Significant Number Of Hospital Admissions Research Articles

Low phospholipid-associated cholelithiasis syndrome (LPAC), a not uncommon cause of biliary problems and hospital admissions.

Biliary diseases are a major source of morbidity and mortality for patients and a burden for the healthcare system. The genetic syndrome LPAC (low phospholipid-associated cholelithiasis) is a little known and rare entity whose treatment with bile salts avoids symptoms, admissions and the need for surgery. Our aim is to determine its incidence and characteristics in our center. Prospective study between February 2021 and September 2022. LPAC was diagnosed if (at least two): onset of biliary problems <40 years of age, recurrence of symptoms after cholecystectomy, ultrasound image of hepatolithiasis (multiple echoic foci, comet-tail images, hepatolithiasis with acoustic shadow). Demographic, clinical, genetic (analysis of MDR3 gene mutations) and ultrasound characteristics were analyzed, as well as their incidence in hospital admissions for biliary causes. 36 patients with LPAC were identified. Of these, 6 were among 237 admissions for biliary causes in the previous 9 months, with an incidence of 2.5% (95%CI 1.17-5.41). By age subgroup, the incidence was 16.7% in those admitted <40 years and 9.1% in those <50 years. Considering women only, the incidence was 21% in those admitted <40 years and 15.8% in those <50 years. All patients remained asymptomatic after treatment with ursodeoxycholic acid and there were no new admissions. LPAC syndrome is not as uncommon as it may appear, especially in women <50 years of age admitted with biliary problems. Its correct diagnosis based on simple criteria would avoid a significant number of hospital admissions and unnecessary cholecystectomies.

Mode, Pattern and Precipitating factors of Acute Poisoning in a Southern District Hospital in Bangladesh

Acute poisoning is common in Bangladesh and causes a significant number of hospital admissions. That causes anumber of mortality, morbidity as well as increases the economic burden in health care system. But it can beprevented. For that it is necessary to observe and study the poisoning related factors and events around the country.So, the aim of our study is to find out and describe the mode, pattern and precipitating factors of poisoning in asouthern district hospital. This cross-sectional observational study was done in the department of Medicine ofPirojpur District Hospital, from January to December 2020. The study was conducted among 100 patients of bothgenders those were hospitalized with the history of poisoning. In the study young people (40% in 14-25 years and37% in 26-35 years) were predominantly affected and 61% were female. Suicidal attempt was the commonest(74;74%) mode of poisoning that mostly caused by pesticides. Stupefying mode was observed in case of 15(15%)male travelers as street poisoning. Highest number of poisoning (45;45%) was caused by pesticides. The sedative(14;14%), copper sulphate (11;11%) and harpic (5;5%) poisoning was observed mostly as a suicidal mode. Historyof savlon (4;4%) and Kerosene (2;2%) poisoning was found as an accidental mode. As a recreational mode two malewere admitted with alcohol poisoning. Considering the precipitating factor, maximum cases (54;54%) had the historyof unsatisfactory family events. Street poisoning (15;15%) was precipitated by the careless behavior of travelers.Accidental poisoning (9,9%) was invited by unmindful and hurried attitude. Problem related to love and affair wasobserved in 8(8%) cases. Study and examination result precipitated poisoning in 7(7%) cases. History of job andincome dissatisfaction was found in 4(4%) cases. So those factors related with the poisoning should be considered.That will help to make a comprehensive strategy in order to resist these preventable events. Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(1):85-89

Mental health services in Ukraine during the early phases of the 2022 Russian invasion.

In February 2022, Russia began its invasion of Ukraine. War increases the demand for mental healthcare among affected populations, but with devastating losses across the nation, it is unclear if Ukrainian mental health services are able to meet the needs of the people. We aimed to evaluate the state of Ukrainian in-patient mental health services, which remains the backbone of the nation's psychiatric services, early in the 2022 Russian invasion. We conducted a nationwide cross-sectional study on Ukrainian in-patient mental health facilities during the 2022 Russian invasion. Using an online questionnaire, we obtained responses from the heads of 32 in-patient mental health facilities across Ukraine, representing 52.5% of all in-patient mental health facilities in the nation. We gathered information on hospital admissions, staff, humanitarian aid received and the additional needs of each facility. Hospital admissions were reduced by 23.5% during the war (April 2022) compared with before the war (January 2022). Across facilities, 9.6% of hospital admissions in April 2022 were related to war trauma, with facilities reporting percentages as high as 30.0%. Facilities reported reductions in staff, with 9.1% of total medical workers displaced and 0.5% injured across facilities. One facility reported that 45.6% of their total medical workers were injured. Although facilities across Ukraine have received humanitarian aid (such as medical supplies, food, volunteers), they reported additionally needing equipment as well as more staff. The mental health service structure in Ukraine has been severely damaged during the 2022 invasion, with staff shortages despite a significant number of hospital admissions related to war trauma.

The cost of pharmacovigilance: a time and motion study of an adverse drug reaction program.

Adverse medication events are associated with a significant number of hospital admissions, and the appropriate recording of these events plays a vital role in medication safety. We set out to analyse the time and extrapolated cost in reporting adverse drug reactions (ADRs). A time and motion study of the tasks involved in reviewing, assessing, reporting and communicating ADRs was done over a period of 2 months. We found a median of 69 min was needed in background work per ADR report. The commitment involved in the support of this program is considerable and will encourage further refinement to streamline the process.

Hospital admissions of patients with osteogenesis imperfecta in the English NHS

SummaryHospital use by patients with osteogenesis imperfecta was largely unknown. This study found that the English NHS provides a significant number of hospital admissions to these patients, translating into large costs to the NHS. Admissions and costs both increased over time. Children under 14 years old accounted for more of the admissions and costs than any other age group.IntroductionThe aim of this study was to characterise hospital use by patients with osteogenesis imperfecta (OI) in the English National Health Service (NHS).MethodsRoutinely collected aggregate data about all inpatient hospital records from patients with OI were used for the period 1 April 2014 to 31 March 2018. Information was extracted on number of admissions, number of patients, length of stay, and costs. Hospital use was summarised using descriptive statistics, categorising patients into 5-year age groups.ResultsThere were 16,245 hospital admissions for OI patients during the analysis period, with a total cost to the NHS of £24,052,451. Of the 4370 patients involved, 2700 (62%) were female. Female patients averaged 3.3 admissions per year and male patients 4.4 admissions per year. Patients aged 0 to 14 years old accounted for 54% of all admissions. Those aged 90 to 94 years had the longest average length of stay per admission (10.5 days) of any age group. Elective admissions cost on average £1260 and non-elective admissions £2529. Over the 4-year study period, number of admissions increased on average by 2.1% per year and number of patients by 6.4% per year.ConclusionThe treatment of patients with OI is associated with a significant number of hospital admissions at an important cost for the NHS, with both number of admissions and costs increasing over time. Children below the age of 14 years had more admissions at a greater total cost than other ages, while the oldest adults had longer average stays and higher costs per admission.

How Many Hospital admissions in Massachusetts Would Have Been Saved, Had the Particulate Air Pollution Level Been Lower?

TPS 681: Short-term health effects of air pollutants 1, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Background: Numerous studies have found higher cardiorespiratory risk associated with particulate matter smaller than 2.5µm in diameter (PM2.5). Most studies have used classical epidemiological methods, limited in their capacity for causal interpretation. We applied a causal modeling approach to assess the short-term impact of high PM2.5 exposure on hospital admissions in Massachusetts. Methods: Daily ZIPcode counts of respiratory and cardiovascular admissions of Medicare beneficiaries >65 were constructed across Massachusetts (2000 -2014). Daily PM2.5 exposure estimates were obtained from a satellite-based spatio-temporally resolved model. A propensity score matching approach was applied to estimate the number of cause-specific hospital admissions attributed to high levels of two-day average exposure to PM2.5 (exposure ≥the 95th percentile=18 µg/m3). Each high pollution ZIP code-day was matched to a low pollution ZIP code-day with similar background characteristics. Then, the impact of PM2.5 exposure was estimated by comparing the total count of admissions (all respiratory, all CVD, myocardial infarction (MI), Ischemic heart disease (IHD), ischemic stroke, congestive heart disease (CHF), and chronic obstructive pulmonary disease (COPD)) on high pollution ZIPcode-days and matched low pollution ZIPcode-days during the study period. Results: Of the days in the study period 187,184 were high-pollution days. The mean and standard deviation of the PM2.5 exposure was 11.4 ± 3.7 µg/m3 in the low pollution days and 22.1 ± 4.5 µg/m3 in the high pollution days. A total of 1,729 (7.1%) respiratory, 618 (1.7%) CVD, 362 (6.4%) COPD, 127 (1.9%) stroke, 119 (1.9%) MI, 122 (0.9%) IHD, and 420 (3.7%) CHF admissions in high pollution days were attributed to PM2.5 exposure. Conclusion: Had there been an intervention to lower the short-term exposure limit to PM2.5 below 18µg/m3, well below the current 24-hours 35 µg/m3 U.S.EPA threshold, a significant number of hospital admissions would have been saved among the study population within the study period.

Inpatient hospital fatality related to coding (ICD-9-CM) of the influenza diagnosis in Spain (2009\u20132015)

BackgroundTo analyze hospitalization episodes with an ICD-9 diagnosis code of influenza (codes 487 and 488) in any diagnostic position from 2009 to 2015 in the Spanish hospital surveillance system.MethodsInformation about age, length of stay in hospital, mortality, comorbidity with an influenza diagnosis code between 1 October 2009 and 30 September 2015 was obtained from the National Surveillance System for Hospital Data (Conjunto Mínimo Básico de Datos, CMBD).Results52,884 hospital admissions were obtained. A total of 24,527 admissions corresponded to diagnoses ICD-9 code 487 (46.4%), and 28,357 (53.6%) corresponded to ICD-9 code 488. The global hospitalization rates were 8.7 and 10.6 per 100,000 people, respectively. Differences between the two diagnostic groups were found for each of the six analyzed seasons. The diagnostic ICD-9-CM 488, male gender, and high-risk patients classified by risk vaccination groups showed direct relationship with inpatient hospital death.ConclusionsInfluenza diagnosis was present in a significant number of hospital admissions. The code used for diagnosis (ICD-9-CM 488), male sex, age groups and associated risk clinical conditions showed a direct relationship with inpatient hospital fatality.

Unplanned admissions for patients with myeloma in the UK: Low frequency but high costs

BackgroundMultiple myeloma (MM) is associated with high healthcare resource utilisation and increasing hospitalisation rates. The aim of this study was to characterise the hospital use by patients with MM in the English National Health Service (NHS). MethodsRoutinely-collected aggregate data about all NHS-funded hospital admissions of patients with MM were analysed. Data were obtained from the English Hospital Episodes Statistics on admissions between 1 April 2014 and 31 March 2018. ResultsA total of 754,345 admissions were reported over four years, equivalent to a mean of 188,586 admissions per year. Of the 41,845 patients admitted during this period, 42% were women and 58% men. From the total admissions, 90% were elective and 10% unplanned. Mean annual estimated costs over the period were £46 million for elective and £56 million for unplanned admissions. The number of elective admissions increased by 4.5% with costs increasing 1.5% per year; for unplanned admissions, these figures were 4.1% and 9.0%, respectively. ConclusionsMM is associated with a significant number of hospital admissions and NHS costs. The majority of the hospital admissions are elective, but the highest burden in terms of costs relates to unplanned admissions, with numbers increasing over time.

Ambulatory management of pulmonary embolism.

The diagnosis of pulmonary embolism can be very difficult and elusive. It depends greatly on the use of diagnostic tests, which are in turn interpreted according to a pre-test clinical probability. These include non-specific tests such as the chest X-ray and electrocardiograph, which help exclude other conditions such as pneumonia or myocardial infarction. On the other hand, more specific tests such as computed tomography or ventilation/perfusion scanning are used to confirm or exclude the diagnosis of pulmonary embolism. The condition is potentially fatal, and in the past patients with suspected pulmonary embolism constituted a significant number of hospital admissions. Despite this, the majority were found not to have pulmonary embolism. More recently, studies have suggested that most patients with suspected pulmonary embolism who are haemodynamically stable can be safely managed on an ambulatory pathway. Therefore, there is a paradigm shift towards investigating and treating pulmonary embolism in the outpatient setting. This article discusses the ambulatory pathway of the diagnosis and treatment of pulmonary embolism.

Comparison of the Knowledge and Perception of Pharmacovigilance Among Pharmacy, Dental and Medical Students in Aden-Yemen

Background: Adverse drug reactions (ADRs) represent a serious health problem. Despite all the benefits of modern medicines, evidence continues to mount that ADRs to them are common, yet often preventable cause of illness, disability and even death. ADRs are responsible for a significant number of hospital admissions. Healthcare professionals have an important role to play in reducing ADRs. Purpose: The goal of this study was to compare the knowledge and attitudes of pharmacy, dental and medical students regard¬ing adverse drug reactions (ADRs), as well as their perceptions of barriers to ADR reporting, in Aden University, Yemen. Methods A cross-sectional study was conducted among final-year students. A total of 130 pharmacy students, 101 medical and 69 dental students completed the self-administered questionnaire. The study was conducted from July 1 to October 31, 2016. The responses of pharmacy students were compared to those of dental and medical students. Results: The mean ages of the pharmacy, medical and dental students were 25.13 ± 1.90 years. A non-significant gender difference (P Key words: Aden; dental; Pharmacy; Medical; Students; Pharmacovigilance; Comparison; Yemen.

Quantification of cocaine in ternary mixtures using partial least squares regression applied to Raman and Fourier transform infrared spectroscopy

AbstractThe use of chemicals is often related to suicide attempts and acute poisoning, which account for a significant number of hospital admissions. The differential diagnosis of patients exposed to poisoning is intricate and varies according to the substance used. The identification of drugs and drug abuse in cases of poisoning often requires time‐consuming and complex techniques, such as chromatography. The use of vibrational spectroscopy such as Raman spectroscopy and Fourier transform infrared spectroscopy (FTIR) enables the quick identification of toxic substances using no reagents or markers. This study aims to apply these techniques in the long term to identify and quantify substances found at the locations of suicide attempts, poisonings, and even drug consumption sites, including crack samples containing a cocaine base and adulterants commonly seized in drug busts, such as caffeine, lidocaine, and sodium carbonate. In this study, Raman and FTIR spectra of ternary mixtures of crack with caffeine and sodium carbonate and crack with lidocaine and sodium carbonate were obtained. These spectra were used for building multivariate models based on partial least squares (PLS) for determining the composition of the samples quantitatively. High correlation coefficients (r &gt; 0.98) and small cross‐validation prediction errors (&lt; 6%) were obtained for both Raman and FTIR spectral models. The results showed that PLS regression enables crack quantification in ternary mixtures using both Raman and FTIR spectroscopy, allowing for quick medical intervention or determination of the cause of death in cases of cocaine toxicity.

A study of cutaneous adverse drug reactions in the outpatient department of Dermatology at a tertiary care center in Gujarat, India

Background: The data for adverse cutaneous drug reactions (ACDRs) is limited in Gujarat. The ACDRs are one of the frequent ADRs and cause of significant morbidity and mortality in patients of all areas of healthcare today. They are responsible for significant number of hospital admissions. Thus, the present study emphasises on the need and importance of an effective pharmacovigilance programme.Methods: A prospective study was undertaken in a 183 cases tertiary care teaching hospital of India. Male to female ratio, most common class of drug, individual drug causing ACDR, common types of ACDRs Parameters were studied. Other Parameters like Causality, preventability and severe or non-severe reactions were analyzed.Results: Majority of the patients (48%) with CADR belonged to the age group 25-44 followed by 45-64 (28%). Most frequent adverse cutaneous drug reactions reported were Urticaria (40%), Maculopapular rash (25%) &amp; Fixed drug eruptions (21%) in decreasing order of frequency. Majority of reactions (96%) were Bizarre/Unpredictable in nature. As a group, antimicrobials (46%) were most frequently associated with CADR followed by NSAIDs (31%) and antiepileptics (11%). Most of the reactions (93%) were mild-moderate and probable (77%) in nature. Approximately 60% of ACDRs reported in this study were preventable.Conclusions: There was slight male preponderance except acneiform eruptions. Cotrimoxazole being the most common offending drug then after Ibuprofen, Phenytoin among the anti-inflammatory, analgesics, antiepileptics class. Causality assessment resulted in high score 77% of probable category.

Epidemiology, Diagnosis, and Management of Neurogenic Orthostatic Hypotension.

Orthostatic hypotension (OH) is a sustained fall in blood pressure on standing which can cause symptoms of organ hypoperfusion. OH is associated with increased morbidity and mortality and leads to a significant number of hospital admissions particularly in the elderly (233 per 100,000 patients over 75 years of age in the US). OH can be due to volume depletion, blood loss, large varicose veins, medications, or due to defective activation of sympathetic nerves and reduced norepinephrine release upon standing (i.e., neurogenic OH). Literature review. Neurogenic OH is a frequent and disabling problem in patients with synucleinopathies such as Parkinson disease, multiple system atrophy, and pure autonomic failure, and is commonly associated with supine hypertension. Several pharmacological and non-pharmacological therapeutic options are available. Here we review the epidemiology, diagnosis, and management of neurogenic OH, and provide an algorithm for its treatment emphasizing the importance of removing aggravating factors, implementing non-pharmacologic measures, and selecting appropriate pharmacological treatments.

Prophylactic tracheal intubation for upper GI bleeding: A meta-analysis.

AIMTo evaluate usefulness of prophylactically intubating upper gastrointestinal bleeding (UGIB) patients.METHODSUGIB results in a significant number of hospital admissions annually with endoscopy being the key intervention. In these patients, risks are associated with the bleeding and the procedure, including pulmonary aspiration. However, very little literature is available assessing the use of prophylactic endotracheal intubation on aspiration in these patients. A comprehensive search was performed in May 2014 in Scopus, CINAHL, Cochrane databases, PubMed/Medline, Embase, and published abstracts from national gastroenterology meetings in the United States (2004–2014). Included studies examined UGIB patients and compared prophylactic intubation to no intubation before endoscopy. Meta-analysis was conducted using RevMan 5.2 by Mantel-Haenszel and DerSimonian and Laird models with results presented as odds ratio for aspiration, pneumonia (within 48 h), and mortality. Funnel plots were utilized for publication bias and I2 measure of inconsistency for heterogeneity assessments.RESULTSInitial search identified 571 articles. Of these articles, 10 relevant peer-reviewed articles in English and two relevant abstracts were selected to review by two independent authors (Almashhrawi AA and Bechtold ML). Of these studies, eight were excluded: Five did not have a control arm, one was a letter the editor, one was a survey study, and one was focused on prevention of UGIB. Therefore, four studies (N = 367) were included. Of the UGIB patients prophylactically intubated before endoscopy, pneumonia (within 48 h) was identified in 20 of 134 (14.9%) patients as compared to 5 of 95 (5.3%) patients that were not intubated prophylactically (P = 0.02). Despite observed trends, no significant differences were found for mortality (P = 0.18) or aspiration (P = 0.11).CONCLUSIONPneumonia within 48 h is more likely in UGIB patients who received prophylactic endotracheal intubation prior to endoscopy.

Repeat Urethroplasty After Failed Urethral Reconstruction: Outcome Analysis of 130 Patients

Male urethral stricture disease accounts for a significant number of hospital admissions and health care expenditures. Although much research has been completed on treatment for urethral strictures, fewer studies have addressed the treatment of strictures in men with recurrent stricture disease after failed prior urethroplasty. We examined outcome results for repeat urethroplasty. A prospectively collected, single surgeon urethroplasty database was queried from 1977 to 2011 for patients treated with repeat urethroplasty after failed prior urethral reconstruction. Stricture length and location, and repeat urethroplasty intervention and failure were evaluated with descriptive statistics, and univariate and multivariate logistic regression. Of 1,156 cases 168 patients underwent repeat urethroplasty after at least 1 failed prior urethroplasty. Of these patients 130 had a followup of 6 months or more and were included in analysis. Median patient age was 44 years (range 11 to 75). Median followup was 55 months (range 6 months to 20.75 years). Overall, 102 of 130 patients (78%) were successfully treated. For patients with failure median time to failure was 17 months (range 7 months to 16.8 years). Two or more failed prior urethroplasties and comorbidities associated with urethral stricture disease were associated with an increased risk of repeat urethroplasty failure. Repeat urethroplasty is a successful treatment option. Patients in whom treatment failed had longer strictures and more complex repairs.

P-0140 Hospital Based Audit of Patients Admitted with Sided Effects of 5FU Based Chemotherapy

ABSTRACT Introduction 5FU based chemotherapy is the backbone of gastrointestinal chemotherapy. Over time dose modifications has improved efficacy and reduced toxicity. Despite advances a significant proportion of patients continue to be admitted to hospital with complications of treatment. This study was an audit of patients receiving 5FU based chemotherapy (IV 5FU or oral capecitabine) who required hospital admission for chemotherapy induced toxicity particularly diarrhoea. Methods All chemotherapy prescribed uses the ChemoCare electronic prescribing software. The records of all patients receiving 5FU based chemotherapy over a 12 month period were reviewed. Any admissions were noted and details collected. Results 465 patients received 5FU based chemotherapy (192 with upper GI cancer and 273 with lower GI cancer). Mean age 67 (range 31 to 88). 40 patients (8.6%) were admitted with chemotherapy related complications (50% because of diarrhoea, 22% febrile neutropenia, 13% cardiac and 11% nausea and vomiting). 3/17(17.6%), 8/64(12.5%), 8/77(10.4%), 8/87(9.2%) and 10/152(6.6%) patients were admitted to hospital receiving FOLFOX, XELOX, ECX, EOX and single agent capecitabine chemotherapy regimens respectively. In total 374 bed days were used. 4 patients ( 70 years ) had a longer hospital stay than younger patients( median 14 days vs. 7 days for colorectal cancer and median 13.2 vs. 9 days for upper GI cancer). The average cost per patient was £3000. Conclusion 5FU chemotherapy continues to result in a significant number of hospital admissions to the hospital at a cost in our UK institute on average of £3000 per patient. 5FU blood level monitoring demonstrates that there is a significant variation in levels with some patients receiving 5FU at a sub-therapeutic level and others having levels in the toxic range. We are introducing 5FU blood level monitoring and will dose adjust patients receiving infusional 5FU according to the protocol highlighted by Gamelin. A reaudit of hospital admissions will then be made to assess potential benefits including reduced toxicity.

Trauma activation: are we making the right call? A 3-year experience at a Level I pediatric trauma center

Background Trauma is the leading cause of death in children, accounting for half of all deaths in patients between birth and 18 years of age, and is the cause of a significant number of hospital admissions. We reviewed our experience at a Level I pediatric trauma center with a 2-level trauma activation (TA) system for mobilization of personnel over a 3-year period. The aim was to assess severity of injury of the trauma patients, resource use, and outcome. Methods After obtaining institutional review board approval, a retrospective analysis of all trauma patients between January 2006 and December 2008 was performed. Data analyzed included number of admissions, level of TA (STAT vs ALERT), mechanism of injury, intensive care unit (ICU) admission, injury severity score (ISS), need for operative intervention, and survival. Results In 3 years, there were 4502 patients entered. Trauma activation was initiated in 1315 patients (29.2%), divided between 211 STATs (4.7%) and 1104 ALERTs (24.5%). Mean patient age was 5.9 ± 4.1 years, 65% of the patients were boys, and blunt trauma accounted for 92% of the admissions. An ICU admission was required in 736 (16.3%) of the entire group, whereas 502 (38.2%) patients in the TA group were admitted to the ICU 1 1 ( P < .01). . The 154 STAT (21%) and 348 ALERT (47%) patients accounted for 68% of all ICU admissions 1 . An ISS listed as severe (16-24) or very severe (>24) was found in 468 (10.4%) and 232 (5.2%) patients, respectively. An ISS listed as 16 or higher was found in 144 (68.2%) of the STATs and 264 (23.9%) of the ALERTs 1 . Operative intervention was required in 2118 patients (47%). The overall mortality rate was 1.9%, and this increased to 5.8% in the TA group 1 . There were 48 deaths (22.7%) in the STAT group, 29 deaths (2.6%) in the ALERT group, and 9 deaths (0.28%) in patients with no TA 1 . When emergency department deaths were excluded, the remaining 60 deaths resulted in a mortality rate of 1.3%. Conclusions Our Level I pediatric trauma center manages a large volume of patients with significant acuity and, evidenced by a TA in 29% of the patients, a severe or very severe ISS in 16% of the patients, 16% of the patients requiring ICU admission, and 47% requiring operative intervention. The TA patients had markedly higher rates of ICU admission, ISS, and mortality. Deaths in the study were lower by almost an order of magnitude comparing TA STATs with TA ALERTs and TA ALERT patients with patients without TA. The TA criteria are in many ways very helpful and is integral to a Level I trauma center. However, opportunities were identified for improvement because of areas of “overutilization” and discordance between TA and ISS.

Basilic vein transposition versus biosynthetic prosthesis as vascular access for hemodialysis

Vascular access (VA) complications account for a significant number of hospital admissions in dialysis and have substantial costs. A native arteriovenous fistula (AVF) cannot be successfully obtained in all patients. At our center, we established an autogenous brachial-basilic AVF (BBAVF) in the upper arm in patients with a failed forearm fistula or with superficial vessels that were unsuitable for preparing a good site for VA. In most of these patients, we resort to prosthetic materials for creating a functioning VA as the last strategy. The present study compared the outcomes of BBAVF and AV graft (AVG) in patients undergoing long-term hemodialysis in whom there was no other possibility of creating a VA. We analyzed 57 complex patients, 27 randomized to receive AVG and 30 randomized to BBAVF, between 2002 and 2008. The Omniflow II Vascular Prosthesis (Bio Nova International Pty Ltd, North Melbourne, VIC, Australia), the latest-generation collagen-polyester composite, was used to create the prosthetic VA. Primary patency (PP) and secondary patency (SP) rates were calculated using the Kaplan-Meier test. The log-rank test was used to compare PP and SP rates of the single VA. Length of hospital admission time, total intervention time, and mean interval to the first venipuncture for dialysis were longer for BBAVF. In the early postoperative period, patients who received BBAVF had a complication rate similar to those who received AVG; however, patients who received AVG showed a higher rate of long-term adverse events. PP and SP rates were higher for BBAVF than for AVG, although this was not statistically significant for SP. Our results show that BBAVF should be the first choice in patients with a good life expectancy and who can rely on an available temporary VA. However, given the shorter time to use, AVG could be an alternative in patients with compromised clinical conditions and in whom a temporary VA is not reliable, considering that the long-term outcome may be considered beneficial regardless.

Impact of environmental tobacco smoke on children admitted with status asthmaticus in the pediatric intensive care unit

Environmental tobacco smoke (ETS) and allergens are risk factors in children with critical status asthmaticus. Genetic studies support that ETS-associated asthma is a special inflammatory entity, causing significant number of hospital admissions and relapses. Accordingly, the course and outcome of patients with ETS-induced status asthmaticus might also be different. We hypothesized that the progression, course, and outcome of patients with ETS-induced status asthmaticus would be worse than those of patients without ETS exposure. Medical records of children who were admitted to the Pediatric Intensive Care Unit (PICU) with the diagnosis of asthma at the Children's Hospital of Winnipeg, Manitoba, over 10 years were audited after Institutional Review Board (IRB) approval. Two hundred thirty records were reviewed. We extracted data including demographics and analyzed the patient's deterioration defined as clinical asthma score (CAS) drift between the ED and PICU. We computed the treatment response, expressed as length of stay (LOS) in the PICU and in hospital. The risk factors were stratified as none, ETS exposure, allergies, and ETS with allergies. There were 55 (25%) patients with no risk factors, 66 (30%) with ETS exposure only, 46 (21%) with allergies only, and 53 (24%) with both. There was a 25% decrease in CAS deterioration when patients were exposed to ETS (P < 0.05). For patients with or without allergies but with exposure to ETS, both the PICU and overall hospital LOS were ∼15% longer (P < 0.05) than for those not exposed to ETS. Stratifying for gender and race in multivariate analysis did not alter the results. Patients with ETS-associated critical status asthmaticus deteriorate and recover slower than non-ETS-exposed patients.

Case Report: Anaphylactic Reaction to Guaifenesin

Adverse drug reactions lead to a significant number of hospital admissions each year and thus contribute to the overall financial burden of health care. Some of these drug reactions are allergic responses. As the overall predictability of allergic responses to drugs remains low, efforts to improve our understanding of the processes underlying these responses continue as we strive toward the ultimate goal of primary prevention. Allergic reactions range from mild pruritic to severe systemic anaphylactic responses. We report a case of a young healthy man who developed an anaphylactic reaction to an over-the-counter expectorant. A skin test showed that the patient had an immunoglobulin E-mediated allergic response to guaifenesin, one of the components of commonly available cough medications. Our review of published literature showed that this is the first report of a severe allergic response to guaifenesin.