Multivariable analysis of predictors of unplanned hospital readmission after pancreaticoduodenectomy: development of a validated risk score.

BACKGROUND: Unplanned hospital readmission after pancreaticoduodenectomy (PD) is usually due to surgical complications and has significant clinical and economic impact. This study developed a risk score to predict 30-day readmission after PD. METHODS: Patients undergoing PD between 2009 and 2016 were reviewed from a prospective database. Predictors of readmission were identified using a multivariable logistic regression model, from which a points-based risk scoring system was derived. RESULTS: 81 of 518 patients (15.6%) were readmitted within 30 days. History of cardiac disease ([odds ratio] OR = 2.12; 95% CI: 1.12-4.56), CRP>140 mg/L on post-operative day 3 (OR = 2.34; 95% CI: 1.37-4.35) and comprehensive complication index >14 (OR = 1.74; 95% CI: 1.03-2.85) were independent predictors of readmission. The regression coefficients were used to generate a risk score with excellent calibration (p = 0.917) and good discrimination (c-index = 0.65; 95% CI: 0.58-0.71; p < 0.001). Patients were categorised as low, moderate and high risk, with readmission rates of 6.4%, 13.4% and 23.0% respectively (p < 0.001). CONCLUSION: The risk score identifies patients at high risk of readmission after pancreaticoduodenectomy. Such patients may benefit from pre-discharge imaging and/or enhanced follow-up, which may potentially reduce the impact of readmissions.

Health Literacy Out Loud Podcasts: Audio Interviews About Health Literacy, Health Communication, and Health from Many Points of View.

This report introduces Health Literacy Out Loud (HLOL) podcasts, which have covered many aspects of health literacy, health communication, and health care from diverse perspectives since 2008. The report includes excerpts from select HLOL podcasts. Each includes a link to listen and learn more. Section two highlights health literacy pioneers including conversations with Len and Ceci Doak, Archie Willard, and Rima Rudd. Section three looks at two of the most common health communication strategies, the written and spoken word. Section four brings in other aspects of communication including cultural aspects of food and nutrition, disability, and health education in a remote South African village. Section five looks more generally at the production of HLOL podcasts.

Health literacy: how visuals can help tell the healthcare story.

Herb, a 66-year old general contractor, had a major heart attack five years ago. His doctor performed an emergency coronary angiography to examine the blood vessels and chambers of his heart. After the procedure, Herb's doctor gave him a simple line drawing of the heart and arteries. She then coloured in where each artery was blocked and wrote alongside how much each was occluded. Seeing so clearly what was wrong, Herb readily agreed to participate in a cardiac rehabilitation program and change his diet and exercise habits. He did so well that he was asked to speak with other patients who had just been diagnosed with cardiovascular disease. To Herb's surprise and disappointment, not one of the more than 100 people he spoke with had ever been given a 'heart picture' like his. Herb often hears people say how these types of drawings could have helped them better understand their diagnosis and treatment recommendations.1.

Communicating with clients in person and over the phone.

Communicating complex health-care and long-term care information clearly, quickly and in ways your clients can truly understand is a major challenge for aging-services providers. This brief focuses on oral communication, discussing why Medicare and other health-care information is so hard to talk about and offering tips you can use to help improve your communication with clients.