Suggestions for Improving the Palliative Care Outpatient Department through a Review of Palliative Care Visits

Aims: To explore unmet needs and enhanced outpatient care functions of palliative care for patients with cancers, scrutinized records of outpatient visits in acute care and regional designated cancer hospital. Methods: A retrospective study was made for a total of 3136 consecutive visits from electronic records between April 2020–March 2023. Results: There were 630 unscheduled visits (20.1%) with 74.0% of them occurring during working hours; a quarter of unscheduled visits were after-hours. Of the total visits, 347 visits (11.1%) resulted in emergent admissions, and of the unscheduled visits, 305 cases (48.4%) were emergent admissions. Ambulances were called in 196 cases (56.5%) of emergent admissions. Moreover, the reasons for unscheduled visits statistically differed from reasons for non-admission cases (p<0.01). Conclusion: Patients’ illness trajectories and our results revealed that palliative care patients with cancers often experience unexpected physical and mental changes. To establish more effective outpatient care, we should construct structures to be available 365 days a year for palliative care patients and to instruct patients and their care givers in advance about warning signs for admission and how to access medical services.

Emergent Admissions to the Epilepsy Monitoring Unit in the Setting of COVID-19 Pandemic-related, State-mandated Restrictions: Clinical Decision Making and Outcomes.

Due to the coronavirus disease 2019 (COVID-19) pandemic, the state of Texas-limited elective procedures to conserve beds and personal protective equipment (PPE); therefore, between March 22 and May 18, 2020, admission to the epilepsy monitoring unit (EMU) was limited only to urgent and emergent cases. We evaluated clinical characteristics and outcomes of these patients who were admitted to the EMU. Nineteen patients were admitted (one patient twice) with average age of 36.26 years (11 female) and average length of stay 3 days (range: 2-9 days). At least one event was captured on continuous EEG (cEEG) and video monitoring in all 20 admissions (atypical in one). One patient had both epileptic (ES) and psychogenic non-epileptic seizures (PNES) while 10 had PNES and 9 had ES. In 8 of 9 patients with ES, medications were changed, while in 5 patients with PNES, anti-epileptic drugs (AED) were stopped; the remaining 5 were not on medications. Of the 14 patients who had seen an epileptologist pre-admission, 13 (or 93%) had their diagnosis confirmed by EMU stay; a statistically significant finding. While typically an elective admission, in the setting of the COVID-19 pandemic, urgent and emergent EMU admissions were required for increased seizure or event frequency. In the vast majority of patients (13 of 19), admission lead to medication changes to either better control seizures or to change therapeutics as appropriate when PNES was identified.

Clinical characteristics of critically ill pregnant women with different admission methods to intensive care unit: data analysis from 2006 to 2019 in the university hospital / 中华危重病急救医学

Objective:To compare the clinical characteristics of critically ill pregnant women admitted to the intensive care unit (ICU) with different admission methods, in order to make more effective and rational use of ICU resources.Methods:A retrospective study was conducted. The clinical data of critically ill pregnant women admitted to ICU of Peking University Third Hospital from January 2006 to July 2019 were analyzed. According to the admission mode to ICU, the pregnant women were divided into emergency admission group (transferred to ICU on the same day or the next day due to critical illness) and planned admission group (transferred to ICU 2 days after admitting in obstetric ward). The clinical characteristics of ICU critical pregnant women, such as the incidence, causes of admission, severity of the disease, main treatment measures, mortality, and medical expenses were collected, and a comparative analysis between the two groups was performed.Results:During the nearly 14 years, a total of 576 critical pregnant women in ICU were enrolled, accounting for 0.8% (576/71 790) of the total number of obstetric inpatients and 4.6% (576/12 412) of the total number of ICU inpatients. Seven maternal deaths accounted for 1.2% of all critically pregnant women transferred to ICU, and the overall mortality of pregnant women was 10/100 thousand. Of the 576 critically pregnant women, there were 327 patients (56.8%) in the emergency admission group and 249 patients (43.2%) in the planned admission group. Compared with the planned admission group, the proportion of elective cesarean section in the emergency admission group was significantly lower (17.7% vs. 94.0%, P < 0.01), and the proportion of emergency cesarean section was significantly higher (65.1% vs. 2.4%, P < 0.01), the acute physiology and chronic health evaluation (APACHE Ⅱ, APACHE Ⅲ) scores, simplified acute physiology score Ⅱ (SAPS Ⅱ) and Marshall score were significantly higher [APACHE Ⅱ score: 6.0 (4.0, 9.8) vs. 4.0 (3.0, 7.0), APACHE Ⅲ score: 14.0 (11.0, 20.3) vs. 12.0 (9.0, 16.0), SAPS Ⅱ score: 8 (0, 12) vs. 3 (0, 8), Marshall score: 2 (1, 4) vs. 1 (1, 3), all P < 0.01]. The length of ICU stay in the emergency admission group was significantly longer than that in the planned admission group [days: 2 (1, 5) vs. 2 (1, 3), P < 0.01], and the total length of hospital stay was significantly shorter [days: 9 (7, 13) vs. 13 (10, 18), P < 0.01]. Both in the emergency admission group and the planned admission group, obstetric factors were the main reason for admission, 60.9% (199/327) and 70.3% (175/249), respectively. The proportion of postpartum hemorrhage was the highest [35.2% (115/327) and 57.0% (142/249)], followed by preeclampsia/eclampsia [7.0% (23/327) and 7.6% (19/249)]. Only 7 of the 19 critically pregnant women with puerperal infection were planned admission. All 21 patients with acute fatty liver of pregnancy (AFLP) during pregnancy were emergency admission. Among the emergency and planned admission patients, 73 patients (22.3%) and 42 patients (16.9%) required mechanical ventilation (duration of mechanical ventilation > 24 hours), 99 patients (30.3%) and 35 patients (14.1%) needed vasoactive agents, 67 patients (20.5%) and 20 patients (8.0%) received hemodynamic monitoring, and 123 patients (37.6%) and 154 patients (61.8%) were given anticoagulation therapy, respectively. In terms of severity score of critical pregnant women, there were significant differences in APACHE Ⅱ, APACHE Ⅲ, SAPS Ⅱ and Marshall scores of pregnant women with different diseases. Among them, the APACHE Ⅲ, SAPS Ⅱ and Marshall scores of AFLP were the highest [21.0 (15.0, 32.5), 12.0 (6.0, 16.5) and 6.0 (3.5, 8.0), respectively]. The APACHE Ⅱ and APACHE Ⅲ scores of postpartum hemorrhage were the lowest [4.0 (3.0, 7.0), 12.0 (10.0, 16.0)]. The SAPS Ⅱ score of pneumonia was the lowest [2.0 (0, 14.0)]. The Marshall score for puerperal infection was the lowest [1.0 (0, 3.0)]. In terms of the total medical expenses, the cost in the emergency admission group was significantly lower than that in the planned admission group [10 thousand Yuan: 3.1 (2.0, 4.7) vs. 4.1 (2.9, 5.8), P < 0.05]. Conclusions:Compared with the critically ill pregnant women who planned to be admitted to ICU, the patients emergency admitted to ICU were more complicated and urgent, and the severity of the condition was scored higher. At present, the severity scoring system commonly used in ICU can only partly evaluate the severity of critically ill pregnant women, therefore, it is necessary to design the specific severity scoring system for critically ill pregnant women to effectively and rationally use the precious ICU resources.

Characteristics of Psychiatric Patients Referred by Police to an Emergency Department / 신경정신의학

OBJECTIVES: This study compared the demographic and clinical characteristics of police referrals with referrals from other sources to a psychiatric emergency department. METHODS: A retrospective cross-sectional study was conducted on the data from the psychiatric emergency department of Ulsan University Hospital from January 2014 to October 2017. The study sample consisted of 79 psychiatric patients who were referred by police, and the characteristics of this group were compared with those of 240 psychiatric patients who were referred by other sources. The collected data were analyzed using a chi-square, Fisher's exact test, and independent sample t-tests. RESULTS: Among the 1768 psychiatric emergency visits, 89 (5.0%) were referred by police, and among the 79 referrals by police chosen as the study group, there were 4(5.1%) cases of emergent psychiatric admission. These patients referred by police were more likely to be male and in a lower socio-economic status. Police referrals were more likely to exhibit violent behavior, be restrained, and more likely to visit after working hours. They were notified more rapidly to the psychiatric department, less notified to other departments, and visited the psychiatric outpatient clinics less after discharge from the emergency department. CONCLUSION: The study results highlight the importance of understanding the characteristics of psychiatric emergency patients referred by police and identifying the problems of the current psychiatric emergency services. Systems need to be developed that clarify the roles of police in psychiatric emergencies and facilitate collaboration between police and mental health institutions.

Impact of elective versus emergent admission on perioperative complications and resource utilization in lumbar fusion.

BACKGROUND: The notion of higher complication rate and mortality in emergency surgeries is well established. There is a paucity of literature demonstrating the impact of emergent versus elective admissions for spinal surgery on the perioperative outcomes. We aim to evaluate the influence of the type of admission (elective or emergent) and day of surgery (same day versus other days within the emergent group) on the incidence, pattern of perioperative complications and hospital charges in the patients undergoing lumbar fusion for degenerative spine disease. METHODS: Data was obtained from the Nationwide Inpatient Sample (NIS) database between 2002 and 2011. We performed multivariate analysis to evaluate the impact of admission type and day of surgery on perioperative outcomes. RESULTS: A total of 266439 patients were identified. The majority of the admissions were elective (92.6%). Emergent admission comprised 7.4% of the total admission. Mean Charlson comorbidity index (CCI) was significantly higher in emergent and 'other days' (<0.001) groups. Emergent admission and surgery performed on the 'other days' were the independent risk factors for the higher incidence of the venous thromboembolic events, surgical site infection and wound dehiscence. The patients in the emergent and 'other days' surgery groups had a longer stay in the hospital (P<0.001). The mean total hospital charges were higher in the emergent admission and 'other days' surgery groups (P<0.001). CONCLUSIONS: 'Emergent admission' and surgery performed on the 'other days' in lumbar fusion are independent risk factors for the higher incidence of perioperative complications. Complicated hospital course and longer stay of the patients in the emergent admission and 'other days' group seems to be associated with higher total hospital charges.

A Comparative Study between Emergent and Elective Admission: Identifying Medicines Brought to Hospital by Inpatients / 医薬品情報学

<b>Objective: </b>Information on medicines brought to hospital by inpatients is essential to optimize drug use and patient safety.  However, the actual situation and usefulness of identifying such medicines on the emergent admission of patients remain to be clarified.  The objective of this study was to examine the usefulness of identifying the medicines patients bring to the hospital on emergent admission.<br><b>Methods: </b>We compared the source of information on identifying medicines between two groups of patient: emergent admissions (<i>N</i>=276) and elective admissions (<i>N</i>=50), and also investigated intervention by pharmacists regarding the medicines patients had brought with them.<br><b>Results: </b>Regarding the source of information to identify the medicines, the rate of utilizing medicine notebooks on emergent admission was significantly lower than on elective admission, and the rate of inquiring with community pharmacies on emergent admission was significantly higher than on elective admission.  The frequencies of intervention by pharmacists in the two groups were similar, and, therefore, the usefulness of identifying the medicines patients brought was noted regardless of the admission course.<br><b>Conclusion: </b>Identifying the medicines patients bring to the hospital might be useful on emergent admission.  Hospital pharmacists should promote an increase in the medicine notebook utilization rate and reinforce cooperation with community pharmacies.

Analysis of admitted emergent medical cases among tourists to gero hot spring / 日本温泉気候物理医学会雑誌

Currently 1.5 million people a year visit the Gero hot spring. A total of 44 patients who suffered from disease while staying there and required treatment were admitted to our hospital during 1987. This paper presents a statistical analysis these 44 cases.<br>There was no large numerical difference between male and female patients, and about 60% of them were 60 to 70 years old. While some came from Aichi Prefecture, a notable number of patients came from remote places. Most of the patients were admitted to the hospital from the end of summer through winter and often at night. About 50% of patients suffered from heart diseases and cerebrovascular disturbances. The next largest percentage had gastrointestinal diseases. Fifty percent of the patients recovered within a couple of days of hospitalization and all other patients, except two patients who died, left the hospital within 20 days. About 70% of these patients were carried to the hospital by ambulance. About 30% of the patients were considered to have contracted the disease while they were drinking, and the majority of them had heart disease, cerebrovascular disturbance, or acute alcoholism. About 40% of the patients contracted the disease while bathing, and the majority of them had cerebrovascular diseases and respiratory disturbance. Although no correlation with weather was found in 21 cases of heart diseases and cerebrovascular disturbance, onset of the disease in other than optimum temperature and humidity was observed in many cases.<br>The following five factors were considered to have aggravated the diseases:<br>1) Advanced age.<br>2) Overwork.<br>3) Chronic disease or insufficient health checks.<br>4) Drinking heavily, bathing after drinking, or bathing for too long.<br>5) Seasonal factors (summer through winter) and improper temperature or humidity for those patients with circulatory diseases.<br>Results of the statistical analysis indicated the necessity for guidance in relaxation and at hot springs as well as improvement of spa facilities.