extreme weather events, additional work to determine the mechanisms of this and other environmental risk factors is urgently needed.