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Venkatesan, Gayathri, Scott Weich, Orla McBride, Liz Twigg, Helen Parsons, Jan Scott, Kamaldeep Bhui, and Patrick Keown. "Size and clustering of ethnic groups and rates of psychiatric admission in England." BJPsych Bulletin 42, no. 4 (May 11, 2018): 141–45. http://dx.doi.org/10.1192/bjb.2018.17.
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Aims and methodTo compare rates of admission for different types of severe mental illness between ethnic groups, and to test the hypothesis that larger and more clustered ethnic groups will have lower admission rates. This was a descriptive study of routinely collected data from the National Health Service in England.ResultsThere was an eightfold difference in admission rates between ethnic groups for schizophreniform and mania admissions, and a fivefold variation in depression admissions. On average, Black and minority ethnic (BME) groups had higher rates of admission for schizophreniform and mania admissions but not for depression. This increased rate was greatest in the teenage years and early adulthood. Larger ethnic group size was associated with lower admission rates. However, greater clustering was associated with higher admission rates.Clinical implicationsOur findings support the hypothesis that larger ethnic groups have lower rates of admission. This was a between-group comparison rather than within each group. Our findings do not support the hypothesis that more clustered groups have lower rates of admission. In fact, they suggest the opposite: groups with low clustering had lower admission rates. The BME population in the UK is increasing in size and becoming less clustered. Our results suggest that both of these factors should ameliorate the overrepresentation of BME groups among psychiatric in-patients. However, this overrepresentation continues, and our results suggest a possible explanation, namely, changes in the delivery of mental health services, particularly the marked reduction in admissions for depression.Declaration of interestNone.
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Kim, Anna M., Kyle C. Rossi, Nathalie Jetté, Ji Yeoun Yoo, Kenneth Hung, and Mandip S. Dhamoon. "Increased risk of hospital admission for mood disorders following admission for epilepsy." Neurology 91, no. 9 (August 1, 2018): e800-e810. http://dx.doi.org/10.1212/01.wnl.0000542492.00605.9d.
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ObjectiveTo determine if epilepsy admissions, compared to admissions for other medical causes, are associated with a higher readmission risk for mood disorders.MethodsThe Nationwide Readmissions Database is a nationally representative dataset comprising 49% of US hospitalizations in 2013. In this retrospective cohort study, we used ICD-9-CM codes to identify medical conditions. Index admissions for epilepsy (n = 58,278) were compared against index admissions for stroke (n = 215,821) and common medical causes (n = 973,078). Readmission rates (per 100,000 index admissions) for depression or bipolar disorders within 90 days from discharge for index hospitalization were calculated. Cox regression was used to test for associations between admission type (defined in 3 categories as above) and readmission for depression or bipolar disorder up to 1 year after index admission, in univariate models and adjusted for age, sex, psychiatric history, drug abuse, income quartile of patient's zip code, and index hospitalization characteristics.ResultsThe adjusted hazard ratio (HR) for readmission for depression in the epilepsy group was elevated at 2.80 compared to the stroke group (95% confidence interval [CI] 2.39–3.27, p < 2 × 10−16), and 2.09 compared to the medical group (95% CI 1.88–2.32, p < 2 × 10−16). The adjusted HR for readmission for bipolar disorder in the epilepsy group was elevated at 5.84 compared to the stroke group (95% CI 4.56–7.48, p < 2 × 10−16), and 2.46 compared to the medical group (95% CI 2.16–2.81, p < 2 × 10−16).ConclusionAdmission for epilepsy was independently associated with subsequent hospital readmission for mood disorders. The magnitude of elevated risk in this population suggests that patients admitted with epilepsy may warrant targeted psychiatric screening during their hospital admission.
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Sullivan, Ellen E. "Development of a preoperative admission group." Journal of PeriAnesthesia Nursing 20, no. 2 (April 2005): 132–34. http://dx.doi.org/10.1016/j.jopan.2005.01.004.
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Rushworth, R. Louise, Georgina L. Chrisp, Benjamin Dean, Henrik Falhammar, and David J. Torpy. "Hospitalisation in Children with Adrenal Insufficiency and Hypopituitarism: Is There a Differential Burden between Boys and Girls and between Age Groups?" Hormone Research in Paediatrics 88, no. 5 (2017): 339–46. http://dx.doi.org/10.1159/000479370.
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Background/Aims: To determine the burden of hospitalisation in children with adrenal insufficiency (AI)/hypopituitarism in Australia. Methods: A retrospective study of Australian hospitalisation data. All admissions between 2001 and 2014 for patients aged 0–19 years with a principal diagnosis of AI/hypopituitarism were included. Denominator populations were extracted from national statistics datasets. Results: There were 3,779 admissions for treatment of AI/hypopituitarism in patients aged 0–19 years, corresponding to an average admission rate of 48.7 admissions/million/year. There were 470 (12.4%) admissions for an adrenal crisis (AC). Overall, admission for AI/hypopituitarism was comparable between the sexes. Admission rates for all AI, hypopituitarism, congenital adrenal hyperplasia (CAH), and “other and unspecified causes” of AI were highest among infants and decreased with age. Admissions for primary AI increased with age in both sexes. Males had significantly higher rates of admission for hypopituitarism. AC rates differed by both sex and age group. Conclusion: This nationwide study of the epidemiology of hospital admissions for a principal diagnosis of AI/hypopituitarism shows that admissions generally decreased with age; males had higher rates of admission for hypopituitarism; females had higher rates of admission for CAH and “other and unspecified causes” of AI; and AC incidence varied by age and sex. Increased awareness of AI and AC prevention strategies may reduce some of these admissions.
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Geczy, Bela, and Janice Sultenfuss. "Group Psychotherapy on State Hospital Admission Wards." International Journal of Group Psychotherapy 45, no. 1 (January 1995): 1–15. http://dx.doi.org/10.1080/00207284.1995.11491265.
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Wood, Kate, and Jeremy Anderson. "The Effect on Hospital Admissions of Psychiatric Case Management Involving General Practitioners: Preliminary Results." Australian & New Zealand Journal of Psychiatry 29, no. 2 (June 1995): 223–29. http://dx.doi.org/10.1080/00048679509075914.
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A two year follow-up of two matched groups of subjects with chronic severe mental illness was performed in order to evaluate a new psychiatric case management system. One group (n=59) received care through psychiatric case management, using an assertive community treatment model that directly involved general practitioners. The other group, matched for age, sex, diagnostic group and number of hospital admissions, received standard outpatient care. Comparing the two years before and after case management, the experimental group showed a dramatic fall in inpatient admission days while the control group admission days remained the same (median difference in admission days across matched subject pairs = 64.5, 95% C.I. from 134.5 to 16). The experimental group remained out of hospital longer before first readmission (Kaplan-Meier survival analysis, P=0.002). This type of case management programme can shorten or prevent admissions to psychiatric hospitals of patients with chronic mental illness, and increase their time before readmission.
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Zhang, Yan, Yadong Niu, and Liang Zhang. "Determinants of patient choice for hospital readmission after township hospitalisation: a population-based retrospective study in China." BMJ Open 8, no. 8 (August 2018): e021516. http://dx.doi.org/10.1136/bmjopen-2018-021516.
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ObjectiveThe lack of coordinated and appropriate healthcare across sectors has produced more patients for county hospitals in China. This study examined differences in patient choice between township and county hospitals for readmission after a first township hospitalisation, and the determinants that influenced this choice.DesignA retrospective study of readmissions across hospitals after a first admission in township hospital. A township–township (TT) inpatient group and a township–county (TC) inpatient group were compared. A two-level logistic regression model was used to examine the determinants of choice for hospital readmission.SettingData were drawn from a population-based health utilisation database for Qianjiang District, China, from 1 January 2008 to 31 December 2013.ParticipantsThis study focused on readmitted patients whose first admission was in a township hospital. Readmission cases were identified as the same diagnosis (International Classification of Diseases, Tenth Revision) in a subsequent hospitalisation within 30 days. In total, 6764 readmissions had first admissions in township hospitals.Primary outcome measuresPatient choice for hospital readmission after a first township hospitalisation.ResultsThe TT group accounted for 62.5% (4225) and the TC group for 37.5% (2539) of readmissions in 6 years, and the proportion of TC readmissions in total inpatients increased from 1.66% to 1.89%. Readmission rates varied among towns (p<0.001). Differences between the TC and TT groups included: length of stay (LOS) of first admission (6.96 days vs 9.23 days), average interval between admissions (6.03 days vs 14.95 days) and disease category. Admission year, age, travel time to county hospital, interval between admissions, first admission LOS and disease category were determinants of choice for hospital readmission.ConclusionsPatients whose first admission was in a township hospital were more likely to be readmitted to a county hospital. A combination of first LOS and interval between admissions may be an effective identification index for TC readmission.Trial registration numberChiCTR-OOR-14005563.
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Carter, Gregory L., Kerrie Clover, Ian M. Whyte, Andrew H. Dawson, and Catherine D'Este. "Postcards from the EDge: 5-year outcomes of a randomised controlled trial for hospital-treated self-poisoning." British Journal of Psychiatry 202, no. 5 (May 2013): 372–80. http://dx.doi.org/10.1192/bjp.bp.112.112664.
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BackgroundRepetition of hospital-treated self-poisoning and admission to psychiatric hospital are both common in individuals who self-poison.AimsTo evaluate efficacy of postcard intervention after 5 years.MethodA randomised controlled trial of individuals who have self-poisoned: postcard intervention (eight in 12 months) plus treatment as usualv.treatment as usual. Our primary outcomes were self-poisoning admissions and psychiatric admissions (proportions and event rates).ResultsThere was no difference between groups for any repeat-episode self-poisoning admission (intervention group: 24.9%, 95% CI 20.6-29.5; control group: 27.2%, 95% CI 22.8-31.8) but there was a significant reduction in event rates (incidence risk ratio (IRR)=0.54, 95% CI 0.37-0.81), saving 306 bed days. There was no difference for any psychiatric admission (intervention group: 38.1%, 95% CI 33.1-43.2; control group: 35.5%, 95% CI 30.8-40.5) but there was a significant reduction in event rates (IRR=0.66, 95% CI 0.47-0.91), saving 2565 bed days.ConclusionsA postcard intervention halved self-poisoning events and reduced psychiatric admissions by a third after 5 years. Substantial savings occurred in general hospital and psychiatric hospital bed days.
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Farrell, Mary. "Admission and exclusion." Ata: Journal of Psychotherapy Aotearoa New Zealand 10, no. 1 (August 30, 2004): 98–104. http://dx.doi.org/10.9791/ajpanz.2004.10.
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The rules of belonging to a group can be clear and transparent or hidden and opaque. This paper examines some of the problems that can be experienced by members and provisional members of NZAP and draws analogies with Shakespeare's Hamlet. Of particular interest are the play's themes of protocol, power, betrayal and hypocrisy and how they can affect large group interaction. The pain and shame of self-consciousness and of feeling excluded can result in continuing difficulties when we meet together in large groups.
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Knox, S., R. S. Bhopal, C. S. Thomson, A. Millard, A. Fraser, L. Gruer, and D. Buchanan. "The challenge of using routinely collected data to compare hospital admission rates by ethnic group: a demonstration project in Scotland." Journal of Public Health 42, no. 4 (December 28, 2019): 748–55. http://dx.doi.org/10.1093/pubmed/fdz175.
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Abstract Background Recording patients’ ethnic group supports efforts to achieve equity in health care provision. Before the Equality Act (2010), recording ethnic group at hospital admission was poor in Scotland but has improved subsequently. We describe the first analysis of the utility of such data nationally for monitoring ethnic variation. Methods We analysed all in-patient or day case hospital admissions in 2013. We imputed missing data using the most recent ethnic group recorded for a patient from 2009 to 2015. For episodes lacking an ethnic code, we attributed known ethnic codes proportionately. Using the 2011 Census population, we calculated rates and rate ratios for all-cause admissions and ischaemic heart diseases (IHDs) directly standardized for age. Results Imputation reduced missing ethnic group codes from 24 to 15% and proportionate redistribution to zero. While some rates for both all-cause and IHD admissions appeared plausible, unexpectedly low or high rates were observed for several ethnic groups particularly amongst White groups and newly coded groups. Conclusions Completeness of ethnicity recoding on hospital admission records has improved markedly since 2010. However the validity of admission rates based on these data is variable across ethnic groups and further improvements are required to support monitoring of inequality.
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Sharma, Preeti, Nikita Gandotra, Deepti Rana, Sabia Rasheed, and Anil Kumar Sharma. "Correlation of admission labour admission test in low risk pregnancies with pregnancy outcome." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 5 (April 29, 2019): 1880. http://dx.doi.org/10.18203/2320-1770.ijrcog20191936.
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Background: Aim of the study was to evaluate the role of NST (labour admission test) as a screening method in management of low risk pregnancies and to study the correlation of NST with fetal outcome.Methods: A prospective observational study conducted over 500 patients managed at our centre after proper evaluation. Patients were evaluated for mode of delivery and neonatal outcome.Results: The maximum number 352 of patients belonged to 20-30 years age group, 113 patients belonged to 31-35 age group. 200 patients were of 37-40 weeks gestation and 185 were of 40-41 weeks gestation. There were 125 patients in the 41-42 weeks gestational period. Among the 500 pregnant mothers who were included in the study 82.6% had Normal NST, 11.6% had suspicious and 5.8% had pathological NST. Cesarean rate was 14.4% in normal NST group, 58.62% in suspicious group and 72.41% in pathological group study. 6.77% in Normal group had meconium stained liquor at delivery whereas 29.31% in suspicious group and 37.93% in pathological group had same.Conclusions: The non-stress test is an important screening tool to identity the fetus in jeopardy in utero. This enables an appropriate timely intervention to achieve the most favorable outcome.
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Tseng, Pei-Ying, Xin-Yu Xie, Ching-Chi Hsu, Sarina Hui-Lin Chien, Jen-De Chen, and Jong-Yi Wang. "Investigating Medical Cost and Mortality Among Psychiatric Patients Involuntary Admissions: A Nationwide Propensity Score-Matched Study." Psychiatry Investigation 19, no. 7 (July 25, 2022): 527–37. http://dx.doi.org/10.30773/pi.2021.0219.
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Objective Involuntary admission to psychiatric inpatient care can protect both patients with severe mental illnesses and individuals around them. This study analyzed annual healthcare costs per person for involuntary psychiatric admission and examined categories of mental disorders and other factors associated with mortality.Methods This retrospective cohort study collected 1 million randomly sampled beneficiaries from the National Health Insurance Database for 2002–2013. It identified and matched 181 patients with involuntary psychiatric admissions (research group) with 724 patients with voluntary psychiatric admissions (control group) through 1:4 propensity-score matching for sex, age, comorbidities, mental disorder category, and index year of diagnosis.Results Mean life expectancy of patients with involuntary psychiatric admissions was 33.13 years less than the general population. Average annual healthcare costs per person for involuntary psychiatric admissions were 3.94 times higher compared with voluntary admissions. The general linear model demonstrated that average annual medical costs per person per compulsory hospitalization were 5.8 times that of voluntary hospitalization. Survival analysis using the Cox proportional hazards model found no significant association between type of psychiatric admission (involuntary or voluntary) and death.Conclusion This study revealed no significant difference in mortality between involuntary and voluntary psychiatric admissions, indicating involuntary treatment’s effectiveness.
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HUGHES, G. J., A. J. VAN HOEK, S. SRISKANDAN, and T. L. LAMAGNI. "The cost of hospital care for management of invasive group A streptococcal infections in England." Epidemiology and Infection 143, no. 8 (September 29, 2014): 1719–30. http://dx.doi.org/10.1017/s0950268814002489.
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SUMMARYThe objective of this study was to estimate the direct financial costs of hospital care for management of invasive group A streptococcal (GAS) infections using hospital records for cases diagnosed in England. We linked laboratory-confirmed cases (n= 3696) identified through national surveillance to hospital episode statistics and reimbursement codes. From these codes we estimated the direct hospital costs of admissions. Almost all notified invasive GAS cases (92% of 3696) were successfully matched to a primary hospital admission. Of these, secondary admissions (within 30 days of primary admission) were further identified for 593 (17%). After exclusion of nosocomial cases (12%), the median costs of primary and secondary hospital admissions were estimated by subgroup analysis as £1984–£2212 per case, totalling £4·43–£6·34 million per year in England. With adjustment for unmatched cases this equated to £4·84–£6·93 million per year. Adults aged 16–64 years accounted for 48% of costs but only 40% of cases, largely due to an increased number of surgical procedures. The direct costs of hospital admissions for invasive GAS infection are substantial. These estimated costs will contribute to a full assessment of the total economic burden of invasive GAS infection as a means to assess potential savings through prevention measures.
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Conway, Richard, Seán Cournane, Declan Byrne, Deirdre O’Riordan, Seamus Coveney, and Bernard Silke. "The Relationship Between Social Deprivation and a Weekend Emergency Medical Admission." Acute Medicine Journal 15, no. 3 (July 1, 2016): 124–29. http://dx.doi.org/10.52964/amja.0622.
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Background: Deprivation increases admission rates; the specific effect of deprivation with regard to weekend admissions is unknown. Methods: We calculated annual weekend admission rates for each small area population unit and related these to quintiles of Deprivation Index from 2002-2014. Univariate and multivariable risk estimates were calculated using truncated Poisson regression. Results: There were 30,794 weekend admissions in 16,665 patients. The admission rate was substantially higher for more deprived areas, 12.7 per 1000 (95%CI 9.4, 14.7) vs 4.6 per 1000 (95%CI 3.3, 5.8). More deprived patients admitted at the weekend had a significantly lower 30-day in-hospital mortality (10.3% vs 14.5%, p<0.001). Conclusion: Deprivation is a powerful determinant of weekend admissions, however these comprise a group of patients with better outcomes.
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Ismail, Zahinoor, Tamara Arenovich, Charlotte Grieve, Peggie Willett, Gautam Sajeev, David C. Mamo, Glenda M. MacQueen, and Benoit H. Mulsant. "Predicting Hospital Length of Stay for Geriatric Patients with Mood Disorders." Canadian Journal of Psychiatry 57, no. 11 (November 2012): 696–703. http://dx.doi.org/10.1177/070674371205701107.
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Objective: To determine predictors of hospital length of stay (LOS) for adult and geriatric patients with mood disorders admitted to inpatient psychiatric beds. Method: Admission and discharge data from a large urban mental health centre, from 2005 to 2010 inclusive, were retrospectively analyzed. Using the Resident Assessment Instrument—Mental Health, an assessment that is used to collect demographic and clinical information within 72 hours of hospital admission, 199 geriatric mood disorder admissions were compared with 570 adult mood disorder admissions. Predictors of hospital LOS were determined using a series of general linear models. Results: Living alone, number of recent psychiatric admissions, involuntary admission, and close or constant observation level predict longer hospital LOS in geriatric, but not in adult mood disorder, patients. Conversely, pain on admission predicts shorter hospital LOS in geriatric, but not among adult, mood disorder patients. Predictors of longer hospital LOS, irrespective of admission group (adult, compared with geriatric), include incapacity, negative symptoms, and increased dependence for instrumental activities of daily living. Conclusions: Addressing these predictive factors early on during admission and in the community may result in shorter hospital LOS and more optimal use of resources.
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van Hasselt, Tim J., Bhavna Singham, Eve Bassett, and Ian D. Wacogne. "Oxygen saturation thresholds in bronchiolitis: examining admissions." Archives of Disease in Childhood 105, no. 12 (August 28, 2019): 1197–99. http://dx.doi.org/10.1136/archdischild-2019-317683.
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ObjectiveExamine admissions for bronchiolitis, comparing centres with oxygen saturation thresholds for admission of 90% versus 92%.DesignProspective multi-centre service evaluation, all admissions for bronchiolitis during 4-week period, November 2018.SettingPaediatric departments across 12 hospitals in the West Midlands, UK.Patients320 patients aged 6 weeks–1 year, diagnosis of bronchiolitis, exclusions: chronic illness or high dependency/intensive care admission.Main outcome measuresReason for admission, admission saturations and length of stay.ResultsInadequate feeding was the the most common reason for admission (80%). Only 20 patients were admitted solely because of low saturations. Median peripheral oxygen saturation in this group was 88%. Median length of stay in 90% centres was 41 hours, against 59 hours for 92% centres (p=0.0074).ConclusionsFew patients were admitted solely due to low oxygen saturations, only one had a potentially avoidable admission if thresholds were 90%. Length of stay was significantly reduced in the 90% threshold centres.
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Nguyen, Phuong T. K., Hoang T. Tran, Dominic A. Fitzgerald, Thach S. Tran, Stephen M. Graham, and Ben J. Marais. "Characterisation of children hospitalised with pneumonia in central Vietnam: a prospective study." European Respiratory Journal 54, no. 1 (April 7, 2019): 1802256. http://dx.doi.org/10.1183/13993003.02256-2018.
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Pneumonia is the most common reason for paediatric hospital admission in Vietnam. The potential value of using the World Health Organization (WHO) case management approach in Vietnam has not been documented.We performed a prospective descriptive study of all children (2–59 months) admitted with “pneumonia” (as assessed by the admitting clinician) to the Da Nang Hospital for Women and Children to characterise their disease profiles and assess risk factors for an adverse outcome. The disease profile was classified using WHO pneumonia criteria, with tachypnoea or chest indrawing as defining clinical signs. Adverse outcome was defined as death, intensive care unit admission, tertiary care transfer or hospital stay >10 days.Of 4206 admissions, 1758 (41.8%) were classified as “no pneumonia” using WHO criteria and only 252 (6.0%) met revised criteria for “severe pneumonia”. The inpatient death rate was low (0.4% of admissions) with most deaths (11 out of 16; 68.8%) occurring in the “severe pneumonia” group. An adverse outcome was recorded in 18.7% of all admissions and 60.7% of the “severe pneumonia” group. Children were hospitalised for a median of 7 days at an average cost of 253 USD per admission. Risk factors for adverse outcome included WHO-classified “severe pneumonia”, age <1 year, low birth weight, previous recent admission with an acute respiratory infection and recent tuberculosis exposure. Breastfeeding, day-care attendance and pre-admission antibiotic use were associated with reduced risk.Few hospital admissions met WHO criteria for “severe pneumonia”, suggesting potential unnecessary hospitalisation and use of intravenous antibiotics. Better characterisation of the underlying diagnosis requires careful consideration.
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Castells-Aulet, Laura, Miguel Hernández-Viadel, Jesús Jiménez-Martos, Carlos Cañete-Nicolás, Carmen Bellido-Rodríguez, Roman Calabuig-Crespo, Pedro Asensio-Pascual, and Guillem Lera-Calatayud. "Impact of involuntary out-patient commitment on reducing hospital services: 2-year follow-up." BJPsych Bulletin 39, no. 4 (August 2015): 196–99. http://dx.doi.org/10.1192/pb.bp.114.047464.
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Aims and methodTo evaluate whether involuntary out-patient commitment (OPC) in patients with severe mental disorder reduces their use of hospital services. This is a retrospective case-control study comparing a group of patients on OPC (n = 75) and a control group (n = 75) which was composed of patients whose sociodemographic variables and clinical characteristics were similar to those of the OPC group. Each control case is paired with an OPC case, so the control case must have an involuntary admission in the month that the index OPC case admission occurred. Emergency room visits, admissions and average length of hospital stay over a 2-year follow-up after the initiation of OPC were compared.ResultsNo statistically significant evidence was found in the use of mental healthcare services between the two groups. Different reasons for admission found between the groups limit similarity when comparing the two.Clinical implicationsThe findings cast doubt over the effectiveness of this legal measure to reduce emergency visits, the number of admissions and the length of stay in the hospital.
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Naser, Abdallah Y., Eman Zmaily Dahmash, Jaber S. Alqahtani, Zahra K. Alsairafi, Fatemah M. Alsaleh, and Hassan Alwafi. "Trends in Hospital Admissions for Mental, Behavioural and Neurodevelopmental Disorders in England and Wales between 1999 and 2019: An Ecological Study." Healthcare 10, no. 11 (October 31, 2022): 2191. http://dx.doi.org/10.3390/healthcare10112191.
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Objectives: To investigate the trends in hospital admissions for mental, behavioural and neurodevelopmental disorders (MBNDs) in England and Wales. Methods: This is an ecological study using the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Hospital admission data was collected for the period between April 1999 and March 2019. Results: The most common type of hospital admission was for mental and behavioural disorders due to psychoactive substance use, which accounted for 26.6%. The admission rate among males increased by 8.1% [from 479.59 (95% CI 476.90–482.27) in 1999 to 518.30 (95% CI 515.71–520.90) in 2019 per 1000 persons; p < 0.001]. The admission rate among females increased by 0.3% [from 451.45 (95% CI 448.91–453.99) in 1999 to 452.77 (95% CI 450.37–455.17) in 2019 per 1000 persons; p = 0.547]. The 15–59 years’ age group accounted for 65.1% of the entire number of such hospital admissions, followed by the 75 years and above age group, with 19.0%. Conclusion: We observed an obvious variation in MBNDs influenced by age and gender. Observational studies are needed to identify other factors associated with increased hospital admission rates related to MBNDs, specifically among the young population (aged 15–59 years) and males.
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Chen, Yu-Chun, Jau-Ching Wu, Hsuan-Kan Chang, and Wen-Cheng Huang. "Early Discharge for Anterior Cervical Fusion Surgery: Prediction of Readmission and Special Considerations for Older Adults." International Journal of Environmental Research and Public Health 16, no. 4 (February 21, 2019): 641. http://dx.doi.org/10.3390/ijerph16040641.
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Anterior cervical discectomy and fusion (ACDF) is the standard surgical management for disc herniation and spondylosis worldwide and reportedly performed with short hospitalization and early discharge (ED). However, it is unknown if ED improves the outcomes of ACDF including among older adults. This cohort study included patients who underwent ACDF surgery in Taiwan over two years analyzed in two groups: the ED group (discharged within 48 hours), and the comparison group (hospitalized for more than 48 h). Both groups were followed-up for at least 180 days. Pre- and post-operative comorbidities, re-admissions and re-operations were analyzed using a multivariate cox-regression model, with bootstrapping, and Kaplan–Meier analysis. Among 5565 ACDF patients, the ED group (n = 405) had a higher chance (crude and adjusted hazard ratio = 2.33 and 2.39, both p < 0.001) of re-admission than the comparison group (n = 5160). The ED group had an insignificant trend toward more re-admissions for spinal problems and re-operations within 180 days. In the ED group, older age (≥60) and hypertension were predictive of re-admission. For ACDF surgery, the ED group had higher rates of re-admission within 180 days of post-op, suggesting that the current approach to ED requires modification or more cautious selection criteria be adopted, particularly for older adults.
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Gastal, Fábio L., Sérgio B. Andreoli, Maria Inês S. Quintana, Maurício Almeida Gameiro, Sérgio O. Leite, and John McGrath. "Predicting the revolving door phenomenon among patients with schizophrenic, affective disorders and non-organic psychoses." Revista de Saúde Pública 34, no. 3 (June 2000): 280–85. http://dx.doi.org/10.1590/s0034-89102000000300011.
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OBJECTIVE: The aim of the study was to identify the variables that predict the revolving door phenomenon in psychiatric hospital at the moment of a second admission. METHODS: The sample consisted of 3,093 patients who have been followed during 5 to 24 years after their first hospital admission due to schizophrenia, and affective or psychotic disorders. Those who had had four or more admissions during the study period were considered as revolving door patients. Logistic regression analyses were used to assess the impact of gender, age, marital status, urban conditions, diagnosis, mean period of stay on the first admission, interval between the first and second admissions on the patterns of hospitalization. RESULTS: The variables with the highest predictive power for readmission were the interval between first and second admissions, and the length of stay in the first admission. CONCLUSIONS: These data may help public health planners in providing optimal care to a small group of patients with more effective utilization of the available services.
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Dohren, Stacey. "Three types of PICU admission for those diagnosed with personality disorder." Journal of Psychiatric Intensive Care 16, no. 2 (September 1, 2020): 53–60. http://dx.doi.org/10.20299/jpi.2020.007.
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This article describes three types of PICU admission which could be considered for patients with a diagnosis of personality disorder. These are: a structured planned admission; a respite admission and a risk management admission. All three types of admission are based on the existing PICU admission criteria. There is a need for admissions for this patient group to be more structured, with robust pathways in and out of services. A key factor is the assessment of readiness and motivation to engage in treatment. This provides the basis for choosing which type of admission should be offered.<br/> There is a lack of consistency about how to assess readiness and motivation to engage in treatment for patients with a diagnosis of personality disorder. Models that are used within the forensic sector are discussed. For those patients who are not yet ready to engage clear pathways and suggested guidance are outlined within this article.<br/> While writing this article it became clear that there is little evidence to guide nursing practice for this patient group within acute mental health inpatient services as a whole. There remains scope for further research into this specific area.
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Baralo, Bohdan, Muhammad Hanif, Archen Krupadev, Sabah Iqbal, Navyamani Kagita, Ruqqiya Mustaqeem, Neel S. Patel, Monisha Panda, Eugene Jinkyu Choi, and Rajesh Thirumaran. "Oncology consults in admitted cancer patients: The ways to reduce length of stay." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e13516-e13516. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e13516.
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e13516 Background: The cancer patients, while being admitted to the hospital often have an oncologist consult (OC) through the admission. The goal of the study is to assess, whether OC impact the length of stay (LOS) and to define the group of cancer patients in whom omitting the OC can decrease LOS. Methods: We reviewed 415 admissions of cancer patients from 1/1/2018 to 11/30/2020 to the both campuses of Mercy Catholic Medical Center. We included patients who are 18 years or older with confirmed malignancy. We excluded COVID positive, patients who died during admission, were transferred to tertiary care institutions, or were recommended hospice care, but decided to continue treatment despite poor prognosis. Patient with hematologic disorders were excluded as well. The LOS of stay in cancer patients with and without OC will be compared using two tailed unpaired t-test and Mann-Whitney test ( < 20 admissions in each group, or one of the groups had a largely skewed data). Sub-analysis will be done accounting for Charlson score, spread of the disease and reason of admission (cancer vs non-cancer related). Statistical software Prism 9 will be used for analysis. Results: 290 admissions were selected using inclusion and exclusion criteria. Throughout all admission 234 admission had OC and mean LOS was 4.86 day compare to 4.23 in 56 patients, who did not have OC. Patients with non-cancer related (non-CR) admissions who had Charlson score ≤6 and no OC had shorter LOS (13 admission with median LOS 3 days) compared to those who had OC (11 admissions with LOS 7days), p 0.0462. Also, patient with non-CR admission and localized cancer tend have shorter LOS when no OC involved (15 admission with median LOS 6 days) compare to OC (16 admissions with median LOS 2.5 days), p 0.0365. No other significant difference in LOS were observed (Table). Conclusions: The cancer patients admitted for the reasons not related to their primary malignancy and who have either localized disease or Charlson score < 6 have shorter length of stay when OC not done. The limitation of the current study is the small number of patients in analysis subgroups, as well as fact that patients who had OC may have more severe disease during admission, despite the fact that patient had same extend of disease and comorbidities. Study with larger number of admissions may be necessary to confirm findings of this study.[Table: see text]
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Sanders, Jamie, Andrea Pallotta, Seth Bauer, Jennifer Sekeres, Ramona Davis, Alan Taege, and Elizabeth Neuner. "Antimicrobial Stewardship Program to Reduce Antiretroviral Medication Errors in Hospitalized Patients with Human Immunodeficiency Virus Infection." Infection Control & Hospital Epidemiology 35, no. 3 (March 2014): 272–77. http://dx.doi.org/10.1086/675287.
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Objective.Evaluate antimicrobial stewardship interventions targeted to reduce highly active antiretroviral therapy (HAART)– or opportunistic infection (Ol)–related medication errors and increase error resolution.Design.Retrospective before-after study.Setting.Academic medical center.Patients.Inpatients who were prescribed antiretroviral therapy before the intervention (January 1, 2011, to October 31, 2011) and after the intervention (July 1, 2012, to December 31, 2012). Patients treated with lamivudine or tenofovir monotherapy for hepatitis B were excluded.Methods.Antimicrobial stewardship interventions included education, modification of electronic medication records, collaboration with the infectious diseases (ID) department, and prospective audit and review of HAART and OI regimens by an ID clinical pharmacist.Results.Data for 162 admissions from the preintervention period and 110 admissions from the postintervention period were included. The number of admissions with a medication error was significantly reduced after the intervention (81 [50%] of 162 admissions vs 37 (34%) of 110 admissions; P < .00)1. A total of 124 errors occurred in the preintervention group (mean no. of errors, 1.5 per admission), and 43 errors occurred in the postintervention group (mean no. of errors, 1.2 per admission). The most common error types were major drug interactions and dosing in the preintervention group and renal adjustment and OI-related errors in the postintervention group. A significantly higher error resolution rate was observed in the postintervention group (36% vs 74%; P < .001). After adjustment for potential confounders with logistic regression, admission in the postintervention group was independently associated with fewer medication errors (odds ratio, 0.4 [95% confidence interval, 0.24-0.77]; P = .005). Overall, presence of an ID consultant demonstrated a higher error resolution rate (32% without a consultation vs 68% with a consultation; P = .002).Conclusions.Multifaceted, multidisciplinary stewardship efforts reduced the rate and increased the overall resolution of HAART-related medication errors.
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Kennedy, Jane, Philippa Hembry, Dan Green, David Skuse, and Simon Lewis. "Predictors of change in global psychiatric functioning at an inpatient adolescent psychiatric unit: A decade of experience." Clinical Child Psychology and Psychiatry 25, no. 2 (January 20, 2020): 471–82. http://dx.doi.org/10.1177/1359104519898215.
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Background: Psychiatric inpatient treatment for children is sometimes beneficial, but predictors of who benefits, and in what circumstances, are largely unknown. This study aimed to identify personal and environmental factors that influence outcome in an adolescent unit that accepts both emergency and planned admissions. Methods: Routine standardised intake and outcome measures were analysed for the period 2009–2018. Potential predictors assessed included the Children’s Global Assessment Scale (CGAS), engagement with treatment, behavioural attitudes and peer relationships on the unit. Findings: One hundred and twelve admissions were tracked. Mean age of admission was 16 years, and 71% were female. A total of 61% had higher (better) CGAS scores on discharge than on admission; 34% of inpatients fully engaged with their treatment. Median admission duration was 118 days for males and 196 days for females. Admission lengths were much shorter for ethnic minority patients, but group sizes were small. Longer admissions led to greater improvement. Poor outcomes were associated with failure to engage with treatment and a deterioration in peer relationships. Interpretation: Compliance with treatment and female gender were both significant predictors of positive change during admission. The establishment of good and supportive peer relationships during the admission was also a potent indicator of benefit.
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Tan, Emily, Andrew Higginbotham, Lorette McQueen, and Kamaldeep Bhui. "Crisis plans in a home treatment team before and after a quality improvement programme." Psychiatrist 36, no. 9 (September 2012): 331–34. http://dx.doi.org/10.1192/pb.bp.111.035956.
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Aims and methodTo measure the take-up of formal crisis plans in a specialist home treatment team (HTT) serving an ethnically diverse urban population; and to implement a quality improvement programme and measure its impact on crisis plan completion. Two audits were completed of patients before and after the implementation of a quality improvement programme. Descriptive data are shown by ethnic group, by gender, and for people with multiple hospital admissions.ResultsAt baseline, 16.7% of patients at high risk of admission had an HTT crisis plan, compared with 26.7% of a comparison group. Only 23.1% of the crisis plans for patients with a history of frequent admission mentioned the prevention of future admissions. Crisis plan completion improved following the quality improvement programme, when 80.0% of discharges had an HTT crisis plan; of these, 73.0% mentioned admission prevention. In the follow-up audit, 22.7% of patients in the multiple admission group had been readmitted to hospital at least once. Crisis plan completion did not appear to differ by ethnic group or gender and did not appear to be related to hospital readmission.Clinical implicationsCrisis plan completion improved with simple practical methods, but completion was unrelated to gender, ethnicity or later readmission.
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Wong, Michael T. H., Michael T. H. Wong, and Christine Tye. "Low Hospital Inpatient Readmission Rate in Patients with Borderline Personality Disorder: A Naturalistic Study at Southern Health, Victoria, Australia." Australian & New Zealand Journal of Psychiatry 39, no. 7 (July 2005): 607–11. http://dx.doi.org/10.1080/j.1440-1614.2005.01633.x.
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Objective: To study how the standard management protocol and the special management contract relate to the clinical profile of patients with borderline personality disorder and their hospital admission pattern. Method: A retrospective review was undertaken using naturalistic data from the Client Management Interface over a 2-year period. The standard management protocol patient group and the special treatment contract patient group were compared with respect to variables which included basic demographic data, number of admissions, length of stay and comorbidity. Results: Eighty patients received a diagnosis of borderline personality disorder. The majority (81.2%) were managed with the standard management protocol and only 41.5% had more than one admission. For those who received a special treatment contract (18.8%), 93.3% of them had more than one admission. The special treatment contract group had a significantly higher total number of admissions (p<0.001), a higher number of admissions when they received (p<0.001) and did not receive (p=0.001) a diagnosis of borderline personality disorder, a higher number of comorbidities (p=0.004) but not more presentations to the emergency department. Conclusions: Most patients with borderline personality disorder treated with the standard management protocol had a low readmission rate. The small group of patients with comorbidities managed with a special treatment contract had multiple readmissions but not more crisis presentations to the emergency department. Further studies are required to elucidate the therapeutic mechanism of the standard management protocol and special treatment contract and how that impacts on presentations and admissions to a hospital.
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Hannegård Hamrin, Tova, and Staffan Eksborg. "Risks for death after admission to pediatric intensive care (PICU)—A comparison with the general population." PLOS ONE 17, no. 10 (October 7, 2022): e0265792. http://dx.doi.org/10.1371/journal.pone.0265792.
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Objective/aim The aim of the study was to quantify excess mortality in children after admission to a Pediatric Intensive Care Unit (PICU), compared to the age and sex matched general Swedish population. Design Single-center, retrospective cohort study. Setting Registry study of hospital registers, a national population register and Statistics Sweden. Patients Children admitted to a tertiary PICU in Sweden in 2008–2016. Interventions None. Main results In total, 6,487 admissions (4,682 patients) were included in the study. During the study period 444 patients died. Median follow-up time for the entire PICU cohort was 7.2 years (IQR 5.0–9.9 years). Patients were divided into four different age groups (0–28 d, > 28 d -1 yr, > 1–4 yr, and > 4 yr) and four different risk stratification groups [Predicted Death Rate (PDR) intervals: 0–10%, > 10–25%, > 25–50%, and > 50%] at admission. Readmission was seen in 929 (19.8%) patients. The Standardized Mortality Ratios (SMRs) were calculated using the matched Swedish population as a reference group. The SMR for the entire study group was 49.8 (95% CI: 44.8–55.4). For patients with repeated PICU admissions SMR was 108.0 (95% CI: 91.9–126.9), and after four years 33.9 (95% CI: 23.9–48.0). Patients with a single admission had a SMR of 35.2 (95% CI: 30.5–40.6), and after four years 11.0 (95% CI: 7.0–17.6). The highest SMRs were seen in readmitted children with oncology/hematology (SMR = 358) and neurologic (SMR = 192) diagnosis. Children aged >1–4 years showed the highest SMR (325). In PDR group 0–10% children with repeated PICU admissions (n = 798), had a SMR of 100. Conclusion Compared to the matched Swedish population, SMRs were greatly elevated up to four years after PICU admission, declining from over 100 to 33 for patients with repeated PICU admissions, and from 35 to 11 for patients with a single PICU admission.
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Miano, Wendy Rowehl, Paula Silverman, Frank Colella, Bernadette McQuigg, Heather Hines, Santina Ciarallo, Lalena Whittington, and Sarah Belcher. "Elective chemotherapy admission pilot and work-flow improvements to reduce excess days." Journal of Clinical Oncology 30, no. 34_suppl (December 1, 2012): 101. http://dx.doi.org/10.1200/jco.2012.30.34_suppl.101.
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101 Background: The Inpatient (Inpt) Oncology Service at University Hospitals Seidman Cancer Center, a large urban academic NCI Comprehensive Cancer Center was charged with identifying opportunities to link patient (pt) quality improvement and decreased length of stay (LOS) in pts admitted for elective chemotherapy (EC). Historically, EC admissions were delayed due to pt variables, inpt bed availability, and chemotherapy order entry errors. Often chemotherapy was not initiated until late evening on day of admission, resulting in increased LOS. Safety concerns associated with late starts included fewer pharmacy resources, lower nurse/pt ratio, and no onsite APRN. Methods: A 2-month pilot was conducted, using an intervention group (IG) and control (C) group representing usual care (UC). The IG group was a subset with oropharyngeal pts and C group, all other EC admissions. Pre-registration and bed placement processes were reviewed. Workflow changes for IG included chemotherapy order set entered in electronic medical record 48 hours before admission, labs drawn day before admission, and weekly huddle including admitting, inpt and outpatient (Outpt) teams to review upcoming week’s admissions. IG pts were pre-scheduled for am admission. Inpt oncology services incorporated admissions into morning workflow. Census was taken above cap to accommodate IG patients. Time parameters were tracked from point of pt arrival in Admitting to initiation of EC. Results: There were 32 pts in the 2-month pilot study; 14 in the IG and 9 in UC. Mean admit time was 0900 (range 0730-1030) for IG and 1200 noon (range 1000-1600) for UC. Initiation of EC before 1500 occurred in 93% of IG compared to 11% of UC pts. This resulted in an average decreased LOS for IG of 1.1 day compared to UC. Pt and family comments included appreciation of predictable admit time and LOS. Conclusions: Because of the 8-week pilot success, these EC workflow changes have been implemented across Oncology services. Weekly huddles and coordination of clinical services across inpt and outpt settings continue to show advantage of proactive planning and troubleshooting before the day of EC admission. More importantly, EC pt safety and experience has improved with these work-flow changes.
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Boliver, Vikki. "Exploring Ethnic Inequalities in Admission to Russell Group Universities." Sociology 50, no. 2 (May 12, 2015): 247–66. http://dx.doi.org/10.1177/0038038515575859.
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Dudin, A. N., R. Manzo, and R. Piscopo. "Single server retrial queue with group admission of customers." Computers & Operations Research 61 (September 2015): 89–99. http://dx.doi.org/10.1016/j.cor.2015.03.008.
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Marincowitz, Carl, Fiona Lecky, Victoria Allgar, and Trevor Sheldon. "Evaluation of the impact of the NICE head injury guidelines on inpatient mortality from traumatic brain injury: an interrupted time series analysis." BMJ Open 9, no. 6 (June 2019): e028912. http://dx.doi.org/10.1136/bmjopen-2019-028912.
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ObjectiveTo evaluate the impact of National Institute for Health and Care Excellence (NICE) head injury guidelines on deaths and hospital admissions caused by traumatic brain injury (TBI).SettingAll hospitals in England between 1998 and 2017.ParticipantsPatients admitted to hospital or who died up to 30 days following hospital admission with International Classification of Diseases (ICD) coding indicating the reason for admission or death was TBI.InterventionAn interrupted time series analysis was conducted with intervention points when each of the three guidelines was introduced. Analysis was stratified by guideline recommendation specific age groups (0–15, 16–64 and 65+).Outcome measuresThe monthly population mortality and admission rates for TBI.Study designAn interrupted time series analysis using complete Office of National Statistics cause of death data linked to hospital episode statistics for inpatient admissions in England.ResultsThe monthly TBI mortality and admission rates in the 65+ age group increased from 0.5 to 1.5 and 10 to 30 per 100 000 population, respectively. The increasing mortality rate was unaffected by the introduction of any of the guidelines.The introduction of the second NICE head injury guideline was associated with a significant reduction in the monthly TBI mortality rate in the 16–64 age group (-0.005; 95% CI: −0.002 to −0.007).In the 0–15 age group the TBI mortality rate fell from around 0.05 to 0.01 per 100 000 population and this trend was unaffected by any guideline.ConclusionThe introduction of NICE head injury guidelines was associated with a reduced admitted TBI mortality rate after specialist care was recommended for severe TBI. The improvement was solely observed in patients aged 16–64 years.The cause of the observed increased admission and mortality rates in those 65+ and potential treatments for TBI in this age group require further investigation.
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Khoo, Joanna, Helen Hasan, and Kathy Eagar. "Examining the high users of hospital resources: implications of a profile developed from Australian health insurance claims data." Australian Health Review 42, no. 5 (2018): 600. http://dx.doi.org/10.1071/ah17046.
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Objective To develop and examine a profile of the demographic, hospital admission and clinical characteristics of high users of hospital resources within a cohort of privately insured Australians. Methods Hospital admissions claims data from a group of private health insurance funds were analysed. The top 1% of hospital users were selected based on three measures of resource utilisation: number of admissions, total bed days and total insurance benefits paid. The demographic, hospital admission and clinical characteristics data were compared for these three measures of resource utilisation. Results Compared with the general insured population, the three high-use cohorts are older, have more public hospital admissions and have more same-day admissions. The three high-use cohorts have the same top five principal diagnosis categories. These five categories account for more than two-thirds of admissions. The top 1% of users is responsible for a large proportion of total resource utilisation, accounting for 13% of total costs and 21% of total bed days. Conclusions The highest users of hospital resources have a distinct profile, accounting for a large proportion of total resource utilisation for a narrow range of health conditions. The age and hospital admission profile of this group suggest both policy and service considerations for the targeting of interventions to support this high-needs group. What is known about this topic? Statistics are regularly published on the uptake and use of private health insurance in Australia but there is little detailed information on resource utilisation in specific subgroups, particularly those with the highest levels of hospitalisation. What does this paper add? This paper provides a profile of high resource utilisation among a privately insured cohort, describing demographic, hospital admission and clinical characteristics across three measures of resource utilisation. Patterns of use are detailed in this profile, for example the top 1% of users have a higher proportion of public hospital admissions as a private patient. The clinical profile of admissions was similar for the three measures of resource utilisation and there was considerable overlap in the individuals categorised in each high-use group. What are the implications for practitioners? The narrow demographic and clinical profile of the high resource utilisation groups shows a chronic disease burden that is different to the focus of current chronic disease policy measures. The high-use conditions identified in this study are less amenable to preventive measures and new strategies may be required to target this high-needs group.
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Rushworth, R. Louise, Henrik Falhammar, Craig F. Munns, Ann M. Maguire, and David J. Torpy. "Hospital Admission Patterns in Children with CAH: Admission Rates and Adrenal Crises Decline with Age." International Journal of Endocrinology 2016 (2016): 1–7. http://dx.doi.org/10.1155/2016/5748264.
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Objective. To examine patterns of hospitalisation for acute medical conditions in children with congenital adrenal hyperplasia (CAH).Design. A retrospective study of hospitalisation using administrative data.Setting. All hospitals in NSW, Australia.Patients. All patients admitted with CAH and a random sample of admissions in patients aged 0 to 18 years without adrenal insufficiency (AI).Main Outcome Measures. Admissions and comorbidities by age and sex.Results. Of 573 admissions for medical problems in CAH children, 286 (49.9%) were in males, and 236 (41.2%) had a principal diagnosis of CAH or had an adrenal crisis (AC). 37 (6.5%) ACs were recorded. An infection was found in 43.5% (n=249) of the CAH patient admissions and 51.7% (n=1613) of the non-AI group,p<0.001. Children aged up to one year had the highest number of admissions (n=149) and six ACs (four in males). There were 21 ACs recorded for children aged 1–5 years. Older CAH children had fewer admissions and fewer ACs. No in-hospital deaths were recorded.Conclusions. Admission for medical problems in CAH children declines with age. An AC was recorded in 6.5% of the admissions, with the majority of ACs occurring in the 1 to 5 years age group and there were no deaths.
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Naraghi, Reza, Alan Bryant, and Linda Slack-Smith. "Description of Total Population Hospital Admissions for Morton's Metatarsalgia in Australia." Journal of the American Podiatric Medical Association 104, no. 5 (September 1, 2014): 451–54. http://dx.doi.org/10.7547/0003-0538-104.5.451.
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Background Morton's metatarsalgia is a painful perineural fibroma of a plantar nerve, most commonly of the second or third intermetatarsal spaces of the forefoot. The aim of this study was to investigate hospital admissions with a diagnosis of Morton's metatarsalgia in the Australian population from 1998 to 2008. Methods Data regarding admissions with a diagnosis code of ICD-10 G57.6 were extracted from the Australian Institute of Health and Welfare databases of hospital morbidity from 1998 to 2008. The event of interest was an admission with ICD-10 G57.6 (Morton's metatarsalgia). The explanatory variables included sex and age group. Rates were calculated using the estimated resident population counts to determine denominators. Results Morton's metatarsalgia admissions were almost three-fold higher for women in the population compared to men. The rate of admissions for Morton's metatarsalgia was the highest for the total population in the 55- to 59-year-old age group. Among women admitted for Morton's metatarsalgia, the highest rate was in the 50- to 54-year-old age group; among men, the highest rate was in the slightly older 55- to 59-year-old age category. Conclusions Population-level information on admissions for Morton's metatarsalgia show that admissions were three times higher among women compared to men. The highest admission rate was in the 50- to 55-year-old age group.
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Steur, Anouk, Paulien A. M. A. Raymakers-Janssen, Martin C. J. Kneyber, Sandra Dijkstra, Job B. M. van Woensel, Dick A. van Waardenburg, Cornelis P. van de Ven, et al. "Characteristics and Outcome of Children with Wilms Tumor Requiring Intensive Care Admission in First Line Therapy." Cancers 14, no. 4 (February 14, 2022): 943. http://dx.doi.org/10.3390/cancers14040943.
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Survival rates are excellent for children with Wilms tumor (WT), yet tumor and treatment-related complications may require pediatric intensive care unit (PICU) admission. We assessed the frequency, clinical characteristics, and outcome of children with WT requiring PICU admissions in a multicenter, retrospective study in the Netherlands. Admission reasons of unplanned PICU admissions were described in relation to treatment phase. Unplanned PICU admissions were compared to a control group of no or planned PICU admissions, with regard to patient characteristics and short and long term outcomes. In a multicenter cohort of 175 children with an underlying WT, 50 unplanned PICU admissions were registered in 33 patients. Reasons for admission were diverse and varied per treatment phase. Younger age at diagnosis, intensive chemotherapy regimens, and bilateral tumor surgery were observed in children with unplanned PICU admission versus the other WT patients. Three children required renal replacement therapy, two of which continued dialysis after PICU discharge (both with bilateral disease). Two children died during their PICU stay. During follow-up, hypertension and chronic kidney disease (18.2 vs. 4.2% and 15.2 vs. 0.7%) were more frequently observed in unplanned PICU admitted patients compared to the other patients. No significant differences in cardiac morbidity, relapse, or progression were observed. Almost 20% of children with WT required unplanned PICU admission, with young age and treatment intensity as potential risk factors. Hypertension and renal impairment were frequently observed in these patients, warranting special attention at presentation and during treatment and follow-up.
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Alanazi, Abeer F. R., Abdallah Y. Naser, Prisca Pakan, Atheer F. Alanazi, Alyamama Abdulaziz A. Alanazi, Zahra Khalil Alsairafi, and Fatemah M. Alsaleh. "Trends of Hospital Admissions Due to Congenital Anomalies in England and Wales between 1999 and 2019: An Ecological Study." International Journal of Environmental Research and Public Health 18, no. 22 (November 11, 2021): 11808. http://dx.doi.org/10.3390/ijerph182211808.
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Objectives: To investigate the trends in congenital anomalies-related hospital admissions in England and Wales. Methods: This was an ecological study that was conducted using hospital admission data taken from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Congenital malformations, deformations and chromosomal abnormalities hospital admissions data were extracted for the period between April 1999 and March 2019. Results: Hospital admission rate increased by 4.9% [from 198.74 (95% CI 197.53–199.94) in 1999 to 208.55 (95% CI 207.39–209.71) in 2019 per 100,000 persons, trend test, p < 0.01]. The most common hospital admissions causes were congenital malformations of the circulatory system, the musculoskeletal system, genital organs, and the digestive system. The most notable increase in hospital admissions rate was observed in congenital malformations of the respiratory system (1.01-fold). The age group below 15 years accounted for 75.1% of the total number of hospital admissions. Males contributed to 57.5% of the whole number of hospital admission. Hospital admission rate between females was increased by 6.4% [from 162.63 (95% CI 161.10–164.16) in 1999 to 173.05 (95% CI 171.57–174.54) in 2019 per 100,000 persons]. Hospital admission rate between males was increased by 3.4% [from 236.61 (95% CI 234.72–238.50) in 1999 to 244.70 (95% CI 242.92–246.49) in 2019 per 100,000 persons]. Conclusions: Males had a higher percentage of hospitalisation compared to females. Further studies to investigate the factors associated with higher hospitalisation rate among males are needed.
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Lee, Kevin Kyungmin, Osman Rahimi, Charlie Kyungchan Lee, Amaan Shafi, and Dalia Hawwass. "A Meta-Analysis: Coronary Artery Calcium Score and COVID-19 Prognosis." Medical Sciences 10, no. 1 (January 21, 2022): 5. http://dx.doi.org/10.3390/medsci10010005.
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Background: Multiple studies have investigated the correlations of mortality, mechanical ventilation, and intensive care unit (ICU) admissions with CAC scores. This analysis overviews the prognostic capability of CAC scoring in mortality, mechanical ventilation, and ICU admission for hospitalized COVID-19 patients. Methods: Online search was conducted on PubMed, Cochrane Library, and Scopus from inception to 22 November 2021 to identify studies involving CAC scores in relation to ICU admission, mechanical ventilation, and death rates. Results: A total of eight studies were analyzed. In the absence of CAC group compared with the presence of CAC score, there was an increase in mortality in the presence of CAC (RR 2.24, 95% CI, 1.41–3.56; p < 0.001). In the low CAC group and high CAC group, high CAC group had increase in mortality (RR 2.74; 95% CI, 1.94–3.86; p < 0.00001). There was no statistical difference in outcomes of mechanical ventilation and ICU admission between any of the groups. Conclusion: This meta-analysis strictly examined the outcomes of interest in death, mechanical ventilation, and ICU admission while comparing the CAC scores in patients with COVID-19. Given these findings, CAC scoring can aid in stratifying patients, thus allowing earlier interventions in rapidly developing illnesses.
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O'Loughlin, Fionnula, and Marcus Webb. "Controlled assessment of alcoholics admitted involuntarily to a general psychiatric hospital." Irish Journal of Psychological Medicine 13, no. 4 (December 1996): 140–43. http://dx.doi.org/10.1017/s0790966700004390.
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AbstractObjective:As the provision for the involuntary admission to hospital of alcoholics is likely to be discarded in a new Irish Mental Health Act, the characteristics of patients committed under the 1945 Irish Mental Treatment Act were explored and compared with those alcoholics admitted voluntarily.Method:All alcoholics admitted compulsorily from 1989-1992 to a general psychiatrichospital in Dublin were compared retrospectively with voluntarily admitted alcoholics. Data was taken from case notes.Results:Results showed that patients admitted compulsorily were older (t = 3.74, df = 62, p < 0.001) and had more physical complications (X2= 8.4, df = 1, p < 0.004) than those admitted voluntarily. Although results did not reach a statistically significant level, there were proportionately more females in the compulsorily admitted group compared with the voluntary group. The outcome of admission overall was better in those admitted voluntarily, although this was influenced both by length of stay and previous admissions for treatment of alcohol dependence. One particularly interesting finding, regardless of admission category, was that duration of admission was statistically significantly longer for women when compared with men.Conclusions:Compulsory admission of alcoholics to a psychiatric hospital for very brief periods was not shown to be strikingly helpful, but this study cannot decide whether or not longer periods of compulsory admission would be valuable.
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Walicka, Magdalena, Agnieszka Tuszyńska, Marcin Chlebus, Yaroslav Sanchak, Andrzej Śliwczyński, Melania Brzozowska, Daniel Rutkowski, Monika Puzianowska-Kuźnicka, and Edward Franek. "Predictors of In-Hospital Mortality in Surgical Wards: A Multivariable Retrospective Cohort Analysis of 2,800,069 Hospitalizations." World Journal of Surgery 45, no. 2 (October 26, 2020): 480–87. http://dx.doi.org/10.1007/s00268-020-05841-3.
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Abstract Background Identifying prognostic factors that are predictive of in-hospital mortality for patients in surgical units may help in identifying high-risk patients and developing an approach to reduce mortality. This study analyzed mortality predictors based on outcomes obtained from a national database of adult patients. Materials and methods This retrospective study design collected data obtained from the National Health Fund in Poland comprised of 2,800,069 hospitalizations of adult patients in surgical wards during one calendar year. Predictors of mortality which were analyzed included: the patient’s gender and age, diagnosis-related group category assigned to the hospitalization, length of the hospitalization, hospital type, admission type, and day of admission. Results The overall mortality rate was 0.8%, and the highest rate was seen in trauma admissions (24.5%). There was an exponential growth in mortality with respect to the patient’s age, and male gender was associated with a higher risk of death. Compared to elective admissions, the mortality was 6.9-fold and 15.69-fold greater for urgent and emergency admissions (p < 0.0001), respectively. Weekend or bank holiday admissions were associated with a higher risk of death than working day admissions. The “weekend” effect appears to begin on Friday. The highest mortality was observed in less than 1 day emergency cases and with a hospital stay longer than 61 days in any type of admission. Conclusion Age, male gender, emergency admission, and admission on the weekend or a bank holiday are factors associated with greater mortality in surgical units.
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Tolmac, Jovanka, and Matthew Hodes. "Ethnic variation among adolescent psychiatric in-patients with psychotic disorders." British Journal of Psychiatry 184, no. 5 (May 2004): 428–31. http://dx.doi.org/10.1192/bjp.184.5.428.
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BackgroundThere is strong evidence that the rates of psychiatric admission for psychosis in the UK are elevated for the Black adult population compared with the White population. Black adults also have a higher rate of involuntary psychiatric admissions. There have been no studies in this country investigating links between ethnic background and psychiatric admission in the adolescent population.AimsTo investigate whether Black compared with White adolescents from London are over represented in psychiatric in-patient settings and whether they are more likely to be detained under the Mental Health Act 1983.MethodCross-sectional survey of London adolescents aged 13–17 years, who were in-patients in psychiatric units.ResultsAdolescents from the Black group (Black African, Black Caribbean, Black British) were over represented among those admitted with a diagnosis of a psychotic disorder when compared with adolescents from the White group (White British/White Irish, White Other): odds ratio=3.7,95% C12.0–6.7. They were also more likely to be detained on admission and more likely to be born outside the UK and have refugee background.ConclusionsThe possible impact of various background factors influencing admission is discussed.
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Ward, Laurie A., George N. Coritsidis, and Christos P. Carvounis. "Risk Factors to Predict Renal Failure and Death in the Medical Intensive Care Unit." Journal of Intensive Care Medicine 11, no. 2 (March 1996): 114–19. http://dx.doi.org/10.1177/088506669601100205.
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The ability to predict outcomes based on admission criteria has important implications, both prognostically and for assessing interventions on comparable groups. Use of severity of disease scoring systems such as the APACHE II score for predicting mortality has become widespread. There is no comparable formula for acute renal failure. We prospectively evaluated 115 consecutive admissions to the medical intensive care unit to define risk for renal failure from admission data and to assess the impact of admission hypoalbuminemia levels on outcome. Diagnosis, age, serum creatinine and albumin levels, urinary electrolyte concentrations and osmolality, daily serum creatinine levels, and urine output were recorded. Admission APACHE II score was calculated. Admission hypoalbuminemia (57% of patients) was associated with both acute renal failure and death (odds ratios, 16.19 and 8.06, respectively). The Glasgow coma score distinguished between patients in whom acute renal failure developed and in those it did not. Low urine osmolality (<400 mOsm/kg) was the most significant factor in predicting mortality (odds ratio, 9.87). Mortality was lowest in the normal albumin group (2%), intermediate in the low albumin/no renal failure group (12%), and highest in the low albumin/acute renal failure group (53%). The APACHE II score was accurate in 3 of 14 deaths in the hypoalbuminemic population and in the one normal albumin patient who died. We conclude that at admission, hypoalbuminemia, urinary hypo-osmolality, and abnormal creatinine levels are predictive of acute renal failure and death, diagnosis, and mental status impact on the risk for acute renal failure. APACHE II lacks predictive value in hypoalbuminemic patients.
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Jose B Cherayath and Jitin George. "Incidence of Bacteremia at the Time of ICU Admission and its Impact on Outcome." Academia Anesthesiologica International 5, no. 1 (May 22, 2020): 61–63. http://dx.doi.org/10.21276/aan.2020.5.1.12.
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Background: For patients admitted in ICU, if they are suspected with infection, at admission time, blood culture is taken. Aim: This study aimed to evaluate the bacteraemia incidence at the ICU admission time, and assess its impact on the outcome.Subjects and Methods:This is a retrospective study which was conducted in a tertiary hospital. At time of admission, data from all the ICU admissions with suspected sepsis were analysed over a period of July 2016 to June 2018. The positive blood culture group (Group A) consisted of patients with clinically significant BSI.Results:600 patients were selected in the study. 250 patients out of 600 patients (42%) were on antibiotics. 380 patients out of 600 patients (63%) were direct ICU admission from casualty, 70 patients from hospital wards (11%), 45 patients from other ICU’s in the hospital (8%) and 105 patients from other hospitals (18%). Blood cultures were positive only in 70 patients (11.6%) with significant BSI. ICU mortality was significantly higher in positive blood culture group (i.e. 30/70), when compared with negative blood culture group (i.e. 68/530). Mortality was higher in patients with pseudomonas aeruginosa (75%) though it was not statistically significant.Conclusion:In the ICU, only in minority of patients with suspected infection, blood cultures may be positive. Even though the patients are administered with antibiotics, prognosis of the patients with positive blood culture is worse.
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King, Daniel A., Essam Hussein, Gali Epstein Shochet, and Yaron P. Bar-Lavie. "Admission Rate of Patients With Major Psychiatric Disorders to the Intensive Care Unit." American Journal of Critical Care 29, no. 6 (November 1, 2020): 480–83. http://dx.doi.org/10.4037/ajcc2020934.
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Background Major psychiatric disorders such as major depression and schizophrenia interfere with patients’ life activities and ability to function. These disorders correlate with a higher prevalence of medical and psychiatric comorbidities. Objective To compare the admission rate of patients with major psychiatric disorders between the intensive care unit and other departments in a tertiary care center. Methods In a retrospective study of records of 238 721 patients, data were collected from admission files and the intensive care unit computer system. The study group was 245 patients with psychiatric disorders admitted to the intensive care unit. Control groups were 9226 psychiatric patients in other hospital departments and 3032 nonpsychiatric patients in the intensive care unit. Results A major psychiatric disorder was diagnosed twice as often in the 3277 patients admitted to the intensive care unit as in patients admitted to other departments (7.5% vs 3.8%, P < .001). The study group had fewer male patients than did the nonpsychiatric intensive care unit group (52% vs 66%, P < .001); the age distribution was similar. Patients with a psychiatric disorder required longer stays than other intensive care unit patients. However, their mortality rate was significantly lower (8.57% vs 17.1%, P = .001). A direct correlation between the admission and a psychiatric condition was found in one-third of admissions in the study group. Conclusions Psychiatric patients’ admission rate to the intensive care unit was significantly higher than their admission rate to other departments. Their intensive care unit stays were also longer, which may increase resource use.
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Akoh, JA, F. Radford, and H. Legrys. "Non-Elective Admission of Patients Aged 75 Years and Over to the Surgical Assessment Unit of an Acute Hospital." Bulletin of the Royal College of Surgeons of England 92, no. 9 (October 1, 2010): 1–5. http://dx.doi.org/10.1308/147363510x523037.
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The number of emergency admissions to hospital has increased in recent years. Greater expectations from patients, the increased use of 'on-call' GP services and increased pressure from the emergency department due to the four-hour wait target are among the causal factors suggested to lower the threshold for admission and increase inappropriate admissions. Increasing age is also associated with increased admission rates and the elderly are the most rapidly increasing group among emergency surgical admissions. Emergency surgery has more risks in the elderly due to reduced cardio-respiratory reserves and greater co-morbidities. In addition, the elderly often have greater social needs, requiring social service input prior to discharge. With the current reduction in community and convalescent beds the length of acute hospital admissions in the elderly is predicted to rise.
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Leão Gomes, Lucimar, and Fernando Madalena Volpe. "VALIDATION OF A DYNAMIC RISK CLASSIFICATION SYSTEM FOR IN-HOSPITAL DEATH, BASED ON ELECTRONIC RECORDS OF NON-SURGICAL ADMISSIONS TO GENERAL HOSPITALS." RAHIS- Revista de Administração Hospitalar e Inovação em Saúde 18, no. 4 (November 21, 2021): 101–12. http://dx.doi.org/10.21450/rahis.v18i4.7186.
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Objective: To develop and validate a risk-classification system for in-hospital death, clinically useful for general hospital adult primarily non-surgical cases.
Methods: Admissions for non-surgical conditions at 5 public general hospitals of Minas Gerais were included. Procedures: Build a predictive model for death during admission, using logistic regression; Create a severity index based on the independent effect of the selected variables, and then, validate its ability to predict in-hospital death during index admission; Validate the predictive scale by challenging it with a new dataset.
Results: The final multivariate model included seven significant predictive variables: age, gender, diagnostic-related group, hospital of index admission, admission to the ICU, total length of stay, and unplanned surgical procedure. This model presented adequate fit and fair discriminative performance (AUC=0.78). Temporal validation with a new sample also presented an adequate fit, and the discriminative performance was again fair (AUC=0.76).
Conclusions: A dynamic and clinically useful risk classification system for in-hospital death of non-surgical admissions has been validated.
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Hollinghurst, Joe, Richard Fry, Ashley Akbari, Alan Watkins, Neil Williams, Sarah Hillcoat-Nallétamby, Ronan A. Lyons, Andrew Clegg, and Sarah E. Rodgers. "Do home modifications reduce care home admissions for older people? A matched control evaluation of the Care & Repair Cymru service in Wales." Age and Ageing 49, no. 6 (September 18, 2020): 1056–61. http://dx.doi.org/10.1093/ageing/afaa158.
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Abstract Background home advice and modification interventions aim to promote independent living for those living in the community, but quantitative evidence of their effectiveness is limited. Aim assess the risk of care home admissions for people with different frailty levels receiving home advice and modification interventions against a control group who do not. Study design and setting matched control evaluation using linked longitudinal data from the Secure Anonymised Information Linkage (SAIL) Databank, comprising people aged 60–95, registered with a SAIL contributing general practice. The intervention group received the Care & Repair Cymru (C & RC) service, a home advice and modification service available to residents in Wales. Methods frailty, age and gender were used in propensity score matching to assess the Hazard Ratio (HR) of care home admissions within a 1-, 3- and 5-year period for the intervention group (N = 93,863) compared to a matched control group (N = 93,863). Kaplan–Meier curves were used to investigate time to a care home admission. Results the intervention group had an increased risk of a care home admission at 1-, 3- and 5-years [HR (95%CI)] for those classified as fit [1-year: 2.02 (1.73, 2.36), 3-years: 1.87 (1.72, 2.04), 5-years: 1.99 (1.86, 2.13)] and mildly frail [1-year: 1.25 (1.09, 1.42), 3-years: 1.25 (1.17, 1.34), 5-years: 1.30 (1.23, 1.38)], but a reduced risk of care home admission for moderately [1-year: 0.66 (0.58, 0.75), 3-years: 0.75 (0.70, 0.80), 5-years: 0.83 (0.78, 0.88)] and severely frail individuals [1-year: 0.44 (0.37, 0.54), 3-years: 0.54 (0.49, 0.60), 5-years: 0.60(0.55, 0.66)]. Conclusions HRs indicated that the C & RC service helped to prevent care home admissions for moderately and severely frail individuals. The HRs generally increased with follow-up duration.
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Patel, Rashmi, Edward Chesney, Alexis E. Cullen, Alex D. Tulloch, Matthew Broadbent, Robert Stewart, and Philip McGuire. "Clinical outcomes and mortality associated with weekend admission to psychiatric hospital." British Journal of Psychiatry 209, no. 1 (July 2016): 29–34. http://dx.doi.org/10.1192/bjp.bp.115.180307.
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BackgroundStudies indicate that risk of mortality is higher for patients admitted to acute hospitals at the weekend. However, less is known about clinical outcomes among patients admitted to psychiatric hospitals.AimsTo investigate whether weekend admission to a psychiatric hospital is associated with worse clinical outcomes.MethodData were obtained from 45 264 consecutive psychiatric hospital admissions. The association of weekend admission with in-patient mortality, duration of hospital admission and risk of readmission was investigated using multivariable regression analyses. Secondary analyses were performed to investigate the distribution of admissions, discharges, in-patient mortality, episodes of seclusion and violent incidents on different days of the week.ResultsThere were 7303 weekend admissions (16.1%). Patients who were aged between 26 and 35 years, female or from a minority ethnic group were more likely to be admitted at the weekend. Patients admitted at the weekend were more likely to present via acute hospital services, other psychiatric hospitals and the criminal justice system than to be admitted directly from their own home. Weekend admission was associated with a shorter duration of admission (B coefficient –21.1 days, 95% CI –24.6 to –17.6, P<0.001) and an increased risk of readmission in the 12 months following index admission (incidence rate ratio 1.13, 95% CI 1.08 to 1.18, P<0.001), but in-patient mortality (odds ratio (OR) = 0.79, 95% CI 0.51 to 1.23, P = 0.30) was not greater than for weekday admission. Fewer episodes of seclusion occurred at the weekend but there was no significant variation in deaths during hospital admission or violent incidents on different days of the week.ConclusionsBeing admitted at the weekend was not associated with an increased risk of in-patient mortality. However, patients admitted at the weekend had shorter admissions and were more likely to be readmitted, suggesting that they may represent a different clinical population to those admitted during the week. This is an important consideration if mental healthcare services are to be implemented across a 7-day week.
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Ganguly, Sarojit, Sameer Gore, Geoff Marston, and Ashok Roy. "Trends in admissions to an intellectual disability hospital." Psychiatric Bulletin 33, no. 10 (October 2009): 371–74. http://dx.doi.org/10.1192/pb.bp.108.020123.
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Aims and MethodLong-term admission trends in a large specialist National Health Service (NHS) hospital were examined over a 3-year period. These were compared with three earlier 3-year periods. the medical records were examined for admission numbers, source of admissions, length of stay, legal status, reason for admission and readmission rate.ResultsThe percentage of patients admitted from home decreased over time, whereas the admissions from group homes increased threefold. Long-stay admissions decreased in the second and third periods followed by an increase in the fourth period. There was a progressive increase in formal admissions and a decrease in informal ones. There was an increase in admissions of people with psychiatric illness and a decrease in admissions because of social difficulties. the percentage of first admissions gradually increased and the percentages of readmissions gradually decreased.Clinical ImplicationsPeople with intellectual disability are more likely to be admitted for psychiatric reasons and to be detained under the Mental Health Act than in the 1970s. There should be a much greater interaction between hospital and community services to facilitate shorter stays and early discharge. Out-of-area placements need to be taken account of while commissioning for the total need in a geographical area.
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Law-Min, R., F. Oyebode, and M. S. Haque. "First Compulsory Admissions under Part II of the Mental Health Act 1983: A retrospective five-year study." Medicine, Science and the Law 43, no. 3 (July 2003): 248–54. http://dx.doi.org/10.1258/rsmmsl.43.3.248.
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The aim was to explore what happened during a five-year period to a group of patients with no previous psychiatric admissions, who were detained for the first time in a psychiatric hospital under part II of the Mental Health Act 1983. Subjects (n=189) who were detained under Section 2 or 3 in 1996 and 1997 in Queen Elizabeth Psychiatric Hospital, Birmingham were identified from computerised inpatient admission records. The mean age was 40.0 years (range 21-65). Nearly half of the cohort had a diagnosis of psychoses. Asians had the highest proportion of psychoses (64%) compared to African-Caribbean patients (48%) and White patients (41%). Almost half of the sample had a further admission, with Asian and African-Caribbean patients more likely to be readmitted than their white counterparts. Nearly a third of the cohort had a further compulsory detention. On re-admission, African-Caribbean subjects were more likely to be detained compared to Asian and White subjects. Fifty per cent had a further compulsory admission within a year of the index admission. The high number of psychoses in the Asian group may be due to their psychosis being more serious at presentation as a result of denial of illness and an increased co-morbidity with drug use in Asian men.