Impact of admitting department on the management of acute coronary syndrome after an out of hospital cardiac arrest.

AIM: This study aimed to analyze the influence of the hospital admitting department on adherence to the Guidelines of European Society of Cardiology for management of acute coronary syndromes in patients after out-of-hospital cardiac arrest (OHCA) of coronary etiology. METHODS: We studied retrospective-prospective register of 102 consecutive patients with OHCA as a manifestation of acute coronary syndrome (ACS). Patients were admitted to the coronary care unit (CCU) 52, general intensive care unit (GICU) 21, or GICU after initial Cath lab treatment (CAG-GICU) 29. This study compared the differences in the management of ACS in patients with OHCA of coronary etiology based on the admitting department in a tertiary care institution. RESULTS: Twelve of the 21 (57.1%) patients admitted to the GICU were evaluated as having ACS on-site where they experienced OHCA. In the CCU group, 50 out of 52 (96.2%) and 28 of 29 (100%) patients in the CAG-GICU group (P<0.001). Coronary angiography was performed in 10 of 21 patients (48%) admitted to the GICU. It was performed in 49 out of 52 (94%) CCU patients and, in the CAG-GICU group, 28 out of 29 patients. The mean time to CAG differed significantly across groups (that is, GICU 200.7 min., CCU 71.2 min., and CAG-GICU 7.5 min. (P<0.001)). Aspirin was used in 48% of GICU, 96% of CCU, and 79% of CAG-GICU patients (P<0.001), while in the pre-hospital phase, aspirin was used in 9.5% of GICU, 71.2% of CCU, and 50% of CAG-GICU patients (P<0.001). P2Y12 inhibitor prescriptions were lower in patients admitted to the GICU (33% vs. 89% CCU and 57% CAG-GICU, P<0.001). The department's choice significantly affected the time to initiation of antithrombotics, which was the longest in the GICU. CONCLUSION: The choice of admission department for patients with OHCA caused by ACS was found to affect the extent to which the recommended treatments were used. An examination of OHCA patients by a cardiologist upon admission to the hospital increased the likelihood of an early diagnosis of ACS as the cause of OHCA.

Effect of holiday admission for acute aortic dissection on in-hospital mortality in Japan: A nationwide study.

BACKGROUND: Patients admitted on weekends have higher mortality than those admitted on weekdays. However, whether the "weekend effect" results in a higher mortality after admission for acute aortic dissection (AAD),-classified according to Stanford types-remains unclear. This study aimed to examine the association between admission day and in-hospital mortality in AAD Type A and B. METHODS: We used data from the Japanese registry of all Cardiac and Vascular Diseases Diagnostic Procedure Combination, a nationwide claim-based database with data from 953 certified hospitals, and enrolled in-patients with AAD admitted between April 1, 2012, and March 31, 2016. Based on the admission day, we stratified patients into groups (Weekdays, Saturdays, and Sundays/holidays). The influence of the admission day on in-hospital mortality was assessed via multi-level logistic regression analysis. We also performed a Stanford type-based stratified analysis. RESULTS: Among the included 25,641 patients, in-hospital mortality was 16.0%. The prevalence of patients admitted with AAD was relatively higher on weekdays. After adjustment for covariates, patients admitted on a Sunday/holiday showed an increased risk of in-hospital mortality (odds ratio [OR] 1.20; 95% confidence interval [CI] 1.07-1.33, p<0.001) than patients admitted on weekdays. Among patients admitted on a Sunday/holiday, only the subgroup of Stanford Type A showed a significantly increased risk of in-hospital mortality. (Stanford Type A, non-surgery vs. surgery groups: 95% CI 1.06-1.48 vs. 1.17-1.68, p<0.001 for both groups, OR 1.25 vs. 1.41, respectively, Stanford Type B, non-surgery vs. surgery groups: 95% CI 0.64-1.09 vs. 0.40-2.10; p = 0.182 vs. 0.846; OR 0.84 vs. 0.92). CONCLUSIONS: In conclusion, patients with AAD Type A admitted on a Sunday/holiday may have an increased in-hospital mortality risk.

Association between hospital admissions and healthcare provider communication for individuals with sickle cell disease.

Objective: To test the hypothesis that caregivers' or adult participants' low ratings of provider communication are associated with more hospital admissions among adults and children with sickle cell disease (SCD), respectively. Secondarily, we determined whether there was an association between the caregivers' or participants' health literacy and rating of providers' communication. Methods: Primary data were collected from participants through surveys between 2014 and 2016, across six sickle cell centers throughout the U.S. In this cross-sectional cohort study, 211 adults with SCD and 331 caregivers of children with SCD completed surveys evaluating provider communication using the Consumer Assessment of Healthcare Providers and Systems (CAHPS), healthcare utilization, health literacy, and other sociodemographic and behavioral variables. Analyses included descriptive statistics, bivariate analyses, and logistic regression. Results: Participants with better ratings of provider communication were less likely to be hospitalized (odds ratio (OR) = 0.54, 95% confidence interval (CI) = [0.35, 0.83]). Positive ratings of provider communication were associated with fewer readmissions for children (OR = 0.23, 95% CI = [0.09, 0.57]). Participants with better ratings of provider communication were less likely to rate their health literacy as lower (regression coefficient (B) = -0.28, 95% CI = [-0.46, -0.10]). Conclusions: Low ratings of provider communication were associated with more hospitalizations and readmissions in SCD, suggesting the need for interventions targeted at improving patient-provider communication which could decrease hospitalizations for this population.

Elderly Patients With Isolated Hip Fracture Requiring Surgical Intervention: Does Admitting Service Matter?

The American College of Surgeons requires trauma centers to track the number of injured patients admitted to a surgical service as well as nonsurgical admissions (NSAs) as a quality marker. We aim to compare the relationship between admitting service and outcomes in patients with isolated hip fracture (IHF). A 4-year retrospective cohort review of data collected from a single institution's trauma registry for adult patients with IHF was done. Patients were stratified into 2 groups based on admission to a surgical service versus NSA. Demographic and outcome variables including age, gender, Injury Severity Score (ISS), intensive care unit length of stay (ICU-LOS), deep venous thrombosis (DVT), and mortality rates were compared. Analysis of variance and χ test were used for data analysis with statistical significance defined as p < .05. A total of 629 patients with IHF were admitted. Of those, 30 (4.8%) were admitted to a surgical service and 599 (95.2%) were NSAs. Patients admitted to a surgical service were younger but average ISS was similar in both groups. Those admitted to a surgical service had a significantly shorter ICU-LOS than NSA patients (2.97 days vs. 4.91, p < .001). Readmission rate at 30 days (3.3% vs. 1.2%, p > .05) and DVT rates (0% vs. 0.4%, p > .05) were similar between groups. Mortality rates did not differ between groups (3.3% vs. 2.2%, p > .05). Patients with hip fracture requiring surgical intervention admitted to a trauma service have a shorter ICU-LOS than those admitted to nonsurgical services. Other quality markers were similar.

Referral and admission to intensive care: A qualitative study of doctors' practices in a Tanzanian university hospital.

BACKGROUND: Intensive care is care for critically ill patients with potentially reversible conditions. Patient selection for intensive care should be based on potential benefit but since demand exceeds availability, rationing is needed. In Tanzania, the availability of Intensive Care Units (ICUs) is very limited and the practices for selecting patients for intensive care are not known. The aim of this study was to explore doctors' experiences and perceptions of ICU referral and admission processes in a university hospital in Tanzania. METHODS: We performed a qualitative study using semi-structured interviews with fifteen doctors involved in the recent care of critically ill patients in university hospital in Tanzania. Inductive conventional content analysis was applied for the analysis of interview notes to derive categories and sub-categories. RESULTS: Two main categories were identified, (i) difficulties with the identification of critically ill patients in the wards and (ii) a lack of structured triaging to the ICU. A lack of critical care knowledge and communication barriers were described as preventing identification of critically ill patients. Triaging to the ICU was affected by a lack of guidelines for admission, diverging ideas about ICU indications and contraindications, the lack of bed capacity in the ICU and non-medical factors such as a fear of repercussions. CONCLUSION: Critically ill patients may not be identified in general wards in a Tanzanian university hospital and the triaging process for the admission of patients to intensive care is convoluted and not explicit. The findings indicate a potential for improved patient selection that could optimize the use of scarce ICU resources, leading to better patient outcomes.

Whole-body computed tomography: a new point of view in a hospital check-up unit? Our experience in 6516 patients.

BACKGROUND: There is a growing awareness that prevention and early diagnosis may reduce the high mortality associated with cancer, cardiovascular and other diseases. The role of whole-body computed tomography (WB-CT) in self-referred and asymptomatic patients has been debated. AIM: To determine frequency and spectrum of WB-CT findings in average-risk subjects derived from a Medical-Check-Up-Unit, to evaluate recommendations reported and distribution according to sex and age-groups. MATERIALS AND METHODS: We retrospectively reviewed 6516 subjects who underwent WB-CT (June 2004/February 2015). All were > 40 years and referred by Medical-Check-Up-Unit of our hospital. The main findings were categorized and classified as normal or not. Its distribution according to sex and age-groups was evaluated using Chi-square test and linear-by-linear association test, respectively. Number of recommendations, type and interval of follow-up were recorded. Descriptive statistics were used. RESULTS: WB-CT performed in 6516 patients (69% men, 31% women, mean age = 58.4 years) revealed chest (81.4%), abdominal (93.06%) and spine (65.39%) abnormalities. Only 1.60% had completely normal exploration. Abnormal WB-CT in men was significantly higher than women (98.64% vs. 97.87%; p = 0.021), with significant increase as age was higher (40-49 years: 95.65%; 50-59 years: 98.33%; 60-69 years: 99.47%; > 69 years: 99.89%) (p < 0.001). Although most findings were benign, we detected 1.47% primary tumors (96, mainly 35 kidneys and 15 lungs). 17.39% of patients received at least one recommendation predominantly in chest (78.19%) and follow-up imaging (69.89%). CONCLUSION: The most common WB-CT findings in asymptomatic subjects are benign. However, this examination allows identifying an important number of relevant and precocious findings that significantly increase with age, involving changes in lifestyle and precocious treatment.

Acute circulatory complications in people with diabetes mellitus type 2: How admission varies between urban and rural Victoria.

OBJECTIVE: To identify the extent to which rurality influences the admission and mortality rates for acute circulatory complications among people with type 2 diabetes mellitus. DESIGN: Retrospective study. SETTING: All Victorian hospitals. PARTICIPANTS: State-wide hospital admissions from 1 July 2010 to 30 June 2015 using the Victorian Admitted Episodes Dataset. Data included patients with type 2 diabetes mellitus and diagnosis of acute cardiovascular events, acute cerebrovascular haemorrhage or infarction, acute peripheral vascular events or hypertensive diseases. MAIN OUTCOME MEASURE: Rates of admission and mortality were calculated for local government areas and Department of Health regions. Regression analysis identified the influence between admission rates and various predictor variables. RESULTS: In total, 5785 emergency hospital admissions occurred during the study period, with the highest and lowest mortality and admission rates occurring in rural areas. Moderately high admission rates were identified in urban areas. Cardiovascular events far outnumbered other acute circulatory admissions. Regression analysis identified a number of significant socioeconomic variables, primarily for metropolitan residents. Socioeconomic disadvantage was the only significant factor in rural areas. CONCLUSION: Victorian admission and mortality rates for acute circulatory complications are greatest in rural areas; yet, there is considerable heterogeneity in the admission rates within both rural and metropolitan areas. Furthermore, socioeconomic status is more influential than remoteness in determining emergency admissions. Further research needs to investigate the particular variables that lead to poorer outcomes rurally, investigate socioeconomic disadvantage in rural areas and have greater emphasis on peripheral vascular disease prevention.

Costs of outpatient and inpatient MRSA screening and treatment strategies for patients at elective hospital admission - a decision tree analysis.

Background: Nosocomial infections are among the most common complications in hospitals. A major part is caused by multidrug-resistant organisms (MDRO). MRSA is still the most prominent and frequent MDRO. The early detection of carriers of multidrug-resistant bacteria is an effective measure to reduce nosocomial infections caused by MDRO. For patients who are planning to go to the hospital, an outpatient screening for MDRO and pre-hospital decolonization is recommended. However, the effectiveness of such pre-admission MDRO management in preparation for a planned hospital stay has not yet been sufficiently scientifically examined from an economic perspective. Methods: A decision tree will be used to develop scenarios for MDRO screening and treatment in the context of the outpatient and inpatient sectors using MRSA-positive patients as an example. Subsequently, the expected costs for the respective strategy are presented. Results: The decision tree analysis shows that the expected costs of outpatient MRSA management are €8.24 and that of inpatient MRSA management are €672.51. Conclusion: The forward displacement of the MRSA screening to the ambulatory sector and any subsequent outpatient decolonization for patients with a planned hospitalization is the most cost-effective strategy and should become a standard benefit. Excluding opportunity costs, the expected costs of inpatient MRSA management are €54.94.

Hemodilution is not the only reason of difference: Comparison of fasting and non-fasting lipoproteins in paired samples.

INTRODUCTION: Low-density lipoprotein cholesterol (LDL) is an important risk factor for cardiovascular disease (CVD) and generally measured after 8-12 h fasting. However, some recent studies have pointed that non-fasting lipoproteins, especially LDL concentrations, are better indicators for demonstrating CVD risk and atherosclerosis. They asserted that nutrition is a negligible factor on changes in lipoprotein concentrations and claimed this difference as a result of hemodilution effect, caused from fluid intake and can be eliminated by applying some adjustments. We aimed to compare the fasting and non-fasting LDL values of the same individuals and discuss whether non-fasting and fasting LDL results can be used in place of each other, directly or after applying hemodilution correction models. MATERIAL AND METHODS: Fasting and non-fasting blood samples of 248 apparently healthy participants were collected. Lipid panel tests, albumin and hemoglobin levels were studied in each sample. Results were evaluated in seven different models which were recommended to correct the hemodilution effect on fasting and non-fasting lipid concentrations of the same individual. Concordance of fasting and non-fasting risk group of the individual were calculated according to the National Cholesterol Education Program classification. RESULTS: Fasting and non-fasting LDL and non-high density lipoprotein cholesterol (non-HDL) concentrations were significantly different in every model (p < 0.001). Concordance results of fasting and non-fasting LDL and non-HDL risk groups were 63.8% and 77.9% respectively. CONCLUSIONS: Our results demonstrated that fasting and non-fasting LDL and non-HDL concentrations could not be used in place of each other even when the results were adjusted for elimination of the hemodilution effect.

Measuring Patient and Staff Satisfaction Before and After Implementation of a Paperless Registration System.

EXECUTIVE SUMMARY: While many aspects of patient care have transitioned to digital technology, the patient registration process often is still paper based. Several studies have examined the effects of changes in clinic workflows and appointment scheduling on patient satisfaction, but few have investigated changes from a paper-based to a paperless registration process. The authors measured patient and staff satisfaction before and after implementation of a new, tablet-based registration process at NYU Langone Health's Center for Women's Health in New York City. Mean preimplementation patient satisfaction scores on the six questions related to the registration process (1-5 scale, with 5 being the highest score) ranged from 4.0 to 4.5. Postimplementation satisfaction scores on the nine questions (six premeasure questions and three additional questions related to the tablet-based process) ranged from 4.4 to 4.6, with four of the six premeasures showing statistically significant improvement in patient satisfaction. Staff satisfaction was generally lower (2.8-3.6 preimplementation and 2.8-4 postimplementation), with no statistically significant difference between time frames. Patient satisfaction was relatively high under the paper registration process, and it improved significantly in some respects under the paperless process, while staff satisfaction did not change. The convenience and ease of use of a paperless registration system can help maintain or increase patient and staff satisfaction while introducing new workflows and improving the efficiency of the outpatient registration process. In adopting technology that can lead to changing workflows, organizations should train staff members and support them during the process.

Psychostimulant-related health service demand in an inner-city hospital, 2012-2015.

OBJECTIVE: To analyse routinely collected data from a hospital database of drug health consultation-liaison (CL) assessments. We aimed to investigate changes in psychostimulant-related health service demand in an inner-city hospital to inform the development of locally appropriate models of care. METHODS: We used de-identified drug health CL service data from 2012 to 2015. Psychostimulant-related consultations and admissions were compared with opioid-related consultations and admissions over time, by sex and by ward type (medical units, mental health units or emergency department). RESULTS: The CL service collected information on 8800 consultations and 4405 hospital admissions from 2012 to 2015. Psychostimulant use was responsible for 684 (7.8%) consultations and 372 (8.4%) admissions. Opioids were related to 1914 (21.8%) consultations and 864 (19.6%) admissions. Psychostimulants were the subject of three times more consultations in 2015 than in 2012, and more than twice as many admissions. Time trend analysis showed a significant time effect for consultations and admissions relating to psychostimulants. Conversely, no significant changes were observed in consultations and admissions relating to opioids. CONCLUSION: This study identified a rapid rise in the demand for psychostimulant-related inpatient assessments, suggesting the use of these drugs has increased locally. Because of the impact on the public health system, there is a need to invest in and implement new treatment strategies and services for psychostimulant users.

Poor outcomes among elderly patients hospitalized for influenza-like illness.

BACKGROUND AND OBJECTIVE: Global Influenza Hospital Surveillance Network is a worldwide initiative that aims to document the burden of influenza infections among acute admissions and vaccine effectiveness in particular countries. As a partner of this platform, we aimed to determine the frequency of influenza infections among acute admissions with influenza-like illness and the outcomes of enrolled patients during the 2015-2016 influenza season in selected hospitals in Turkey. PATIENTS AND METHODS: The investigators screened the hospital admission registries, chart review or available records, and screened all patients hospitalized in the previous 24-48 hours or overnight in the predefined wards or emergency room. A total of 1351 patients were screened for enrollment in five tertiary care referral hospitals in Ankara and 774 patients (57.3% of the initial screened population) were eligible for swabbing. All of the eligible patients who consented were swabbed and tested for influenza with real-time polymerase chain reaction (PCR) based methods. RESULTS: Overall, influenza positivity was detected in 142 patients (18.4%). The predominant influenza strain was A H1N1pdm09. Outcomes were worse among elderly patients, regardless of the presence of the influenza virus. Half of the patients over 65 years of age were admitted to the intensive care unit, while one third required any mode of mechanical ventilation and one fourth died in the hospital in that particular episode. CONCLUSION: These findings can guide hospitals to plan and prepare for the influenza season. Effective influenza vaccination strategies, particularly aimed at the elderly and adults with chronic diseases, can provide an opportunity for prevention of deaths due to influenza-like illness.

Effectiveness of a nurse-led preadmission intervention for parents of children with profound multiple disabilities undergoing hip-joint surgery: A quasi-experimental pilot study.

PURPOSE: The aim of this study was to assess the effectiveness of a family-centered care (FCC) intervention provided by an advanced practice nurse (APN) for parents of children with profound disabilities undergoing surgery. DESIGN AND METHODS: In a quasi-experimental design, we used the MPOC-20 to assess satisfaction with FCC and interviews to identify potential mechanisms for improving satisfaction. RESULTS: There was a positive effect on the MPOC-20 domain "general information," albeit with a small effect size (Cohen's d = 0.35). The interviewed parents expected additional support. PRACTICE IMPLICATIONS: Emphasis should be placed on providing comprehensive care coordination by an experienced APN. Shared care management is crucial in improving FCC.

Ineligibility criteria and deprivation of liberty in relation to guardianship.

Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses how the law surrounding deprivation of liberty safeguards relates to a person who is the subject of a guardianship order.

[Health status and access to health services by the population of L'Aquila (Abruzzo Region, Italy) six years after the earthquake]. / Stato di salute e accesso alle prestazioni sanitarie nella popolazione terremotata del comune di L'Aquila. Un bilancio a sei anni dal sisma.

Natural disasters, such as the earthquake that occurred in the province of L'Aquila in central Italy, in 2009, generally increase the demand for healthcare. A survey was conducted to assess perception of health status an d use of health services in a sample of L'Aquila's resident population, five years after the event, and in a comparison population consisting of a sample of the resident population of Avezzano, a town in the same region, not affected by the earthquake. No differences were found in perception of health status between the two populations. Both groups reported difficulties in accessing specialized healthcare and rehabilitation services.

Effects of Air Pollution on Hospital Emergency Room Visits for Respiratory Diseases: Urban-Suburban Differences in Eastern China.

A study on the relationships between ambient air pollutants (PM2.5, SO2 and NO2) and hospital emergency room visits (ERVs) for respiratory diseases from 2013 to 2014 was performed in both urban and suburban areas of Jinan, a heavily air-polluted city in Eastern China. This research was analyzed using generalized additive models (GAM) with Poisson regression, which controls for long-time trends, the "day of the week" effect and meteorological parameters. An increase of 10 µg/m³ in PM2.5, SO2 and NO2 corresponded to a 1.4% (95% confidence interval (CI): 0.7%, 2.1%), 1.2% (95% CI: 0.5%, 1.9%), and 2.5% (95%: 0.8%, 4.2%) growth in ERVs for the urban population, respectively, and a 1.5% (95%: 0.4%, 2.6%), 0.8% (95%: -0.7%, 2.3%), and 3.1% (95%: 0.5%, 5.7%) rise in ERVs for the suburban population, respectively. It was found that females were more susceptible than males to air pollution in the urban area when the analysis was stratified by gender, and the reverse result was seen in the suburban area. Our results suggest that the increase in ERVs for respiratory illnesses is linked to the levels of air pollutants in Jinan, and there may be some urban-suburban discrepancies in health outcomes from air pollutant exposure.