Journal articles on the topic 'Admissions in evidence'
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Monyakane, ’Mampolokeng ’Mathuso Mary-Elizabet. "The Danger for an Underestimation of Necessary Precautions for the Admissibility of Admissions in Section 219A of the South African Criminal Procedure Act 51 of 1977." Criminal Law Forum 31, no. 1 (December 12, 2019): 81–120. http://dx.doi.org/10.1007/s10609-019-09381-x.
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AbstractThe Prima facie view regarding the admissibility of admissions, as evidence, in criminal matters is that, to admit admissions as evidence, the court requires a single consideration as to whether the admission was made freely and voluntarily. Without too much ado, the simple view to this understanding presupposes that admission of an admission as evidence against its maker is of a lesser danger compared to the admission of a confession. The admissibility of confessions against their makers does not come as easily as that of admissions. There are many prescribed requirements to satisfy before confessions are admitted as evidence. This comparison has led to a questionable conclusion that requirements for the admissibility of admissions are of a less complexity equated to the requirements for the admission of confessions. This paper answers the question whether an inference that the requirements for the admissibility of admissions are of a less complexity compared to the requirements for the admission of confessions is rational? It equates this approach to the now done away with commonwealth states rigid differentiation perspective. In the 1800s the commonwealth states, especially those vowing on the Wigmorian perspective on the law of evidence, developed from a rigid interpretation of confessions and admissions and adopted a relaxed and wide definitions of the word, “confession.” To this extent there was a relaxed divide between confessions and admissions hence their common classification and application of similar cautionary rules. The article recounts admissibility requirement in section 219A of the South African Criminal Procedure Act 51 of 1977 (CPA) (Hereinafter CPA). It then analyses Section 219A of the CPA requirement in the light of the rationale encompassing precautions for the admission of confessions in terms of 217(1) of the CPA. It exposes the similarities of potential prejudices where confessions and admissions are admitted as evidence. It reckons that by the adherence to this rigid differentiation perspectives of confessions and admissions which used to be the practice in the commonwealth prior the 1800s developments, South African law of evidence remains prejudicial to accused persons. To do away with these prejudices this article, recommends that section 219A be amended to include additional admissibility requirements in section 217(1). In effect it recommends the merging of sections 217(1) and 219A of the CPA.
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Walsh, Bronagh. "Unplanned admissions and readmissions in older people: a review of recent evidence on identifying and managing high-risk individuals." Reviews in Clinical Gerontology 24, no. 3 (July 10, 2014): 228–37. http://dx.doi.org/10.1017/s0959259814000082.
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SummaryRising unplanned hospital admissions are a problem in ageing populations worldwide. These admissions are associated with poor outcomes for older people, contribute to rising health care costs and impede the provision of planned care. Policy and practice in recent years has focused on identification of those at risk of unplanned admission and early intervention via a range of admission avoidance services. Despite this, unplanned admissions in older people continue to rise, and managing demand for unplanned care remains a priority. Questions remain about the risk factors for unplanned admission and the best approaches to identifying and intervening with those at risk. This review explores recent evidence on admission rates, risk factors for unplanned admission in older people, identification of those at highest risk and interventions to avert unplanned admission.
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Zimmermann, Judith, Alina von Davier, and Hans Rudolf Heinimann. "Adaptive admissions process for effective and fair graduate admission." International Journal of Educational Management 31, no. 4 (May 8, 2017): 540–58. http://dx.doi.org/10.1108/ijem-06-2015-0080.
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Purpose Graduate admission has become a critical process for quality assurance in tertiary education. Hitherto, most research has investigated the validity of admissions instruments. However, surprisingly little work has been conducted on the overall organization of admission, which often remains “informal, ad hoc, and lacking in continuity.” The purpose of this paper is to investigate how to systematically design an admissions process for effectiveness, fairness, and the ability to continually improve, and determine how to condense and analyze the massive amount of data available from student records to obtain high-value feedback for admissions decision making. Design/methodology/approach An admissions process was systematically designed based on results from process management theory. Tenets of decision theory were applied to the organization of decision making and validity theory was utilized for validating admissions instruments. Performance of the implemented process was evaluated via student records covering a seven-year period. Findings The authors have designed a four-phase admissions process that ensures high quality through screening, scoping, selection, and evaluation/feedback. The last phase introduces closed-loop control and facilitates stabilization and continual improvement. Additionally, the authors have established a three-stage decision-making hierarchy that promotes consistency and equal treatment in admissions. The evaluations of undergraduate achievements and GRE® General Test scores indicate that both are valid admissions instruments in the European context. Finally, the evaluation of the implemented process provides evidence that decision making has effectively improved over the years and has become more consistent. Originality/value The systematic design of the admissions process presented generalizes well and is a significant contribution to the organization of decentralized graduate admission.
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Song, Jinglin, Chen Chen, Shaoyang Zhao, Leming Zhou, and Hong Chen. "Trading quality for quantity? Evidence from patient level data in China." PLOS ONE 16, no. 9 (September 16, 2021): e0257127. http://dx.doi.org/10.1371/journal.pone.0257127.
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In China, overcrowding at hospitals increases the workload of medical staff, which may negatively impact the quality of medical services. This study empirically examined the impact of hospital admissions on the quality of healthcare services in Chinese hospitals. Specifically, we estimated the impact of the number of hospital admissions per day on a patient’s length of stay (LOS) and hospital mortality rate using both ordinary least squares (OLS) and instrumental variable (IV) methods. To deal with potential endogeneity problems and accurately identify the impact of medical staff configuration on medical quality, the daily air quality index was selected as the IV. Furthermore, we examined the differential effects of hospital admissions on the quality of care across different hospital tiers. We used the data from a random sample of 10% of inpatients from a city in China, covering the period from January 2014 to June 2019. Our final regression analysis included a sample of 167 disease types (as per the ICD-10 classification list) and 862,722 patient cases from 517 hospitals. According to our results, the LOS decreased and hospital mortality rate increased with an increasing number of admissions. Using the IV method, for every additional hospital admission, there was a 6.22% (p < 0.01) decrease in LOS and a 1.86% (p < 0.01) increase in hospital mortality. The impact of healthcare staffing levels on the quality of care varied between different hospital tiers. The quality of care in secondary hospitals was most affected by the number of admissions, with the average decrease of 18.60% (p < 0.05) in LOS and the increase of 6.05% (p < 0.01) in hospital mortality for every additional hospital admission in our sample. The findings suggested that the supply of medical services in China should be increased and a hierarchical diagnosis and treatment system should be actively promoted.
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Cooper, Simon. "Hearsay: Identification and Admissions." Journal of Criminal Law 66, no. 5 (October 2002): 459–66. http://dx.doi.org/10.1177/002201830206600510.
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This article seeks to explore the relationship between identification evidence and the rule against hearsay evidence. It focuses on how the courts have ignored or sought to evade application of the rule and concludes by examining a recent decision of the Court of Appeal that illustrates the lengths that courts will resort to in order to admit evidence perceived as being reliable.
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Nasir, Syed Sameer, and Alva B. Weir. "ICU deaths in patients with advanced cancer: Criteria to decrease potentially inappropriate admissions and analysis of advance planning discussions." Journal of Clinical Oncology 34, no. 26_suppl (October 9, 2016): 47. http://dx.doi.org/10.1200/jco.2016.34.26_suppl.47.
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47 Background: A significant number of advanced cancer admissions to intensive care unit (ICU) are inappropriate, as they do not prolonged survival. No clear consensus criteria for reasonable admissions of advanced cancer patients have been developed. Methods: We established four criteria for ICU admissions in advanced cancer patients: post procedure complication, recent cancer diagnosis, good performance status and life expectancy of > 6 months. We reviewed charts of all patients who died in the ICU at a university-affiliated hospital between 2005-2010. We then identified advanced cancer patients and looked for presence or absence of these criteria. We also reviewed evidence of advance planning discussions (APDs), prior to ICU admission to evaluate their benefit in preventing inappropriate admissions. Results: 421 deaths occurred in ICU between 2005-2010. 52 patients had advanced cancer. 27% were diagnosed with cancer one month or less prior to admission. 40% had ECOG performance status of 0-1. 27% had life expectancy of more than 6 months and 15% were admitted for post procedure complications. Overall, 37% did not satisfy any of our reasonable criteria at the time of ICU admission. In our chart review for evidence of APDs, 31% had completed APDs prior to ICU admission. 47% of patients who did not satisfy any of our reasonable admission criteria had APDs indicating desire for limited medical intervention. Patients lacking both reasonable admission criteria and APDs were 15%. Conclusions: Incorporating proposed admission criteria in ICU admission guidelines may prevent significant number of inappropriate, advanced cancer admissions to the ICU, thus avoiding ineffective, aggressive interventions and delay in timely access to high-quality hospice and palliative care. Our data confirms other data in suggesting that a simple increase in numbers of APDs would not likely change significantly the numbers of inappropriate ICU admissions. [Table: see text]
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Kamis, Rais, Jessica Pan, and Kelvin KC Seah. "Do college admissions criteria matter? Evidence from discretionary vs. grade-based admission policies." Economics of Education Review 92 (February 2023): 102347. http://dx.doi.org/10.1016/j.econedurev.2022.102347.
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Rizavas, Ioannis, Rossetos Gournellis, Phoebe Douzenis, Vasiliki Efstathiou, Panagiota Bali, Kostas Lagouvardos, and Athanasios Douzenis. "A Systematic Review on the Impact of Seasonality on Severe Mental Illness Admissions: Does Seasonal Variation Affect Coercion?" Healthcare 11, no. 15 (July 28, 2023): 2155. http://dx.doi.org/10.3390/healthcare11152155.
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Coercion in psychiatry is associated mainly with involuntary admissions. The purpose of this study was to investigate the associations between hospital admissions of patients suffering from affective and schizophrenic disorders and seasonality. A systematic literature search using PubMed, Scopus and Google Scholar was conducted, including studies with affective and schizophrenia disorder admissions, published from October 1992 to August 2020. A total of 31 studies were included in the review. Four broad severe mental illness admission categories were identified regarding seasonality: affective disorders, schizophrenia disorders, involuntary admission affective disorders and involuntary admission schizophrenia disorders. There was clear and strong evidence for spring and summer peaks for severe mental illness admissions; data provided for age, gender and involuntary admissions was limited. Seasonality may have a significant effect on the onset and exacerbation of psychopathology of severe mental illness and should be considered as a risk factor in psychiatric admissions, violence and the risk of mental health coercion. A better understanding of the impact of seasonality on severe mental illness will help professionals to provide the best practices in mental health services in order to reduce and prevent psychiatric hospitalizations (especially involuntary admissions) resulting in further coercive measures.
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Conway, Richard, Declan Byrne, Seán Cournane, Deirdre O’Riordan, and Bernard Silke. "The Problems with Risk Prediction during an Emergency Medical Admission Using Laboratory Data – Evidence from Potassium." Acute Medicine Journal 18, no. 1 (January 1, 2019): 16–22. http://dx.doi.org/10.52964/amja.0743.
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Background: The prediction of clinical outcomes using biochemical markers is an important tool. Methods: We calculated a risk score for all emergency admissions 2002-2017. We related potassium and mortality in a multivariable fractional polynomial model. We investigated the potassium distribution and relationship of potassium to mortality over time. Results: There were 106,586 admissions in 54,928 patients. Mortality was higher for those with an admission potassium above the median – 6.1% vs 4.6% (p<0.001), OR 1.07 (95%CI: 1.06, 1.09). There was a progressive increase in mortality from the lowest – 8.9% (95%CI: 8.3%, 9.4%) to highest potassium decile – 14.2% (95%CI: 13.5%, 14.8%). The frequency of admission hypokalaemia and the mortality at any given potassium decreased over time. Conclusion: Admission potassium predicts mortality.
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Davis, Erin, Richard Braha, Shannon McAlorum, and Debbie Kelly. "A brief history of pharmacy admissions in North America." Canadian Pharmacists Journal / Revue des Pharmaciens du Canada 152, no. 6 (August 5, 2019): 370–75. http://dx.doi.org/10.1177/1715163519865571.
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The move from a Bachelor of Science in Pharmacy to a Doctor of Pharmacy degree, both in the United States and in Canada, has been accompanied by a general move towards increased prepharmacy admission requirements and longer pharmacy programs. Historically, the most thoroughly researched pharmacy admissions variables include grade point average (GPA), Pharmacy College Admissions Test (PCAT), interviews and critical thinking tests. Most programs now require a combination of academic (GPA ± PCAT) and nonacademic characteristics (e.g., interviews, volunteering, critical thinking tests, essays). This review focuses on GPA and the PCAT as academic admissions measures and the interview (both traditional and the multiple mini-interview) and critical thinking tests as nonacademic measures. There is evidence that prepharmacy GPA, the PCAT and admissions interviews are correlated with academic success in a pharmacy program. Repeating a prepharmacy course is a negative predictor of academic success. The multiple mini-interview and various critical thinking tests have been studied in pharmacy admissions, but the evidence to date does not support their use for predicting success. Several areas require further research, including finding an effective measure of reasoning and critical thinking skills. The relationship between admission test scores and clinical performance also requires further study, as academic achievement in pharmacy programs has been the main measure of success to date.
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Riandini, Tessa, Kelvin Bryan Tan, and Deidre Anne De Silva. "Lessons from Severe Acute Respiratory Syndrome Coronavirus 2003 Pandemic as Evidence to Advocate for Stroke Public Education During the Current Coronavirus Disease 2019 Pandemic." Annals of the Academy of Medicine, Singapore 49, no. 8 (August 30, 2020): 538–42. http://dx.doi.org/10.47102/annals-acadmedsg.2020203.
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Introduction: The coronavirus disease 2019 (COVID-19) outbreak is affecting hospital admissions of stroke patients. This, in turn, will reduce the use of proven stroke treatments, which will result in poorer stroke outcomes. We examined local stroke admissions before, during, and after the 2003 outbreak of the severe acute respiratory syndrome (SARS) (these periods being defined in both the Singapore and worldwide contexts), to extrapolate stroke admission patterns in Singapore during the current COVID-19 crisis. Materials and Methods: National inpatient admission data from the Ministry of Health (MOH), Singapore, and death data from the Registry of Births and Deaths (RBD), Singapore, were analysed. Trends of local stroke admissions and stroke-related mortality pre-SARS, during SARS, and post-SARS periods, both in the Singapore and worldwide contexts, were analysed using time series plot in monthly time units. Differences between periods were presented as percentage change between: (1) SARS and pre-SARS periods, and (2) post-SARS and SARS periods and compared using two-sample t-tests. Results: There was a 19% decline in stroke admissions into all local hospitals during the Singapore SARS period (P = 0.002) and a 13% reduction during the worldwide SARS period (P = 0.006). Stroke admissions increased by 18% after the Singapore SARS period was over (P = 0.003) and rose by a further 8% when the worldwide SARS period ended (P = 0.046). Stroke-related mortality remained stable throughout. Conclusions: During the SARS pandemic, there was a reduction in the number of stroke admissions, and this was apparent during both the local SARS and worldwide SARS outbreak periods. We should take appropriate steps through public education to minimise the expected reduced stroke admissions during the COVID-19 pandemic, inferred from the findings during the SARS pandemic. Key words: Care-seeking behaviour, COVID-19, Inpatient admission, Pandemic, SARS
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Hecker, Kent, and Geoff Norman. "Have admissions committees considered all the evidence?" Advances in Health Sciences Education 22, no. 2 (March 24, 2017): 573–76. http://dx.doi.org/10.1007/s10459-016-9750-1.
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SHALLCROSS, L. J., A. C. HAYWARD, A. M. JOHNSON, and I. PETERSEN. "Evidence for increasing severity of community-onset boils and abscesses in UK General Practice." Epidemiology and Infection 143, no. 11 (December 22, 2014): 2426–29. http://dx.doi.org/10.1017/s0950268814003458.
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SUMMARYIn England, hospital admissions for severe staphylococcal boils and abscesses trebled between 1989 and 2004. We investigated this trend using routine data from primary and secondary care. We used The Health Improvement Network (THIN), a large primary-care database and national data on hospital admissions from Hospital Episode Statistics (HES). Time trends in the incidence of primary-care consultations for boils and abscesses were estimated for 1995–2010. HES data were used to calculate age-standardized hospital admission rates for boils, abscesses and cellulitis. The incidence of boil or abscess was 450 [95% confidence interval (CI) 447–452] per 100 000 person-years and increased slightly over the study period (incidence rate ratio 1·005, 95% CI 1·004–1·007). The rate of repeat consultation for a boil or abscess increased from 66 (95% CI 59–73) per 100 000 person-years in 1995 to peak at 97 (95% CI 94–101) per 100 000 person-years in 2006, remaining stable thereafter. Hospital admissions for abscesses, carbuncles, furuncles and cellulitis almost doubled, from 123 admissions per 100 000 in 1998/1999 to 236 admissions per 100 000 in 2010/2011. Rising hospitalization and recurrence rates set against a background of stable community incidence suggests increased disease severity. Patients may be experiencing more severe and recurrent staphylococcal skin disease with limited treatment options.
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Bhui, Kamaldeep, Stephen Stansfeld, Sally Hull, Stefan Priebe, Funke Mole, and Gene Feder. "Ethnic variations in pathways to and use of specialist mental health services in the UK." British Journal of Psychiatry 182, no. 2 (February 2003): 105–16. http://dx.doi.org/10.1192/bjp.182.2.105.
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BackgroundInequalities of service use across ethnic groups are important to policy makers, service providers and service users.AimsTo identify ethnic variations in pathways to specialist mental health care, continuity of contact, voluntary and compulsory psychiatric in-patient admissions; to assess the methodological strength of the findings.MethodA systematic review of all quantitative studies comparing use of mental health services by more than one ethnic group in the UK. Narrative analysis supplemented by meta-analysis, where appropriate.ResultsMost studies compared Black and White patients, finding higher rates of in-patient admission among Black patients. The pooled odds ratio for compulsory admission, Black patients compared with White patients, was 4.31 (95% CI 3.33–5.58). Black patients had more complex pathways to specialist care, with some evidence of ethnic variations in primary care assessments.ConclusionsThere is strong evidence of variation between ethnic groups for voluntary and compulsory admissions, and some evidence of variation in pathways to specialist care.
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Alam, Rafiul, Md Shamsur Rahman, Eshrat Jahan, Farhana Afroze, and Mohammad Tajul Islam. "Causes and determinants of neonatal deaths: Evidence from a secondary care hospital in Bangladesh." Bangladesh Journal of Child Health 43, no. 3 (October 7, 2020): 138–44. http://dx.doi.org/10.3329/bjch.v43i3.49569.
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Background: Neonatal death is a major barrier to improve child survival in Bangladesh. This study assessed the patterns of neonatal admissions, causes of deaths and associated risk factors to prioritize and design interventions to improve quality of services.
Materials & Methods: This study was conducted at the Satkhira District Hospital, a secondary health care facility in Bangladesh. From January to December 2014 hospital records of neonatal admissions and outcomes were reviewed and analyzed. Risk factors were determined by logistic regression analysis.
Results: A total of 2,632 neonates were admitted during the period. More than one-third had admission bodyweight below 2500 grams. The leading causes of admissions were perinatal asphyxia (39.6%), prematurity/low-birth weight (LBW) (16.3%), pneumonia (11.9%) and sepsis (10.0%). The overall neonatal case fatality rate (CFR) was 11.7%. The main causes of neonatal deaths were perinatal asphyxia (41.6%) and prematurity/ LBW (35.8%). Most of the deaths (74.3%) occurred on first day of life. Significant risk factors for death were body weight on admission <1500 grams (OR: 17.08; 95% CI: 7.22 - 40.44; p<0.001), first day of life (OR: 7.99; 95% CI: 2.86 -22.27; p<0.001).
Conclusions: The main causes of neonatal deaths were perinatal asphyxia and prematurity/LBW and most of the deaths occurred on first day of life.
Bangladesh J Child Health 2019; VOL 43 (3) :138-144
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Soni, Anushka, Stephanie Santos-Paulo, Andrew Segerdahl, M. Kassim Javaid, Rafael Pinedo-Villanueva, and Irene Tracey. "Hospitalization in fibromyalgia: a cohort-level observational study of in-patient procedures, costs and geographical variation in England." Rheumatology 59, no. 8 (December 6, 2019): 2074–84. http://dx.doi.org/10.1093/rheumatology/kez499.
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Abstract Objectives Fibromyalgia is a complex, debilitating, multifactorial condition that can be difficult to manage. Recommended treatments are usually delivered in outpatient settings; evidence suggests that significant inpatient care occurs. We describe the scale and cost of inpatient care with a primary diagnostic code of fibromyalgia within the English National Health Service. Methods We conducted a cohort-level observational study of all patients admitted to hospital due to a diagnosis of fibromyalgia, between 1 April 2014 and 31 March 2018 inclusive, in the National Health Service in England. We used data from Hospital Episode Statistics Admitted Patient Care to study: the age and sex of patients admitted, number and costs of admissions, length of stay, procedures undertaken, class and type of admission, and distribution of admissions across clinical commissioning groups. Results A total of 24 295 inpatient admissions, costing £20 220 576, occurred during the 4-year study period. Most patients were women (89%) with peak age of admission of between 45 and 55 years. Most admissions were elective (92%). A number of invasive therapeutic procedures took place, including a continuous i.v. infusion (35%). There was marked geographical variation in the prevalence and cost of inpatient fibromyalgia care delivered across the country, even after accounting for clinical commissioning group size. Conclusions Many patients are admitted for treatment of their fibromyalgia and given invasive procedures for which there is weak evidence, with significant variation in practice and cost across the country. This highlights the need to identify areas of resource use that can be rationalized and diverted to provide more effective, evidence-based treatment.
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KISELY, STEPHEN, LESLIE ANNE CAMPBELL, ANITA SCOTT, NEIL J. PRESTON, and JIANGUO XIAO. "Randomized and non-randomized evidence for the effect of compulsory community and involuntary out-patient treatment on health service use: systematic review and meta-analysis." Psychological Medicine 37, no. 1 (August 21, 2006): 3–14. http://dx.doi.org/10.1017/s0033291706008592.
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Background. There is limited randomized controlled trial (RCT) evidence for compulsory community treatment. Other study methods may clarify their effectiveness. We reviewed RCT and non-RCT evidence for the effect of compulsory community treatment on hospital admissions, bed-days, compliance and out-patient contacts.Method. A systematic review of RCTs, controlled before-and-after (CBA) studies, and interrupted time series (ITS) analyses. Meta-analysis of RCTs.Results. Eight papers covering five studies (two RCTs and three CBAs) met inclusion criteria (total n=1108). There was no statistical difference in 12-month admission rates between subjects on involuntary out-patient treatment and controls. Survival analyses of time to admission were equivocal. All five studies reported decreases in the number of bed-days following involuntary out-patient treatment but this only reached statistical significance in one situation; patients receiving the intervention were less likely to have admissions of over 100 days. There was no difference in treatment adherence between the intervention and control groups in either RCT or two of the CBA studies. However, the third CBA study reported a statistically significant increase of nearly five visits in the mean number of overall contacts in the involuntary out-patient treatment group.Conclusions. The evidence for involuntary out-patient treatment in reducing either admissions or bed-days is very limited. It therefore cannot be seen as a less restrictive alternative to admission. Other effects are uncertain. Evaluation of a wide range of outcomes should be included if this type of legislation is introduced.
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Raisbeck, Bertram. "Inadmissible Admissions and Unfair Evidence—Time to Reappraise?" Journal of Criminal Law 52, no. 4 (November 1988): 400–405. http://dx.doi.org/10.1177/002201838805200405.
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Kulasegaram, Kulamakan. "Use and ornament: expanding validity evidence in admissions." Advances in Health Sciences Education 22, no. 2 (January 3, 2017): 553–57. http://dx.doi.org/10.1007/s10459-016-9749-7.
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Williams, Vijai, Nishant Jaiswal, Anil Chauhan, Pranita Pradhan, Muralidharan Jayashree, and Meenu Singh. "Time of Pediatric Intensive Care Unit Admission and Mortality: A Systematic Review and Meta-Analysis." Journal of Pediatric Intensive Care 09, no. 01 (November 18, 2019): 001–11. http://dx.doi.org/10.1055/s-0039-3399581.
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AbstractThe aim of this study was to determine the association between the time of admission (day, night, and/or weekends) and mortality among critically ill children admitted to a pediatric intensive care unit (PICU). Electronic databases that were searched include PubMed, Embase, Web of Science, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Ovid, and Cochrane Library since inception till June 15, 2018. The article included observational studies reporting inhospital mortality and the time of admission to PICU limited to patients aged younger than 18 years. Meta-analysis was performed by a frequentist approach with both fixed and random effect models. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach was used to evaluate the quality of evidence. Ten studies met our inclusion criteria. Five studies comparing weekday with weekend admissions showed better odds of survival on weekdays (odds ratio [OR]: 0.77; 95% confidence interval [CI]: 0.60–0.99). Pooled data of four studies showed that odds of mortality were similar between day and night admissions (OR: 0.93; 95% CI: 0.77–1.13). Similarly, three studies comparing admission during off-hours versus regular hours did not show better odds of survival during regular hours (OR: 0.77; 95% CI: 0.57–1.05). Heterogeneity was significant due to variable sample sizes and time period. Inconsistency in adjusting for confounders across the included studies precluded us from analyzing the adjusted risk of mortality. Weekday admissions to PICU were associated with lesser odds of mortality. No significant differences in the odds of mortality were found between admissions during day versus night or between admission during regular hours and that during off-hours. However, the evidence is of low quality and requires larger prospective studies.
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Kurysheva, Anastasia, Harold V. M. van Rijen, and Gönül Dilaver. "How do admission committees select? Do applicants know how they select? Selection criteria and transparency at a Dutch University." Tertiary Education and Management 25, no. 4 (October 19, 2019): 367–88. http://dx.doi.org/10.1007/s11233-019-09050-z.
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Abstract In this study, we investigated the currently applied selective admission criteria and tools of the two-year research master’s programs of both the Graduate Schools of Life Sciences and Natural Sciences of Utrecht University (the Netherlands). In addition, we evaluated their transparency to applicants. Both admissions staff members and applicants participated. To determine admission criteria that are important for admission decisions, we ranked 51 admission criteria and, on their basis, combined into six domains: academic background, grades, cognitive ability, research background, personality and personal competencies, motivation factors. To evaluate transparency, we contrasted the perceptions of applicants with the actual importance of admission criteria, as reported by admission staff members. We found that admissions criteria related to personality and personal competencies are less important in admission decisions than criteria related to grades, academic background and motivation. The applicants find the admissions decisions transparent to a moderate degree. This study also revealed that selectors use criteria and tools both with and without predictive value for later graduate performance. Moreover, some of the currently applied admission instruments might be prone to admission biases. We advocate selectors to use admission criteria and tools that are evidence-based, resistant to admission biases, and transparent to the applicants.
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Liu, Lydia. "Holistic Admissions in Higher Education." Journal of Postsecondary Student Success 1, no. 4 (July 20, 2022): 1–19. http://dx.doi.org/10.33009/fsop_jpss131099.
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As U.S. higher education institutions adapt their admissions policies to advance diversity and inclusion, holistic admissions has taken a center stage in many institutions’ admissions practices. This article provides an overview of the definition of holistic admissions, the differences between holistic admissions and other types of admissions, challenges and promises in implementing holistic review, particularly around the test-optional component, evidence of desired outcomes of holistic admissions, and future research needs.
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Machado, A. S., A. Elias De Sousa, F. Andrade, and M. Vieira-Coelho. "Multiple inpatient admissions for cannabis-induced psychotic disorder - sociodemographic, clinical and treatment evaluation." European Psychiatry 65, S1 (June 2022): S792. http://dx.doi.org/10.1192/j.eurpsy.2022.2046.
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Introduction Current evidence contradicts the idea that cannabis-induced psychotic disorder (CIPD) has an overall benign prognosis, with up to half of these patients being with a schizophrenia spectrum disorder later in life. Objectives To characterize sociodemographic and clinical characteristics and treatment plan of inpatients with multiple admissions for CIPD over a one-year period, compared to those with a single admission. Methods Retrospective observational study of inpatient episodes with CIPD between january 1st 2018 and september 30th 2021 in a tertiary psychiatric inpatient unit. Statistical analysis was performed using SPSS software, version 27.0. Results Our sample included 80 inpatients, 15 (18.8%) with multiple admissions for CIPE within one year period and 65 (81.3%) with a single admission. The multiple admissions group had a median of 1 ±0,915 admissions within the same year. Being readmitted for CIPE was associated with outpatient compulsory treatment at discharge (OR 3,01 (95% CI 1,27-7,18, p=0,034). These patients had 3.14 higher odds of future admissions to psychiatry unit (CI 95% 1.70-5.78, p<0.001). We found no statistically significant differences regarding the sociodemographic and clinical characteristics, daily vs. occasional use of cannabis in patients with multiple admissions for CIPE. Conclusions Patients with multiple admissions for CIPD tend to have more relapses and require assertive treatment measures. However, they did not differ regarding the sociodemographic and clinical characteristics studied from patients with single admissions. This suggests that additional assessment of these patients might be important to predict the course of the disease. Disclosure No significant relationships.
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McDonald, Robert J., Harry J. Cloft, and David F. Kallmes. "Impact of admission month and hospital teaching status on outcomes in subarachnoid hemorrhage: evidence against the July effect." Journal of Neurosurgery 116, no. 1 (January 2012): 157–63. http://dx.doi.org/10.3171/2011.8.jns11324.
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Object The authors sought to identify the presence of a “July effect,” a transient increase in adverse outcomes during July, among a cohort of spontaneous subarachnoid hemorrhage (SAH) admissions recorded in the National Inpatient Sample (NIS). Methods The discharge status, admission month, patient demographics, treatment parameters, and hospital characteristics among spontaneous SAH admissions were extracted from the 2001–2008 NIS. Multivariate regression was used to determine whether an unfavorable discharge status and/or in-hospital mortality significantly increased in summer months in a pattern suggestive of a July effect. Additional models were generated to assess the impact of hospital teaching status on these outcomes. Results Among 57,663,486 hospital admissions from the 2001–2008 NIS, 52,879 cases of spontaneous SAH (ICD-9-CM 430) were treated at teaching (36,914 cases [70%]) and nonteaching (15,965 cases [30%]) facilities. Regression models failed to reveal a July effect for in-hospital mortality (χ2 = 0.75, p = 1.000) or unfavorable discharges (χ2 = 1.69, p = 0.999) among monthly SAH admissions, although they did suggest a significant reduction in these outcomes (in-hospital mortality, OR = 0.89, p < 0.001; unfavorable discharges, OR = 0.88, p < 0.001) among teaching hospitals as compared with nonteaching hospitals after adjustment for disparities in demographic, treatment, and hospital characteristics. Conclusions The discharge disposition among SAH admissions within the NIS was not suggestive of a July effect but did reveal that teaching institutions have significantly lower rates of adverse outcomes when compared with nonteaching hospitals. Note, however, that the origins of this difference related to teaching status remain unclear.
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Ong, Luei Wern, Jeffrey D. Dawson, and John W. Ely. "Black Clouds vs Random Variation in Hospital Admissions." Family Medicine 50, no. 6 (June 8, 2018): 444–49. http://dx.doi.org/10.22454/fammed.2018.555558.
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Background and Objectives: Physicians often accuse their peers of being “black clouds” if they repeatedly have more than the average number of hospital admissions while on call. Our purpose was to determine whether the black-cloud phenomenon is real or explainable by random variation. Methods: We analyzed hospital admissions to the University of Iowa family medicine service from July 1, 2010 to June 30, 2015. Analyses were stratified by peer group (eg, night shift attending physicians, day shift senior residents). We analyzed admission numbers to find evidence of black-cloud physicians (those with significantly more admissions than their peers) and white-cloud physicians (those with significantly fewer admissions). The statistical significance of whether there were actual differences across physicians was tested with mixed-effects negative binomial regression. Results: The 5-year study included 96 physicians and 6,194 admissions. The number of daytime admissions ranged from 0 to 10 (mean 2.17, SD 1.63). Night admissions ranged from 0 to 11 (mean 1.23, SD 1.22). Admissions increased from 1,016 in the first year to 1,523 in the fifth year. We found 18 white-cloud and 16 black-cloud physicians in simple regression models that did not control for this upward trend. After including study year and other potential confounding variables in the regression models, there were no significant associations between physicians and admission numbers and therefore no true black or white clouds. Conclusions: In this study, apparent black-cloud and white-cloud physicians could be explained by random variation in hospital admissions. However, this randomness incorporated a wide range in workload among physicians, with potential impact on resident education at the low end and patient safety at the high end.
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Hoe, Thomas P. "Does Hospital Crowding Matter? Evidence from Trauma and Orthopedics in England." American Economic Journal: Economic Policy 14, no. 2 (May 1, 2022): 231–62. http://dx.doi.org/10.1257/pol.20180672.
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This paper estimates the impact of hospital crowding on medical treatment decisions and patient health outcomes. Exploiting pseudorandom variation in emergency admissions, I find that a one-standard-deviation admission shock increases the unplanned readmission rate by 4.1 percent. Nonparametric and heterogeneity analyses suggest that “quicker and sicker” discharges contribute to the additional readmissions. The crowding impacts are larger in hospital departments with fewer beds, sicker patients, and stronger incentives to admit nonemergency patients. (JEL H51, I11, I12, I18)
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Newlon, Cara, Ian Ayres, and Brian Barnett. "Your Liberty or Your Gun? A Survey of Psychiatrist Understanding of Mental Health Prohibitors." Journal of Law, Medicine & Ethics 48, S4 (2020): 155–63. http://dx.doi.org/10.1177/1073110520979417.
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This first-of-its-kind national survey of 485 psychiatrists in nine states and the District of Columbia (DC) finds substantial evidence of clinicians being uninformed, misinformed, and misinforming patients of their gun rights regarding involuntary commitments and voluntary inpatient admissions. A significant percentage of psychiatrists (36.9%) did not understand that an involuntary civil commitment triggered the loss of gun rights, and the majority of psychiatrists in states with prohibitors on voluntary admissions (57%) and emergency holds (56%) were unaware that patients would lose gun rights upon voluntary admission or temporary commitment. Moreover, the survey found evidence that psychiatrists may use gun rights to negotiate “voluntary” commitments with patients: 15.9% of respondents reported telling patients they could preserve their gun rights by permitting themselves to be voluntarily admitted for treatment, in lieu of being involuntarily committed. The results raise questions of whether psychiatrists obtained full informed consent for voluntary patient admissions, and suggest that some medical providers in states with voluntary admission prohibitor laws may unwittingly deprive their patients of a constitutional right. The study calls into question the fairness of state prohibitor laws as policy, and — at minimum — indicates an urgent need for psychiatrist training on their state gun laws.
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Dolan, Rachel. "Discussion paper: Pregnant women, mothers, mother and baby units and mental health in prison." PsyPag Quarterly 1, no. 100 (September 2016): 32–36. http://dx.doi.org/10.53841/bpspag.2016.1.100.32.
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Over two thirds of women in prison are mothers and many of their children are under the age of five. No current figures exist for the number of women who give birth during imprisonment, but estimates suggest this may be between 100 and 200 women per year. There are currently six mother and baby units (MBUs) across prisons in England where women can stay with their babies up to the age of 18 months. Although there are only 65 places available, and despite the positive impact they can have, they are rarely full. It has been suggested that mental illness may have an impact on the number of admissions, as may the interpretation of the admission criteria. Despite the limited evidence of their benefits, they are the only alternative to separation for imprisoned mothers, and the evidence that is available suggests that more women and babies could benefit from admission. Further research on admissions and the impacts for mothers and children is necessary.
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Cornell, Portia, Emily Corneau, Kate Magid, Patience Moyo, James Rudolph, Cari Levy, and Vincent Mor. "Are Nursing Home Preferred Networks Good for Patients' Outcomes? Evidence From the Veterans Health Administration." Innovation in Aging 5, Supplement_1 (December 1, 2021): 21. http://dx.doi.org/10.1093/geroni/igab046.074.
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Abstract In the Veterans’ Administration (VA), medical centers contract with community nursing homes to provide care to Veterans. As a purchaser, the VA could pursue a strategy of selecting a high-quality network; alternatively, it could focus resources on oversight by its nursing-home coordinators. The question of whether narrow networks are good for Veterans’ outcomes, conditional on quality, therefore, needs empirical investigation. We examined the effect of network concentration on hospital admissions, conditional on Veterans’ clinical acuity. We operationalized network concentration as the number of Veterans already in residence at the time of admission, and controlled for publicly reported quality measure (star rating). We identified 93,805 VA-paid admissions to nursing homes between 2013 to 2016. To address selectin bias, we estimated effects using a distance- based instrumental variable (IV) for each measure, with the log of distance to the nearest nursing home with a specified number of Veterans at the facility in the previous month (1-4, 5-9, and 10-13, and 14+ Veterans). Going to a facility with 10-13 or 14+ Veterans had a higher hospitalization probability (6.2 and 3.3 percentage points higher, respectively), than going to a facility with 1-4 Veterans. If quality rating improves outcomes, then broader networks are beneficial if consumers (Veterans) choose based on quality, given a broader choice set. Conditional on quality, concentrated networks do not seem to lead to fewer hospital admissions. Our results suggest that the VA could do more in its oversight role to work with these nursing homes to decrease hospital admissions.
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Ross, Colin A. "Inpatient Treatment of Multiple Personality Disorder*." Canadian Journal of Psychiatry 32, no. 9 (December 1987): 779–81. http://dx.doi.org/10.1177/070674378703200910.
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Multiple personality disorder (MPD) was once thought to be rare, but there is increasing evidence that it is relatively common. In a period of a year the author had 73 inpatient admissions under his care, of which 8 were for MPD. Three of the MPD admissions were for previously undiagnosed cases in an unselected general adult population. Thus 4.4% of the author's inpatients, once MPD patients diagnosed prior to admission are excluded, had MPD. The implications of this finding are discussed. The diagnosis and inpatient treatment of MPD are reviewed.
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Ismail, Haitham. "Duration of hospital admission in severe mental illness: is longer better?" BJPsych Advances 27, no. 4 (June 24, 2021): 213–18. http://dx.doi.org/10.1192/bja.2021.15.
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SUMMARYA Cochrane review has compared short-stay hospital admission with long-stay/standard admission of patients with severe mental illness for a number of outcomes in a total 2030 participants from 6 randomised trials. It reached the conclusion, supported by limited evidence, that short admissions in mental health units do not increase the risk of death, readmission or worsening of mental state, and pose less risk of delayed discharge and patient's unemployment. This commentary examines the available evidence from previous studies and discusses its relevance to current practice.
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Maguire, James F., P. Pearl O'Rourke, Steven D. Colan, Raif S. Geha, and Robert Crone. "Cardiotoxicity During Treatment of Severe Childhood Asthma." Pediatrics 88, no. 6 (December 1, 1991): 1180–86. http://dx.doi.org/10.1542/peds.88.6.1180.
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We prospectively evaluated 20 patient admissions for severe exacerbation of childhood asthma at The Children's Hospital, Boston, to detect evidence of cardiotoxicity. Evidence of cardiotoxicity was found in all six patient admissions for which isoproterenol infusion was utilized. This included marked elevation of serum creatine phosphokinase isoenzyme (CPK-MB) levels and electrocardiogram abnormalities consistent with transient myocardial ischemia. Peak serum CPK-MB levels were significantly lower and electrocardiogram abnormalities were significantly less frequent during 14 patient admissions for which isoproterenol infusion was not utilized. Risk factors associated with cardiotoxicity included tachycardia, hypercapnia, acidosis, and intravenous isoproterenol therapy. We conclude that cardiotoxicity is not infrequent during therapy for severe exacerbations of childhood asthma. Electrocardiograms and measurement of serum CPK-MB levels are sensitive, useful, and readily obtained indicators of cardiotoxicity. Abnormalities of these studies may detect cardiotoxicity prior to the occurrence of more blatant or catastrophic manifestations of cardiotoxicity. We therefore recommend serial monitoring of serum CPK-MB levels and electrocardiograms for all children requiring an admission to the intensive care unit for management of severe asthmatic exacerbation.
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Winterstein, Almut G., Brian C. Sauer, Charles D. Hepler, and Charles Poole. "Preventable Drug-Related Hospital Admissions." Annals of Pharmacotherapy 36, no. 7-8 (July 2002): 1238–48. http://dx.doi.org/10.1345/aph.1a225.
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OBJECTIVE: To estimate the prevalence of preventable drug-related hospital admissions (PDRAs) and to explore if selected study characteristics affect prevalence estimates. METHODS: Keyword search of MEDLINE (1966–December 1999), International Pharmaceutical Abstracts (1970–December 1999), and hand search. Two reviewers independently selected studies published in peer-reviewed journals and extracted crude prevalence estimates and study characteristics. Trials had to specifically address consequences of drug therapy requiring hospital admission and include a quantitative preventability assessment. Stratified analysis and meta-regression were used to explore the association between study characteristics and prevalence estimates. DATA SYNTHESIS: Fifteen studies reported a median PDRA prevalence of 4.3% (interquartile range [IQR] 3.1–9.5%). The median preventability rate of drug-related admissions was 59% (IQR 50–73%). No evidence of publication bias related to study size could be determined. Because the individual study results were highly heterogeneous (Cochran's Q = 176, df = 14; p < 0.001), no meta-analytic summary estimate was computed. Stratified analysis suggested an association between prevalence estimates and 3 study characteristics: exclusion of first admissions (readmission studies: average PDRA prevalence of 14.0 %, estimated prevalence OR = 3.7); mean age of admissions >70 (OR = 2.1); and inclusion of “indirect” drug-related morbidity, such as omission errors or therapeutic failure (OR = 1.9). There was little evidence of other associations with prevalence estimates, such as selection of specific hospital units, exclusion/inclusion of planned admissions, country, and specified methods of PDRA case ascertainment. CONCLUSIONS: Drug-related morbidity is a significant healthcare problem, and a great proportion is preventable. Study methods in prevalence reports vary and should be considered when interpreting findings or planning future research.
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Howe, Amanda, and Sam Leinster. "Evidence-based admissions may limit ambitions to widen access." Medical Education 36, no. 4 (April 2002): 394–95. http://dx.doi.org/10.1046/j.1365-2923.2002.1178j.x.
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ENGELBERG, JOSEPH, and CHRISTOPHER A. PARSONS. "Worrying about the Stock Market: Evidence from Hospital Admissions." Journal of Finance 71, no. 3 (May 11, 2016): 1227–50. http://dx.doi.org/10.1111/jofi.12386.
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Berkowitz, Daniel, and Mark Hoekstra. "Does high school quality matter? Evidence from admissions data." Economics of Education Review 30, no. 2 (April 2011): 280–88. http://dx.doi.org/10.1016/j.econedurev.2010.10.001.
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Russell, M., B. Clarke, S. Rampes, K. Dokal, A. Mahto, A. Rutherford, and J. Galloway. "THU0438 INADEQUATE CARE FOR PATIENTS HOSPITALISED WITH GOUT: EVIDENCE THAT EULAR GUIDANCE IS NOT UTILISED." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 456.2–456. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3951.
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Background:Hospitalisations due to gout have increased over the last decade, in direct contrast to declining admissions for other inflammatory arthritides including RA [1]. Gout is a treatable condition with recently published EULAR guidelines [2, 3]. Admissions could be avoided with effective use of urate-lowering therapies (ULT).Objectives:We hypothesised that the majority of patients attending hospital with acute gout attacks would not be on ULT. Furthermore, we hypothesised that the majority of patients would not be provided with a plan for ULT commencement and/or uptitration on discharge, leaving them at risk of further hospitalisations.Methods:We retrospectively analysed electronic health records for all patients presenting acutely with a primary admission diagnosis of gout (ICD-10 code: M10) at two hospitals in London, UK, from January – December 2017. Analyses of in-hospital gout management were performed for these patients, including to ascertain the number and proportion of patients who: i) had a known history of gout; ii) were receiving ULT at time of attendance; iii) were provided with a discharge plan for ULT commencement and/or uptitration.Results:Over a 12-month period, there were 234 emergency attendances for gout in 225 individuals. 80% were male, with a mean age of 58 years. 70/234 (30%) attendances resulted in admission to hospital (mean length of stay: 2 days; range: 0-31 days). 211 patients had routinely captured clinical data available for further analysis. 90/211 (43%) patients had prior diagnoses of gout, of whom 38% were on ULT at presentation (32 allopurinol, 2 febuxostat). 38% of patients were discharged with a plan for ULT commencement and/or uptitration. 20 patients re-presented to hospital with acute gout within 12 months (17/20 were not receiving ULT).Conclusion:Most patients hospitalised with gout were not receiving ULT, even those with a prior history of gout attacks. Few were provided with a ULT plan, leaving them at risk of re-admission to hospital. Hospital admissions are unpleasant for patients and incur a high economic burden for health services; if they are to be prevented, there must be a concerted effort to implement and follow gout management guidelines to ensure patients receive ULT at appropriate doses.References:[1]Russell M,et al. Return of the King: Rising Incidence of Acute Hospital Admissions due to Gout. J Rheum 2019 Sep 15.[2]Richette P, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2017;76:29-42.[3]Richette P, et al. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Ann Rheum Dis 2020;79:31-38.Disclosure of Interests: :None declared
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Shaw, Graham P., and Jonathan Coffman. "Components of an Evidence-Based Analytic Rubric for Use in Medical School Admissions." Journal of the American Podiatric Medical Association 107, no. 1 (January 1, 2017): 65–71. http://dx.doi.org/10.7547/16-008.
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Attrition from medical school remains a serious cause of concern for the medical education community. Thus, there is a need to improve our ability to select only those candidates who will succeed at medical school from many highly qualified and motivated applicants. This can be achieved, in part, by reducing the reliance on cognitive factors and increasing the use of noncognitive character traits in high-stakes admissions decisions. Herein we describe an analytic rubric that combines research-derived predictors of medical school success to generate a composite score for use in admissions decisions. The analytic rubric as described herein represents a significant step toward evidenced-based admissions that will facilitate a more consistent and transparent qualitative evaluation of medical school applicants beyond their grades and Medical College Admissions Test scores and contribute to a redesigned and improved admissions process.
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Ofori-Asenso, Richard, Danny Liew, Johan Mårtensson, and Daryl Jones. "The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia." Journal of Clinical Medicine 9, no. 9 (September 22, 2020): 3055. http://dx.doi.org/10.3390/jcm9093055.
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Background: Limited available evidence suggests that a small proportion of inpatients undergo prolonged hospitalization and use a disproportionate number of bed days. Understanding the factors contributing to prolonged hospitalization may improve patient care and reduce the length of stay in such patients. Methods: We undertook a retrospective cohort study of adult (≥20 years) patients admitted for at least 24 h between 14 November 2016 and 14 November 2018 to hospitals in Victoria, Australia. Data including baseline demographics, admitting specialty, survival status and discharge disposition were obtained from the Victorian Admission Episode Dataset. Multivariable logistic regression analysis was used to identify factors independently associated with prolonged hospitalization (≥14 days). Cox proportional hazard regression model was used to examine the association between various factors and in-hospital mortality. Results: There were almost 5 million hospital admissions over two years. After exclusions, 1,696,112 admissions lasting at least 24 h were included. Admissions with prolonged hospitalization comprised only 9.7% of admissions but utilized 44.2% of all hospital bed days. Factors independently associated with prolonged hospitalization included age, female gender, not being in a relationship, being a current smoker, level of co-morbidity, admission from another hospital, admission on the weekend, and the number of admissions in the prior 12 months. The in-hospital mortality rate was 5.0% for those with prolonged hospitalization compared with 1.8% in those without (p < 0.001). Prolonged hospitalization was also independently associated with a decreased likelihood of being discharged to home (OR 0.53, 95% CI 0.52–0.54). Conclusions: Patients experiencing prolonged hospitalization utilize a disproportionate proportion of bed days and are at higher risk of in-hospital death and discharge to destinations other than home. Further studies are required to identify modifiable factors contributing to prolonged hospitalization as well as the quality of end-of-life care in such admissions.
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Longman, Jo M., Elizabeth Rix, Jennifer J. Johnston, and Megan E. Passey. "Ambulatory care sensitive chronic conditions: what can we learn from patients about the role of primary health care in preventing admissions?" Australian Journal of Primary Health 24, no. 4 (2018): 304. http://dx.doi.org/10.1071/py17191.
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Developing and targeting interventions to reduce hospital admissions for ambulatory care sensitive (ACS) chronic conditions for older people is a key focus for improvement of the health system. To do this, an understanding of any modifiable factors that may contribute to such admissions is needed. To date, the literature on ACS admissions has rarely included the patient perspective. This qualitative study involved one-to-one telephone interviews with 24 patients aged ≥45 years who had had an unplanned admission for an ACS chronic condition to one of two participating regional hospitals between February and August 2015. Data were transcribed and analysed thematically. Most participants did not perceive their admission to be preventable, yet they described a series of interlinking factors, which may have contributed to their admission and which may offer potential points of leverage. Key interlinked themes interpreted were: ‘support deficits’, ‘non-adherence to treatment’ (including medication), ‘mental health’ and ‘lack of awareness or understanding of condition’. Improving system-, clinician- and patient-level factors within a framework of appropriately resourced and supported comprehensive primary health care that is accessible, affordable, holistic, practical and evidence-based may contribute to improving patients’ quality of life and to delaying or preventing hospital admission.
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Mander, Anthony J. "The manic readmissions explosion in Edinburgh." Irish Journal of Psychological Medicine 9, no. 1 (May 1992): 26–29. http://dx.doi.org/10.1017/s0790966700013872.
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AbstractBetween 1975 and 1985 there was a significant increase in the total number of admissions for mania and schizophrenia and a significant decrease for personality disorder to the Royal Edinburgh Hospital. All admissions for 1975 and 1985 in these three groups were subsequently examined retrospectively. The number of first admissions for personality disorder dropped significantly and the number of readmissions for mania increased significantly. Patients with schizophrenia and personality disorder had shorter admissions and a shorter relapse-free interval in 1985 but the overall effect of these changes was to reduce the total number of bed days used by these groups. For mania there was no change in admission length but significant shortening of the relapse-free interval leading to a substantial increase in total bed days used. There was no evidence that a change of diagnostic practice had occurred or that patients admitted with mania in 1985 were less ill. Although there were changes in referral and after-care arrangements, these were not specific to mania. Further work should specifically address the issue of aftercare arrangements and their influence on prognosis in mania, and the resource implications of the continuing rise in admissions.
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Shepherd, H., G. Livingston, J. Chan, and A. Sommerlad. "111 Rates and Risk Factors for Hospital Admission in People With Dementia: Systematic Review." Age and Ageing 49, Supplement_1 (February 2020): i38. http://dx.doi.org/10.1093/ageing/afz198.
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Abstract Background Hospitalisation is often harmful for people with dementia and results in high societal costs, so avoidance of unnecessary admissions is a global priority. However, no intervention has yet reduced admissions of community-dwelling people with dementia. We therefore aimed to examine hospitalisation rates of people with dementia and whether these differ from people without dementia, and to identify socio-demographic and clinical predictors of hospitalisation. Methods We searched MEDLINE, Embase and PsycINFO from inception to May 9, 2019. We included observational studies which (1) examined community-dwelling people with dementia of any age or dementia subtype, (2) diagnosed dementia using validated diagnostic criteria, and (3) examined all-cause general (i.e. non-psychiatric) hospital admissions. Two authors screened abstracts for inclusion and independently extracted data and assessed included studies for risk of bias. Three authors graded evidence strength using Cochrane’s GRADE approach, including assessing for evidence of publication bias using Begg’s test. We used random effects meta-analysis to pool estimates for hospitalisation risk in people with and without dementia. Results We included 34 studies of 277,432 people with dementia; 17 from US, 15 from Europe and 2 from Asia. Pooled relative risk of hospitalisation for people with dementia compared to those without was 1.42 (95% confidence interval 1.21, 1.66) in studies adjusted for age, sex, and physical comorbidity. Hospitalisation rates in people with dementia was between 0.37 and 1.26/person-year in high-quality studies. There was strong evidence that admission is associated with older age, and moderately strong evidence that multimorbidity, polypharmacy, and lower functional ability are associated with admission. There was strong evidence that dementia severity alone is not associated. Conclusions People with dementia are more frequently admitted to hospital than those without dementia, independent of physical comorbidities. Future interventions to reduce unnecessary hospitalisations should target potentially-modifiable factors, such as polypharmacy and functional ability, in high-risk populations.
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Carpenter, Rebecca A., Jara Falkenburg, Thomas P. White, and Derek K. Tracy. "Crisis teams: systematic review of their effectiveness in practice." Psychiatrist 37, no. 7 (July 2013): 232–37. http://dx.doi.org/10.1192/pb.bp.112.039933.
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Aims and methodCrisis resolution and home treatment teams (variously abbreviated to CRTs, CRHTTs, HTTs) were introduced to reduce the number and duration of in-patient admissions and better manage individuals in crisis. Despite their ubiquity, their evidence base is challengeable. This systematic review explored whether CRTs: (a) affected voluntary and compulsory admissions; (b) treat particular patient groups; (c) are cost-effective; and (d) provide care patients value.ResultsCrisis resolution teams appear effective in reducing admissions, although data are mixed and other factors have also influenced this. Compulsory admissions may have increased, but evidence that CRTs are causally related is inconclusive. There are few clinical differences between ‘gate-kept’ patients admitted and those not. Crisis resolution teams are cheaper than in-patient care and, overall, patients are satisfied with CRT care.Clinical implicationsHigh-quality evidence for CRTs is scarce, although they appear to contribute to reducing admissions. Patient-relevant psychosocial and longitudinal outcomes are under-explored.
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Chen, Yen-Fu, Xavier Armoiry, Caroline Higenbottam, Nicholas Cowley, Ranjna Basra, Samuel Ian Watson, Carolyn Tarrant, et al. "Magnitude and modifiers of the weekend effect in hospital admissions: a systematic review and meta-analysis." BMJ Open 9, no. 6 (June 2019): e025764. http://dx.doi.org/10.1136/bmjopen-2018-025764.
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ObjectiveTo examine the magnitude of the weekend effect, defined as differences in patient outcomes between weekend and weekday hospital admissions, and factors influencing it.DesignA systematic review incorporating Bayesian meta-analyses and meta-regression.Data sourcesWe searched seven databases including MEDLINE and EMBASE from January 2000 to April 2015, and updated the MEDLINE search up to November 2017. Eligibility criteria: primary research studies published in peer-reviewed journals of unselected admissions (not focusing on specific conditions) investigating the weekend effect on mortality, adverse events, length of hospital stay (LoS) or patient satisfaction.ResultsFor the systematic review, we included 68 studies (70 articles) covering over 640 million admissions. Of these, two-thirds were conducted in the UK (n=24) or USA (n=22). The pooled odds ratio (OR) for weekend mortality effect across admission types was 1.16 (95% credible interval 1.10 to 1.23). The weekend effect appeared greater for elective (1.70, 1.08 to 2.52) than emergency (1.11, 1.06 to 1.16) or maternity (1.06, 0.89 to 1.29) admissions. Further examination of the literature shows that these estimates are influenced by methodological, clinical and service factors: at weekends, fewer patients are admitted to hospital, those who are admitted are more severely ill and there are differences in care pathways before and after admission. Evidence regarding the weekend effect on adverse events and LoS is weak and inconsistent, and that on patient satisfaction is sparse. The overall quality of evidence for inferring weekend/weekday difference in hospital care quality from the observed weekend effect was rated as ‘very low’ based on the Grading of Recommendations, Assessment, Development and Evaluations framework.ConclusionsThe weekend effect is unlikely to have a single cause, or to be a reliable indicator of care quality at weekends. Further work should focus on underlying mechanisms and examine care processes in both hospital and community.Prospero registration numberCRD42016036487
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Jessup, Rebecca L., Anita A. Spring, and Aspa Grollo. "Current practice in the assessment and management of acute diabetes-related foot complications." Australian Health Review 31, no. 2 (2007): 217. http://dx.doi.org/10.1071/ah070217.
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A retrospective audit of client histories from 1 April 2004 to 31 March 2005 was conducted. Assessment, investigations on admission, management, length of stay and outcomes were assessed and compared with evidence-based guidelines. A total of 62 clients with 115 admissions were identified. The finding that HBA1c (glycated haemoglobin) levels were measured on admission 50% of the time suggested there is significant variability in assessment, investigation and management of acute diabetes-related foot complications. There is a need to better utilise evidence-based clinical guidelines, and for greater emphasis on linking individuals who are at risk of hospitalisation into appropriate outpatient services to improve outcomes.
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Rajapakse, Thilini, Tharuka Silva, Nirosha Madhuwanthi Hettiarachchi, David Gunnell, Chris Metcalfe, Matthew J. Spittal, and Duleeka Knipe. "The Impact of the COVID-19 Pandemic and Lockdowns on Self-Poisoning and Suicide in Sri Lanka: An Interrupted Time Series Analysis." International Journal of Environmental Research and Public Health 20, no. 3 (January 19, 2023): 1833. http://dx.doi.org/10.3390/ijerph20031833.
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Evidence from high-income countries suggests that the impact of COVID-19 on suicide and self-harm has been limited, but evidence from low- and middle-income countries is lacking. Using data from a hospital-based self-poisoning register (January 2019–December 2021) and data from national records (2016–2021) of suicide in Sri Lanka, we aimed to assess the impact of the pandemic on both self-poisoning and suicide. We examined changes in admissions for self-poisoning and suicide using interrupted time series (ITS) analysis. For the self-poisoning hospital admission ITS models, we defined the lockdown periods as follows: (i) pre-lockdown: 01/01/2019–19/03/2020; (ii) first lockdown: 20/03/2020–27/06/2020; (iii) post-first lockdown: 28/06/2020–11/05/2021; (iv) second lockdown: 12/05/2021–21/06/2021; and (v) post-second lockdown: 22/06/2021–31/12/2021. For suicide, we defined the intervention according to the pandemic period. We found that during lockdown periods, there was a reduction in hospital admissions for self-poisoning, with evidence that admission following self-poisoning remained lower during the pandemic than would be expected based on pre-pandemic trends. In contrast, there was no evidence that the rate of suicide in the pandemic period differed from that which would be expected. As the long-term socioeconomic impacts of the pandemic are realised, it will be important to track rates of self-harm and suicide in LMICs to inform prevention.
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Roe, James, Josephine Holland, Anne-Marie Burn, Elinor Hopkin, Lorna Wild, Michelle Fisher, Saeed Nazir, et al. "Experiences and impact of psychiatric inpatient admissions far away from home: a qualitative study with young people, parents/carers and healthcare professionals." BMJ Mental Health 27, no. 1 (January 2024): e300991. http://dx.doi.org/10.1136/bmjment-2024-300991.
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BackgroundThere are significant clinical, policy and societal concerns about the impact on young people (YP), from admission to psychiatric wards far from home. However, research evidence is scarce.AimsTo investigate the impact of at-distance admissions to general adolescent units, from the perspectives of YP, parents/carers and healthcare professionals (HCPs) including service commissioners, to inform clinical practice, service development and policy.MethodSemistructured interviews with purposive samples of YP aged 13–17 years (n=28) and parents/carers (n=19) across five large regions in England, and a national sample of HCPs (n=51), were analysed using a framework approach.ResultsThere was considerable agreement between YP, parents/carers and HCPs on the challenges of at-distance admissions. YP and parents/carers had limited or no involvement in decision-making processes around admission and highlighted a lack of available information about individual units. Being far from home posed challenges with maintaining home contact and practical/financial challenges for families visiting. HCPs struggled with ensuring continuity of care, particularly around maintaining access to local clinical teams and educational support. However, some YP perceived separation from their local environment as beneficial because it removed them from unhelpful environments. At-distance admissions provided respite for some families struggling to support their child.ConclusionsAt-distance admissions lead to additional distress, uncertainty, compromised continuity of care and educational, financial and other practical difficulties, some of which could be better mitigated. For a minority, there are some benefits from such admissions.Clinical implicationsStandardised online information, accessible prior to admission, is needed for all Child and Adolescent Mental Health Services units. Additional practical and financial burden placed on families needs greater recognition and consideration of potential sources of support. Policy changes should incorporate findings that at-distance or adult ward admissions may be preferable in certain circumstances.
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Kosky, Nick, and Tom Burns. "Patient access to psychiatric records: experience in an in-patient unit." Psychiatric Bulletin 19, no. 2 (February 1995): 87–90. http://dx.doi.org/10.1192/pb.19.2.87.
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Forty of 46 consecutive admissions to a psychiatric inpatient unit were encouraged to read their admission notes and discuss them with the Junior doctor. The offer was withheld for two patients with organic impairment. Twenty-eight patients (including 12 on compulsory admissions) accepted the offer. The 12 who refused were characterised by overall lower educational attainment. Diagnosis raised only a few problems, prognosis and maintenance treatment being the focus of most discussions. There was no evidence of a deterioration in the quality of notes or therapeutic relationships as a consequence of access. Only in one case was the exercise judged ‘harmful’, but ‘useful or essential’ in 22. Possible benefits for both patients and doctor are explored.
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Comans, Tracy A., Nancye M. Peel, Ian D. Cameron, Leonard Gray, and Paul A. Scuffham. "Healthcare resource use in patients of the Australian Transition Care Program." Australian Health Review 39, no. 4 (2015): 411. http://dx.doi.org/10.1071/ah14054.
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Objective The aim of the present study was to describe, from the perspective of the healthcare funder, the cost components of the Australian Transition Care Program (TCP) and the healthcare resource use and costs for a group of transition care clients over a 6-month period following admission to the program. Methods A prospective cohort observational study of 351 consenting patients entering community-based transition care at six sites in two states in Australia from November 2009 to September 2010 was performed. Patients were followed up 6 months after admission to the TCP to ascertain current living status and hospital re-admissions over the follow-up period. Cost data were collected by transition care teams and from administrative data (hospital and Medicare records). Results The TCP provides a range of services with most costs attributed to provision of personal care support, case management, physiotherapy and occupational therapy. Most healthcare costs up to 6 months after transition care admission were incurred from the hospital admission leading to transition care and from re-admissions. Orthopaedic conditions incurred the highest costs, with many of these for elective procedures and others resulting from falls. Hospital re-admission rates in the present study were 10% lower than in a previous evaluation of the TCP. Over 6 months, approximately 40% of patients in the study were re-admitted to hospital at an average cost of A$7038. Conclusions Although the cost of the TCP is relatively high, it may have some impact on reducing hospital re-admissions and preventing or delaying residential care admissions. What is known about the topic? A majority of healthcare costs occur in older age. What does this paper add? Hospital costs, both initial and re-admissions, are the major contributor to healthcare costs in transition care recipients. Orthopaedic conditions are the most expensive to treat and neurological conditions are the most variable. What are the implications for practitioners? Reducing the length of hospitalisation and reducing re-admissions for older frail people is a key economic concern for health services. Services such as the TCP aim to do both; however, the evidence that this is effective is limited. Streamlining referrals to transition care to enable earlier access and involving the transition care provider in re-admission decisions may help reduce healthcare costs in future.
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Conway-Klaassen, Janice M. "An Evidence-Supported Medical Laboratory Science Program Admissions Selection Process." American Society for Clinical Laboratory Science 29, no. 4 (October 2016): 227–36. http://dx.doi.org/10.29074/ascls.29.4.227.
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