Risk Factors For Admission Research Articles

Understanding the Impact of COVID-19 on Roma Vulnerable Communities in Western Romania: Insights and Predictive Factors from a Retrospective Study.

The COVID-19 pandemic disproportionately affected vulnerable populations like Roma patients in Western Romania due to marginalization and limited healthcare access. A retrospective study analyzed COVID-19 cases between March 2020 and August 2022 using data from the Directorate of Public Health in Timis county. Demographic, epidemiological, clinical, and laboratory data were assessed, along with risk factors and biomarkers for ICU admission and mortality prediction. The following biomarkers were assessed: C-reactive protein (CRP), ferritin (FER), IL-6, D-dimers, lactate dehydrogenase (LDH), high density lipoprotein cholesterol (HDL), and 25-OH vitamin D (25-OHD). In comparison with the general population (GP), Roma patients were more overweight (p = 0.0292), came from rural areas (p = 0.0001), could not recall transmission source (p = 0.0215), were admitted to the intensive care unit (ICU, p = 0.0399) more frequently, had worse symptomatology (p = 0.0490), showed more elevated levels of CRP (p = 0.0245) and IL-6 (p < 0.0001) and lower levels of HDL (p = 0.0008) and 25-OHD (p = 0.0299). A stronger, significant correlation was observed between CRP and severity (rho = 0.791 vs. 0.433 in GP), and an inverse stronger significant one was observed between HDL and severity (rho = -0.850 vs. -0.734 in GP) in the Roma patients. The male sex continues to be an important risk factor for ICU admission (OR = 2.379) and death (OR = 1.975), while heavy smoking was more important in relation to ICU admission (OR = 1.768). Although the Roma ethnicity was 1.454 times more at risk of ICU admission than the GP, this did not prove statistically significant (p = 0.0751). CRP was the most important predictive factor in regards to admission to the ICU for both Roma (OR = 1.381) and the GP (OR = 1.110) and in regards to death (OR = 1.154 for Roma, OR = 1.104 for GP). A protective effect of normal values of HDL and 25-OHD was observed in the GP for both ICU admission (OR = 0.947, 0.853, respectively) and death (OR = 0.920, 0.921, respectively), while for the Roma group, normal 25-OHD values were only considered protective in regards to death (OR = 0.703). Cutoff values for ICU admission were 28.98 mg/L for Roma and 29.03 mg/L for GP patients, with high specificity for both groups (over 95). Higher rates of ICU admissions, severe symptomatology, and distinct laboratory biomarker profiles among Roma patients emphasize the critical importance of personalized care strategies and targeted interventions to mitigate the disproportionate burden of COVID-19 on vulnerable communities. CRP values at admission have had a clear impact as a risk assessment biomarker for Roma patients, while the significance of IL-6, HDL, and 25-OHD should also not be overlooked in these patients.

Risk Factors for Unexpected Admission Following Lumbar Spine Laminectomy: A National Database Study.

Introduction Laminectomy is one of the most common orthopedic spine surgeries performed in the United States. Compared to other spine operations such as fusions, laminectomies in isolation are of lower morbidity. However, complications may arise that result in readmission to an inpatient healthcare facility.The purpose of this study is to identify the demographics and risk factors associated with unplanned 30-day readmission following a laminectomy. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for patients who underwent a laminectomy procedure from 2015 to 2019 using CPT code 63030. This query yielded 61,708 cases. Demographic, lifestyle, comorbidity, and peri-operative factors were recorded. Independent samples Student's t-tests, chi-squared, and, where appropriate, Fisher's exact tests were used in univariate analyses to identify demographic, lifestyle, and peri-operative variables related to 30-day readmission following a laminectomy procedure. Multivariate logistic regression modeling was subsequently performed. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and reported. Results Of the 61,708 patients included in our sample, 2,359 were readmitted within 30 days of surgery, corresponding to a readmission rate of 3.82%. Results of the univariate analysis revealed statistically significant relationships between readmission status and the following patient variables: patient age, sex, BMI, ASA classification, race, bleeding disorder, chronic obstructive pulmonary disease (COPD), diabetes, hypertension, congestive heart failure (CHF), chronic steroid use, total operative time, and tobacco use (p < 0.05). Multivariate logistic regression modeling confirmed that the following patient variables were associated with statistically significantly increased odds of readmission: age greater than 65 (p < 0.05), female sex (p = 0.013), bleeding disorder (p = 0.011), diabetes (p = 0.006), current smoker (p = 0.010), COPD (p < 0.001), steroid use (p = 0.006), ASA Class II or above (p < 0.05), and total operative time (p < 0.001). Conclusion Unplanned 30-day readmission after laminectomy is infrequent. However, increasing age, female sex, steroid use, current smokers, bleeding disorders, diabetes, COPD, CHF, a higher ASA classification, and longer operative times are independent risk factors for readmission following laminectomy.

Risk Factors and Clinical Prognosis Associated With RSV-ALRI Intensive Care Unit Admission in Children

Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infections (ALRIs) in children <2 years of age. Currently, there are limited data on risk factors for very severe RSV-ALRI requiring intensive care unit (ICU) admission. We conducted a case-control study of children <2 years old admitted with RSV-ALRI to the Sydney Children's Hospital Network, comprising 2 large tertiary pediatric hospitals. Cases were children with laboratory-confirmed RSV-ALRI admitted to ICU, and controls were (1:2, matched on date of admission) children hospitalized with RSV-ALRI but not requiring ICU transfer. Data on risk factors were retrieved from the electronic medical record system. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) associated with risk factors for ICU admission and the association with clinical and treatment factors were determined from logistic regression models. A total of 44 (44%) of 100 cases and 90 (48.1%) of 187 controls were male. Age <6 months and preterm births were associated with a 2.10-fold (95% CI: 1.14-3.79) and 2.35-fold (95% CI: 1.26-4.41) increased risk in ICU admissions, respectively. The presence of any chronic health condition was a significant risk factor for ICU admission. The clinical presentations on admission more commonly seen in cases were apnea (aOR: 5.01, 95% CI: 1.50-17.13) and respiratory distress (aOR: 15.91, 95% CI: 4.52-55.97). Cases were more likely to be hospitalized for longer duration and require respiratory support. Our results can be translated into a clinical risk algorithm to identify children at risk of very severe RSV disease.

Serum zinc concentration in patients with myocardial infarction: a retrospective study

BackgroundZinc regulates the oxidative stress and inflammatory signaling cascade and affects the development and deterioration of cardiovascular disease. We investigated the prognosis of developing heart failure in patients with myocardial infarction.MethodsPatients with myocardial infarction (n = 243) were divided using the median value of zinc concentration on admission into low (< 66 µg/dL at admission, n = 111) and high zinc group (≥ 66 µg/dL at admission, n = 132). During follow-up (mean ± SD: 734 ± 597 days; median 691 days), admission due to heart failure was observed in 12 patients: 10 and 2 cases in the low and high zinc groups, respectively.ResultsThe risk of admission due to heart failure was significantly higher in the low zinc than in the high zinc group (P = 0.0043). Relative to the high zinc group, the hazard ratio for admission due to heart failure was 15.7 (95% confidence interval 1.11–221, P = 0.042) via adjusted Cox proportional hazards analysis. Even after propensity score matching, the risk of admission due to heart failure was significantly higher in the low zinc than in the high zinc group (P = 0.048).ConclusionLow serum zinc concentration may be a risk factor for admission due to heart failure after myocardial infarction.

Respiratory Syncytial Virus-Associated Hospitalizations Among Children

Respiratory syncytial virus (RSV) is the leading cause of hospitalization in US infants. Accurate estimates of severe RSV disease inform policy decisions for RSV prevention. We conducted prospective surveillance for children <5 years old with acute respiratory illness from 2016 to 2020 at 7 pediatric hospitals. We interviewed parents, reviewed medical records, and tested midturbinate nasal ± throat swabs by reverse transcription polymerase chain reaction for RSV and other respiratory viruses. We describe characteristics of children hospitalized with RSV, risk factors for ICU admission, and estimate RSV-associated hospitalization rates. Among 13 524 acute respiratory illness inpatients <5 years old, 4243 (31.4%) were RSV-positive; 2751 (64.8%) of RSV-positive children had no underlying condition or history of prematurity. The average annual RSV-associated hospitalization rate was 4.0 (95% confidence interval [CI]: 3.8-4.1) per 1000 children <5 years, was highest among children 0 to 2 months old (23.8 [95% CI: 22.5-25.2] per 1000) and decreased with increasing age. Higher RSV-associated hospitalization rates were found in premature versus term children (rate ratio = 1.95 [95% CI: 1.76-2.11]). Risk factors for ICU admission among RSV-positive inpatients included: age 0 to 2 and 3 to 5 months (adjusted odds ratio [aOR] = 1.97 [95% CI: 1.54-2.52] and aOR = 1.56 [95% CI: 1.18-2.06], respectively, compared with 24-59 months), prematurity (aOR = 1.32 [95% CI: 1.08-1.60]) and comorbid conditions (aOR = 1.35 [95% CI: 1.10-1.66]). Younger infants and premature children experienced the highest rates of RSV-associated hospitalization and had increased risk of ICU admission. RSV prevention products are needed to reduce RSV-associated morbidity in young infants.

Abstract TP254: The Incidence Rate and Risk Factors of In-Hospital Onset Stroke Among 83,990 Hospitalized Patients

Introduction: Clinical characteristics of patients with in-hospital onset stroke (IHOS) compared to those with out-of-hospital onset stroke are reported to be late detection of stroke onset, less use of rt-PA, presence of atrial fibrillation, and poor outcome. Among hospitalized patients, however, clinical characteristics of patients with IHOS has not been clear. The purpose of this study is to clarify the incidence rate of IHOS among hospitalized patients and to investigate the risk factors associated with IHOS. Methods: Patients consecutively admitted to the Nippon Medical School hospital between April 2018 and March 2023 were assessed. Patients under 18 years and discharged within 24 hours were excluded. Furthermore, patients admitted in Neurology and Neurosurgery also were excluded to remove in-hospital onset recurrent stroke from our study. First, we calculated the incidence rate of IHOS among hospitalized patients. Next, all patients were divided into two groups, Stroke group had IHOS and Control group did not, and investigated the risk factors associated with IHOS using multivariate analysis. Results: Of 98,225 patients hospitalized, 83,990 patients (median age was 69 [54-77] years and 55.3% were male) were enrolled into this study. The number of IHOS patients were 101. Thus, the incidence rate of IHOS was 0.12%. A half of them (n=49) had stroke onset within 1 week after admission. Stroke group had higher mortality (14.9% vs. 2.7%, p &lt; 0.01) and longer length of stay (36 days vs. 8 days, p &lt; 0.01) than Control group. Multivariate analysis demonstrated that risk factors associated with IHOS were old age (OR 1.03, p &lt; 0.01), hypertension (OR 1.57, p = 0.04), diabetes mellitus (OR 1.61, p = 0.03), atrial fibrillation (OR 2.43, p &lt; 0.01), emergency admission (OR 3.38, p &lt; 0.01) and low serum albumin level (OR 0.66, p = 0.03). Conclusions: Among 83,990 hospitalized patients, the incidence rate of IHOS was 0.12%. Risk factors associated with IHOS were old age, hypertension, diabetes mellitus, atrial fibrillation, emergency admission and low serum albumin level. Therefore, among hospitalized patients, cases with emergency admission and cerebrovascular risk factors including atrial fibrillation should be payed attention to prevent in-hospital onset stroke.

1896 Community geriatrician led memory service improving access to dementia diagnosis with focus on admission avoidance

Abstract Introduction The Community Geriatrician team based at the Countess of Chester Hospital is a multidisciplinary team offering comprehensive assessments at home to older patients with frailty. The team review frail patients identified as being at risk of hospital admission. Cognitive impairment and dementia are increasingly common concerns in our patient group and significant risk factors for admission. Frail patients often struggle to access traditional memory clinics for a variety of reasons and can therefore remain undiagnosed. They often require a more holistic approach in their home environment. We therefore identified a need to offer a dedicated frailty memory pathway within our community geriatrician team enabling better access to dementia assessment and diagnosis in complex frail patients. Method A frailty memory assessment pathway was proposed and commenced in 2022. Following identification of a cognitive concern during the initial comprehensive geriatric assessment a further home visit is arranged to assess memory in more depth. Patients are then discussed, and a diagnosis reached via a monthly Frailty memory MDT attended by a consultant psychiatrist, consultant geriatrician, and specialist occupational therapist. Following delivery of a diagnosis our AGE UK well-being coordinator within the team provides post diagnostic support and sign posting to patient and family. A retrospective audit was undertaken reviewing the 44 patients diagnosed since pathway commenced. The number of hospital admissions and number of inpatient bed days was compared in the 3 months pre and post initial assessment. Results In the 3 months following assessment, 82% of patients had a reduction or unchanged number of admissions, there was a total reduction of 71 inpatient bed days. Conclusion We believe our pathway offers a unique multidisciplinary approach to dementia diagnosis in the frail population, improving frail patients access to dementia assessment with a reduction in hospital admissions.

Impacts of the 2021 heat dome on emergency department visits, hospitalizations, and health system operations in three hospitals in Seattle, Washington.

Extreme heat events (EHEs) are associated with excess healthcare utilization but specific impacts on emergency department (ED) operations and throughput are unknown. In 2021, the Pacific Northwest experienced an unprecedented heat dome that resulted in substantial regional morbidity and mortality. The aim of this study was to examine its impact on ED utilization, unplanned hospitalization, and hospital operations in a large academic healthcare system. Retrospective electronic medical records from three Seattle-area hospitals were used to compare healthcare utilization during the EHE compared to a pre-event reference period within the same month. Interrupted time series analysis was used to evaluate the association between EHE exposure and ED visits and hospitalizations. Metrics of ED crowding for the EHE were compared to the reference period using Student's t-tests and chi-squared tests. Additionally, multivariable Poisson regression was used to identify risk factors for heat-related illness and hospital admission. Interrupted time series analysis showed an increase of 21.7 ED visits per day (95% confidence interval [CI]=14.7, 28.6) and 9.9 unplanned hospitalizations per day (95% CI=8.3, 11.5) during the EHE, as compared to the reference period. ED crowding and process measures also displayed significant increases, becoming the most pronounced by day 3 of the EHE; the EHE was associated with delays in ED length of stay of 1.0h (95% CI=0.4, 1.6) compared to the reference period. Higher incidence rate ratios for heat-related illness were observed for patients who were older (incidence rate ratio [IRR]=1.02; 95% CI=1.01,1.03), female (IRR=1.47; 95% CI=1.06, 2.04), or who had pre-existing diabetes (IRR=3.19; 95% CI=1.47, 6.94). The 2021 heat dome was associated with a significant increase in healthcare utilization including ED visits and unplanned hospitalizations. Substantial impacts on ED and hospital throughput were also noted. These findings contribute to the understanding of the role extreme heat events play on impacting patient outcomes and healthcare system function.

The burden of cervical cancer survivorship: Understanding morbidity and survivorship needs through hospital admissions

ObjectiveTo describe disease- and treatment-related survivorship burden amongst survivors of cervical cancer and identify risk factors for hospital admissions after initial treatment. MethodsRetrospective chart review including patients treated for cervical cancer from 2014 to 2020 at a single urban academic institution. Clinical, demographic, and hospital admission characteristics were summarized. Associations between patient characteristics and likelihood of admission were examined using univariate and multivariate regression. ResultsOf 366 patients undergoing surveillance following completion of primary treatment, 156 (43 %) were hospitalized for cancer or treatment-related sequela in the median follow-up of 3.6 years (IQR 1.4–6.4), with a median of 2 admissions (IQR 1–4.5) per patient and 570 unique admissions. While 65 (35 %) of admitted patients had multiple reasons for admission, the most common reasons for admission were: gastrointestinal complications (43 %), infection (38 %), genitourinary complications (33 %), and pain control (23 %). A substantial proportion of admitted patients underwent interventions including surgical procedures (57 %), transfusion of blood products (40 %), and interventional radiology procedures (28 %) and utilized supportive care services including case management (53 %), physical therapy (40 %), and occupational therapy (36 %). On multivariate analysis, odds of admission were higher among Black patients (aOR 2.4, p <.01), uninsured patients (aOR 2.7, p <.05), those with lower performance status (aOR 1.4, p <.05), and those with recurrence (aOR 5.5, p <.001). ConclusionSurvivors of cervical cancer represent a high-risk population frequently hospitalized after initial treatment. Black patients, uninsured patients, those with recurrence, and those with lower performance status faced higher odds of admission. Comprehensive, team-based care is necessary to address complex survivorship needs.

Utilizing machine learning for survival analysis to identify risk factors for COVID-19 intensive care unit admission: A retrospective cohort study from the United Arab Emirates.

The current situation of the unprecedented COVID-19 pandemic leverages Artificial Intelligence (AI) as an innovative tool for addressing the evolving clinical challenges. An example is utilizing Machine Learning (ML) models-a subfield of AI that take advantage of observational data/Electronic Health Records (EHRs) to support clinical decision-making for COVID-19 cases. This study aimed to evaluate the clinical characteristics and risk factors for COVID-19 patients in the United Arab Emirates utilizing EHRs and ML for survival analysis models. We tested various ML models for survival analysis in this work we trained those models using a different subset of features extracted by several feature selection methods. Finally, the best model was evaluated and interpreted using goodness-of-fit based on calibration curves,Partial Dependence Plots and concordance index. The risk of severe disease increases with elevated levels of C-reactive protein, ferritin, lactate dehydrogenase, Modified Early Warning Score, respiratory rate and troponin. The risk also increases with hypokalemia, oxygen desaturation and lower estimated glomerular filtration rate and hypocalcemia and lymphopenia. Analyzing clinical data using AI models can provide vital information for clinician to measure the risk of morbidity and mortality of COVID-19 patients. Further validation is crucial to implement the model in real clinical settings.

Predicting early hospital admissions for emergency department patients at the time of triage

Objective: This study aimed to determine factors predicting hospital admissions at King Abdulaziz Medical City in Emergency Department (ED), Riyadh, Saudi Arabia. Methods: A retrospective study was conducted at the Emergency Department of King Abdulaziz Medical City among adult patients aged &amp;ge;14 years triaged in ED and arriving by either paramedic transport or self-referral and presented to ED from 01/01/2021 to 01/01/2022. The data were collected from the patient&amp;apos;s medical records and a pre-designed checklist was prepared to collect data. Results: The majority of patients (88.7%) arrived at the ED walk-ins, as for the patient acuity, a substantial segment of the population (86.9%) fell into category 3. Exactly half of the patients reported no known comorbidities. The prior visit to the emergency department within the past 72 hours was documented in 12.3% of the cases. As for the patients&amp;apos; outcomes post-triage, a large proportion (78.4%) were discharged after their ED visit. The majority of emergency visits were associated with no complications (92.5%), while morbidity was reported among 4.2% and mortality among 3.4% of the visits. The rate of hospital admission was significantly higher among patients aged 25-34 years and 55-64 years, who arrived walk-in, who had patient acuity category &amp;quot;3&amp;quot; and had no previous ED Visit &amp;lt; 72 hours (p=˂0.05). Conclusion: It was found that being bedridden, having dementia, having no prior ED visits within 72 hours, and having end-stage renal disease on dialysis were risk factors for hospital admission.

Risk factors for unplanned intensive care unit admission after esophagectomy: a retrospective cohort study of 628 patients with esophageal cancer.

Esophagectomy patients who experience unplanned ICU admission (UIA) may experience a heavier economic burden and worse clinical outcomes than those who experience routine intensive care unit (ICU) admission. The aim of this study was to identify the risk factors for postoperative UIA in patients who underwent esophagectomy. We retrospectively included patients with esophageal cancer who underwent esophagectomy. The characteristics of postoperative UIA were described, and univariable and multivariable analyses were performed based on the logistic regression model. Furthermore, a recursive partitioning analysis was adopted to stratify the patients according to the risk of UIA. A total of 628 patients were included in our final analysis, among whom 57 (9.1%) had an UIA. The patients in the UIA cohort had a higher rate of in-hospital mortality (P<0.001), longer hospital stay (P<0.001), and higher associated costs (P<0.001). Multivariable analysis showed that hybrid/open esophagectomy (OR=4.366, 95% CI=2.142 to 8.897, P<0.001), operation time (OR=1.006, 95% CI=1.002 to 1.011, P=0.007), intraoperative blood transfusion (OR=3.118, 95% CI=1.249 to 7.784, P=0.015) and the prognostic nutrition index (PNI) (OR=0.779, 95% CI=0.724 to 0.838, P<0.001) were independently associated with UIA. We identified several critical independent perioperative risk factors that may increase the risk of UIA following esophagectomy, and the above risk factors should be the focus of attention to reduce the incidence of postoperative UIA.

Risk factors for unplanned intensive care unit admission after liver resection in the helix trial

Risk factors for unplanned intensive care unit admission after liver resection in the helix trial

Pulmonary embolism and risk factors of ICU admission: systematic review

To forecast mortality and identify adult patients who required admission to an intensive care unit (ICU), we compared the efficacy of the most widely used early warning scores. The present review assessed the pulmonary embolism and risk factors of ICU admission; systematic review. A search of the literature was conducted in the bibliographic databases PubMed and EMBASE between 2009 and 2022. Each reviewer verified independently that each possibly relevant title and abstract qualified. There were nine studies that were included in the review. National early warning score (NEWS) was the best indicator of ICU admission; however, the modified early warning score (MEWS) performed better in sepsis patients. According to emergency department (ED) Mortality, the NEWS was the most accurate score for predicting mortality in the entire ED population, and the mortality in emergency department sepsis score was the most accurate measure for patients with sepsis. For all endpoints, NEWS and MEWS had good outcomes in the ICU and ED. Numerous investigations should be conducted utilizing various prognostic scores on ED and ICU patients. Anemia in patients with venous thrombosis was associated with a higher risk of ICU admission and mortality.

Risk factors during admission on mortality of newborns in neonatal care units

Background Neonatal mortality is defined as the death of live born within the first 28 days of life. It represents a great burden on the health and community. Many risk factors are associated with neonatal mortality. Aim Evaluate perinatal admission risk factors and their relation to neonatal mortality in newborns admitted to neonatal care units participating in the Egyptian Neonatal Network (EGNN). Patients and methods This retrospective study included 4621 newborns admitted to Neonatal Care Units participating in the Egyptian Neonatal Network over 3 years (2014–2016). The record of the cases was revised to determine the maternal characteristics, the incidence of neonatal mortality, and the associated risk factors associated with mortality. Results Among the studied factors, increased gravidity, parity, and number of live children and lower gestational age, birth and, admission weight, length, and HC, are associated with increased neonatal mortality in neonatal intensive care unit (NICUs) (P value&lt;0.001). Conclusion Determination of risk factors in neonatal death can help to identify sick neonates who are more likely to die in NICUs and provide on-time care. Help doctors to tell parents what possibly happened to their babies. And used as a tool to compare the outcome of different NICUs and evaluate their performance.

Factors Associated with Mortality and Admission in Intensive Care for Kidney and Kidney-Pancreas Transplant Recipients with Respiratory Infection

Background and Objective: Kidney transplantation is a therapy of choice for chronic kidney disease at an advanced stage, however, such intervention has postoperative complications and adverse effects related to immunosuppressive therapy, namely infectious conditions. This study aims to investigate risk factors for mortality and admission to intensive care in kidney transplant recipients with respiratory tract infections.

Improving outcomes in frail older adults with complex care needs in an ambulatory setting through timely, integrated person-centered care. A case for rapid access frailty clinics in Singapore.

Background: Frailty is a significant risk factor for recurrent hospital admissions and emergency department presentations. Frail older adults are especially vulnerable to hospital related adverse outcomes recognisably functional decline, delirium, institutionalisation and mortality. Fragmentation of care resulting in poorly defined care responsibilities, together with the limitation of community resources to manage acute issues in this group of patients, increase the likelihood of them presenting to an acute care setting.&#x0D; Methods: A retrospective study evaluated frail older adults seen in an ambulatory Geriatric clinic in a government funded public hospital from 2021 to 2022. The aim of the study was to determine if timely evaluation of acute issues in an ambulatory setting could avoid a hospital admission or an emergency department presentation. &#x0D; Results: Preliminary data in this study showed that (1) timely review of acute issues (&lt;1 week from presentation) led to avoidance of hospital admission, emergency department presentation as well as admission in the next 30 days; (2) the common presentations successfully managed include worsening behavioral and psychological symptoms of dementia (BPSD), delirium, infections and falls; (3) majority of the patients seen were moderately to severely frail based on their clinical frailty score (CFS). Additionally, there was high level of patient and caregiver satisfaction reported.&#x0D; Conclusion: This study shows that hospital admissions and emergency department presentations can potentially be avoided in frail older adults whose acute medical issues are recognised and managed early. Important contributing factors to the effective management of these patients include: easy accessibility to the primary geriatrician involved, same day investigations, timely follow ups, good social/family support as well as the engagement of community services. Rapid access frailty clinics, a service model built upon the similar recognition that acute issues in frail older adults needed to be addressed promptly, has been described and shown to have benefit elsewhere. In Singapore, innovations in care delivery both within the hospital and in the community has become ever more crucial with an increasingly frail population and in already overwhelmed healthcare institutions. Rapid access frailty clinics can be a useful hospital-based service delivery model to improve care of our frail older adults.

Effectiveness of a Community-Based Intensive Case Management Model on Reducing Hospitalization for People With Severe Mental Illness in Seoul.

To overcome the limited effectiveness of standard case management services, the Seoul Intensive Case Management program (S-ICM) for patients with serious mental illnesses was introduced in 2017. This study aimed to evaluate its effectiveness in reducing the length of hospital stay. Monitoring data from April 2019 to March 2020 were retrieved from the Seoul Mental Health Welfare Center. A total of 759 participants with serious mental illnesses were included. The average length of admission per month was compared between the pre-ICM (previous year) and during-ICM periods. For post-ICM observation subgroup, average length of admission per month was compared between pre-ICM, during-ICM, and post-ICM periods. To determine the relative contributions of risk factors for during-ICM and post-ICM admission, multivariate logistic regression analyses were performed. The average admission stay for pre-ICM period was significantly longer than that for during-ICM period (1.47 vs. 0.26 days). Among the predictors for during-ICM admission, pre-ICM psychiatric admission was the most important risk factor, followed by medical aid beneficiary and suicidal behavior. In the subgroup analysis of the post-ICM observation period, the pre-ICM, during-ICM, and post-ICM average admission stays were 1.45, 0.29, and 0.57 days/month, respectively. There was a significant difference in the average length of stay between the pre-ICM and during-ICM periods and between the pre-ICM and post-ICM periods. Post-ICM admission risks included pre-ICM admission, S-ICM duration <3 months, and chronic unstable symptoms. The results suggest that the S-ICM effectively reduces psychiatric hospitalization duration, at least over a short-term period.

Prognostic Value of the Area of Lung Involved in Severe and Non-Severe Bronchiolitis: An Observational, Ultrasound-Based Study.

Point of care lung ultrasound (LUS) has a definite role in viral bronchiolitis when combined with clinical data. Previous data showed a bigger involvement of the superior lung zones in more severe cases. The aim of the present study is to describe whether different lung areas are implicated to different degrees in patients admitted to a Pediatric Intensive Care Unit (PICU) and needing ventilation compared to those with less severe forms. observational, prospective study. LUS scores of single lung areas and clinical data were collected for all children aged 0-12 months presenting with bronchiolitis to the participating centers and used as covariates for logistic regression having "PICU admission" as outcome. A subsequent analysis was carried out to investigate factors concurring with different lung zones' involvement. 173 patients were enrolled. Difficulty in feeding, presence of wheezing, SpO2 were all risk factors for PICU admission. Superior lung areas' LUS scores presented higher Odds Ratios for PICU admission and need for ventilation than inferior ones. Age and prematurity concurred in determining their higher LUS scores. Superior lobes' greater involvement could be favored by the geometrical distribution of relative bronchi, exiting with an acute angle from mainstem bronchi in small children where airway caliber is small and only small volumes of secretions can be occlusive.

Methicillin resistant Staphylococcus aureus infections in children: A prospective study

Community acquired MRSA (CA MRSA) can cause invasive diseases posing a challenge to treating physicians. The knowledge about the disease load, clinical pattern, risk factors, outcome and susceptibility pattern in a given geo demographic context contribute crucially to the treatment outcome of MRSA infections in children. To study the profile, clinical pattern, factors affecting the immediate outcome and antimicrobial susceptibility of MRSA infections in children A prospective observational study was conducted in children between 2 months and 12 years admitted with MRSA infections, from January 2016 to December 2017 in the Institute of Maternal and Child Health, Government Medical College Kozhikode, Kerala state, India. Out of 431 children evaluated 83(19.3%) had MRSA infections with 44(53%) CA MRSA and 39(47%) hospital associated MRSA (HA MRSA). Twenty one (53.8%) of HA MRSA infections were hospital onset MRSA (HAHO MRSA) and 18(46.2%) community onset MRSA (HACO MRSA). There were 37 infants, 16 toddlers, 12 preschool children, 18 school children, 48 males and 35 females in the study population. Blood (50.6%), pus (33.7%), and body fluids (15.7%) were the sites of isolation. Skin and soft tissue infections (SSTI)(30.10%), pneumonia (28.90%), empyema (9.64%), meningitis (7.23%), septicaemia (12.05%), bone and joint infections (9.64%), peritonitis (2.41%) and septic shock (18.1%) were the clinical presentation. Mortality occurred in 9.9% and paediatric intensive care requirement in 45.8% patients. Anaemia and thrombocytopenia were identified as the risk factors for PICU admissions (corrected OR; 95% C I, 3.38; 1.02–11.18 and 8.35; 1.35–45.03 respectively). Thrombocytopenia was associated with mortality (corrected OR 43.74, 95% C I 3.86–495.9). Susceptibility to clindamycin, co-trimoxazole, amikacin and rifampicin were 79.5%, 73.5%, 68.7% and 90.4% respectively. MRSA constituted a significant proportion of bacterial infections in children, the majority being community onset. Pneumonia and empyema predominate over SSTI. Thrombocytopenia was associated with mortality and PICU admission. Clindamycin, co-trimoxazole and amikacin can be utilised in the treatment of less severe MRSA infections