Significant Reduction In Admissions Research Articles

Epinephrine for bronchiolitis

Bronchodilators are commonly used for acute bronchiolitis, despite uncertain effectiveness. To examine the efficacy and safety of epinephrine in children less than two with acute viral bronchiolitis. We searched CENTRAL (2010, Issue 3) which contains the Acute Respiratory Infections Group's Specialized Register, MEDLINE (1950 to September Week 2, 2010), EMBASE (1980 to September 2010), Scopus (1823 to September 2010), PubMed (March 2010), LILACS (1985 to September 2010) and Iran MedEx (1998 to September 2010). We included randomized controlled trials comparing epinephrine to placebo or another intervention involving children less than two years with acute viral bronchiolitis. Studies were included if the trials presented data for at least one quantitative outcome of interest.We selected primary outcomes a priori, based on clinical relevance: rate of admission by days one and seven of presentation for outpatients, and length of stay (LOS) for inpatients. Secondary outcomes included clinical severity scores, pulmonary function, symptoms, quality of life and adverse events. Two review authors independently screened the searches, applied inclusion criteria, assessed risk of bias and graded the evidence. We conducted separate analyses for different comparison groups (placebo, non-epinephrine bronchodilators, glucocorticoids) and for clinical setting (inpatient, outpatient). We included 19 studies (2256 participants). Epinephrine versus placebo among outpatients showed a significant reduction in admissions at Day 1 (risk ratio (RR) 0.67; 95% confidence interval (CI) 0.50 to 0.89) but not at Day 7 post-emergency department visit. There was no difference in LOS for inpatients. Epinephrine versus salbutamol showed no differences among outpatients for admissions at Day 1 or 7. Inpatients receiving epinephrine had a significantly shorter LOS compared to salbutamol (mean difference -0.28; 95% CI -0.46 to -0.09). One large RCT showed a significantly shorter admission rate at Day 7 for epinephrine and steroid combined versus placebo (RR 0.65; 95% CI 0.44 to 0.95). There were no important differences in adverse events. This review demonstrates the superiority of epinephrine compared to placebo for short-term outcomes for outpatients, particularly in the first 24 hours of care. Exploratory evidence from a single study suggests benefits of epinephrine and steroid combined for later time points. More research is required to confirm the benefits of combined epinephrine and steroids among outpatients. There is no evidence of effectiveness for repeated dose or prolonged use of epinephrine or epinephrine and dexamethasone combined among inpatients.

Early psychosis treatment in an integrated model within an adult mental health service

ObjectiveTo compare the treatment of patients with early psychosis, 2 years after the introduction of an integrated model of enhanced management within a public adult mental health service, with an historic cohort from the same service. MethodVariables examined in the 2001 cohort were compared with 2008 patients. Computer database review and a file audit were conducted for all patients with early psychosis across the first 2 years of the program. ResultsCompared to the historic cohort, patients in the current cohort were 24% less likely to have been admitted (P=0.004). There were statistically significant reductions in involuntary status and use of a locked unit. Rates of police involvement in admission and use of seclusion were also reduced, though this trend was not significant. Average length of stay was reduced. Median duration of untreated psychosis was 3 months in both 2001 and 2008 cohorts. ConclusionsThe introduction of an integrated model of management within an area mental health service for patients with early psychosis contributed to significant reductions in admissions, involuntary status and use of a locked ward. The data suggests that enhanced treatment of early psychosis patients can be offered within generic services.

Clinical outcome of assertive community treatment (ACT) in a rural area in Denmark: A case–control study with a 2-year follow-up

Aim: The aim of the present study was to evaluate the effect of assertive community treatment (ACT) in the Tønder Region, South Jutland, where the first Danish ACT team was established to treat patients with severe and persistent mental illness (SMI). Methods: The study compares outcome over a 2-year period between recipients of ACT and standard community mental healthcare. Results: The study included 86 cases and 88 controls. At the time of recruitment, the cases and the controls did not differ significantly in demographic details and eligibility criteria. At the 2-year follow-up, the ACT patients showed a significant reduction in admissions, bed days and day hospital days, and a significant increase in the number of consultations compared with the controls. Adherence to outpatient services was higher in the ACT group. No significant improvements in psychopathology were found after 2 years, but a significant improvement in met needs and fewer unmet needs, indicating better functioning, occurred. Clients’ satisfaction with care (Client Satisfaction Questionnaire, CSQ) was significantly higher among ACT patients than among controls. Conclusion: The treatment of these patients in this ACT service has yielded promising results, suggesting that ACT treatment may be a useful intervention for SMI patients. However, large, rigorous, randomized control trials with ACT are needed in Europe as the existing evidence mainly comes from American studies.

Reduction in Hospitalizations for Pneumonia Associated With the Introduction of a Pneumococcal Conjugate Vaccination Schedule Without a Booster Dose in Australia

Postmarketing surveillance of heptavalent pneumococcal conjugate vaccine (7vPCV) has shown significant reductions in admissions coded as pneumonia in countries where a booster dose is given in the second year of life. In Australia, a 3-dose primary schedule at 2, 4, and 6 months of age without a booster has been funded nationally for non-Indigenous children since 2005. All hospital discharges in Australia with the primary diagnosis coded as pneumonia between July 1998 and June 2007 were identified from a national electronic database. Monthly rates of hospitalization for pneumonia over this period were determined for the age groups < 2, 2-4,5-17, 18-39, 40-64, and > or = 65 years. Negative binomial regression modeling,adjusting for background and seasonal trends, was used to quantify the effect of the 7vPCV program. A total of 523,591 eligible hospital discharges were identified. In the 30 months following 7vPCV introduction, there were significant adjusted reductions in all-cause pneumonia in children aged < 2 and 2 to 4 years of 38%(95% CI 36%-40%), and 29% (26%-31%), respectively. Reductions of between 3% and 11% were observed in the older age groups. The significant differential effects observed are strongly suggestive of the PCV7 program being responsible for the observed reduction in pneumonia hospitalizations in Australia, and the magnitude was comparable to that documented in countries with a booster dose. This finding appears robust and may be related to high levels of vaccination coverage and catch-up early in the program, or to relatively lower levels of serotype replacement without a booster dose.

Sample Size in Disease Management Program Evaluation: The Challenge of Demonstrating a Statistically Significant Reduction in Admissions

Prior to implementing a disease management (DM) strategy, a needs assessment should be conducted to determine whether sufficient opportunity exists for an intervention to be successful in the given population. A central component of this assessment is a sample size analysis to determine whether the population is of sufficient size to allow the expected program effect to achieve statistical significance. This paper discusses the parameters that comprise the generic sample size formula for independent samples and their interrelationships, followed by modifications for the DM setting. In addition, a table is provided with sample size estimates for various effect sizes. Examples are described in detail along with strategies for overcoming common barriers. Ultimately, conducting these calculations up front will help set appropriate expectations about the ability to demonstrate the success of the intervention.

Effectiveness of home based support for older people: systematic review and meta-analysis.

Objective: To evaluate the effectiveness of home visiting programmes that offer health promotion and preventive care to older people. Design: Systematic review and meta-analysis of 15 studies of home visiting.Participants:...

The impact of a community screening program on psychiatric hospital admissions.

A rural CMHC screening program significantly reduced admission rates to a state hospital compared with hospital-based screening. Personnel from CMHCs in three counties evaluated each potential admission to the hospital to evaluate their need for hospitalization. Hospital staff screened admissions from the remaining counties of the state. Both community and hospital screening resulted in significant reductions in admissions with community screening producing larger declines. Additional possible advantages of community screening for improved treatment outcomes, efficient utilization of community resources, and reduced costs are discussed.

Impact of an ORT Corner in a Teaching Hospital

An ORT (Oral Rehydration Therapy) Corner was set up in Rajshahi Medical College in July 1990. 4267 Patients aged between 0-12 years who attended the ORT corner of the diarrhoeal training unit in the year of 2003 were studied to find out the impact of this unit in the management of diarrhoeal diseases in children and its effect on diarrhoeal admission in the hospital. 53.56% (2285) of them were male and 46.21% (1972) were female. Only 1.54% (66) of the patient who attended the ORT Corner needed hospital admission. 78.72% Patients were under 5 year of age and 90.57% (3865) patients had no dehydration (group-A) and they were sent home with ORS (Oral Rehydration Solution) and necessary advice. 8.3% (355) patients had some dehydration (Group -B) and they were treated at the ORT corner with ORS for 2-6 hours and sent home after initial rehydration. But 19 (0.44%) patients had needed hospital admission later due to failure of ORS treatment. 47 (1.10%) Patient had severe dehydration (Group-C), who had persistent diarrhoea and immediately admitted in Paediatric unit and given necessary treatment. Total diarrhoeal admission in indoor was 74 in 2002 and 66 in 2003 and a significant reduction in admission was observed during the study period from that of the previous year. (p &lt; 0.01). It was concluded that the ORT corner was vary effective simple and safe in the management of diarrhoea in children and reduced the number of diarrhoeal admissions in the hospital. doi: 10.3329/taj.v20i1.3090 TAJ 2007; 20(1): 52-55