Reingreso hospitalario a 30 días en pacientes pediátricos con enfermedades crónicas complejas / Thirty-day readmissions in children with complex chronic conditions

Introducción: La tasa de reingreso hospitalario a 30 días del alta es una medida de calidad de la atención médica. Los pacientes pediátricos con enfermedades crónicas complejas tienen altas tasas de reingreso. La falla en la transición entre el cuidado hospitalario y domiciliario podría explicar este fenómeno. Objetivos: Estimar la tasa de incidencia de reingreso hospitalario a 30 días en pacientes pediátricos con enfermedades crónicas complejas, estimar cuántos son potencialmente prevenibles y explorar posibles factores asociados a reingreso. Materiales y método: Estudio de cohorte prospectivo incluyendo pacientes hospitalizados con enfermedades crónicas complejas de un mes a 18 años de edad. Se excluyeron pacientes con enfermedad oncológica y cardiopatías congénitas. Se evaluaron el reingreso a 30 días y el reingreso potencialmente prevenible. Se valoraron características sociodemográficas, geográficas, clínicas y de la transición hacia el cuidado domiciliario. Resultados: Se incluyeron 171 hospitalizaciones; dentro de los 30 días reingresaron 28 pacientes (16,4%; IC95% 11,6-22,7). De los 28 reingresos, 23 (82,1%; IC95% 64,4-92,1) fueron potencialmente prevenibles. La enfermedad respiratoria se asoció con mayor probabilidad de reingreso. No se encontró asociación entre el reingreso a 30 días y los factores de la transición al cuidado domiciliario evaluados. Conclusiones: La tasa de reingreso a 30 días en pacientes con enfermedad crónica compleja fue del 16,4%, y el 82,1% fueron potencialmente prevenibles. Únicamente la enfermedad respiratoria se comportó como factor de riesgo para reingreso a 30 días.(AU)

Introduction: The rate of hospital readmission within 30 days of discharge is a quality indicator in health care. Paediatric patients with complex chronic conditions have high readmission rates. Failure in the transition between hospital and home care could explain this phenomenon. Objectives: To estimate the incidence rate of 30-day hospital readmission in paediatric patients with complex chronic conditions, estimate how many are potentially preventable and explore factors associated with readmission. Materials and method: Cohort study including hospitalized patients with complex chronic conditions aged one month to 18 years. Patients with cancer or with congenital heart disease requiring surgical correction were excluded. The outcomes assessed were 30-day readmission rate and potentially preventable readmissions. We analysed sociodemographic, geographic, clinical and transition to home care characteristics as factors potentially associated with readmission. Results: The study included 171 hospitalizations, and 28 patients were readmitted within 30 days (16.4%; 95% CI, 11.6–22.7). Of the 28 readmissions, 23 were potentially preventable (82.1%; 95% CI, 64.4–92.1). Respiratory disease was associated with a higher probability of readmission. There was no association between 30-day readmission and the characteristics of the transition to home care. Conclusions: The 30-day readmission rate in patients with complex chronic disease was 16.4%, and 82.1% of readmissions were potentially preventable. Respiratory disease was the only identified risk factor for 30-day readmission.(AU)

Thirty-day readmissions in children with complex chronic conditions.

INTRODUCTION: The rate of hospital readmission within 30 days of discharge is a quality indicator in health care. Paediatric patients with complex chronic conditions have high readmission rates. Failure in the transition between hospital and home care could explain this phenomenon. OBJECTIVES: To estimate the incidence rate of 30-day hospital readmission in paediatric patients with complex chronic conditions, estimate how many are potentially preventable and explore factors associated with readmission. MATERIALS AND METHOD: Cohort study including hospitalised patients with complex chronic conditions aged 1 month to 18 years. Patients with cancer or with congenital heart disease requiring surgical correction were excluded. The outcomes assessed were 30-day readmission rate and potentially preventable readmissions. We analysed sociodemographic, geographic, clinical and transition to home care characteristics as factors potentially associated with readmission. RESULTS: The study included 171 hospitalizations, and 28 patients were readmitted within 30 days (16.4%; 95% CI, 11.6%-22.7%). Of the 28 readmissions, 23 were potentially preventable (82.1%; 95% CI, 64.4%-92.1%). Respiratory disease was associated with a higher probability of readmission. There was no association between 30-day readmission and the characteristics of the transition to home care. CONCLUSIONS: The 30-day readmission rate in patients with complex chronic disease was 16.4%, and 82.1% of readmissions were potentially preventable. Respiratory disease was the only identified risk factor for 30-day readmission.

Copper-Catalyzed Synthesis of Difluoromethyl Alkynes from Terminal and Silyl Acetylenes.

An efficient method for the direct C(sp)-H difluoromethylation of terminal alkynes and the desilylation-difluoromethylation of (trimethylsilyl)acetylenes is disclosed. The copper-catalyzed transformation provides access to a wide range of structurally diverse CF2H alkynes in good yields, utilizing a (difluoromethyl)zinc reagent and an organic oxidant. The difluoromethylation of important synthons and API's is showcased. The synthetic utility of these (difluoromethyl)alkynes is demonstrated by selected cycloaddition reactions. Additionally, a slight modification to the reaction conditions allowed the selective preparation of a 2-difluoromethylindole.

Factores asociados al riesgo nutricional en adultos mayoresautónomos de la ciudad de Arequipa, Perú / Nutrition-related risk factors in autonomous elderly people from Arequipa, Peru

Objetivo: Determinar la frecuencia de desnutrición oriesgo de desnutrición y los factores asociados, en adultosmayores autónomos no institucionalizados que viven en laCiudad de Arequipa, Perú. Métodos: Estudio transversal en muestra de 214 adultosmayores. Para valorar el estado nutricional se utilizó el MiniNutritional Assessment (MNA), la evaluación funcional porla escala de Lawton y Brody, el cuestionario Pfeiffer paramedición del estado mental, síntomas depresivos a travésde la escala de Yesavage y riesgo sociofamiliar con el Testde Gijón. Para la asociación entre los factores de riesgo conel MNA, se calculó el Odds Ratio crudo (OR) y Odds Ratioajustado (ORa), este último a través de un modelo de regresión logística binario, con intervalos de confianza del95% (IC95%). Resultados: Del total de sujetos estudiados, el 88,3% sonmujeres y el 11,7% hombres. El 51% presentó riesgo de desnutrición y 2% desnutrición. Los factores de riesgo asociadosa la desnutrición o riesgo nutricional fueron: edad (OR=3,2;IC95% [1,6-6,2]), patologías previas (OR=3,9;IC95% [1,7-8,8]), dependencia funcional (OR=3,8; IC95%[2,0-7,4]) y es-tar en riesgo social (OR=3,1; IC95% [1,8-5,5]). Los OR ajus-tados identificaron los mismos factores de riesgo conexcepción de la dependencia funcional (ORa= 1,7; IC95%[0,6-4,5]). Conclusiones: Estos hallazgos mostraron un alto porcentaje de adultos mayores con riesgo nutricional o desnutriciónasociados a la edad, patologías previas, dependencia funcional y riesgo social.(AU)

Objective: Determine the frequency of malnutrition or riskof malnutrition and the associated factors, in non institutionalized autonomous older adults living in the city of Arequipa,Peru. Methods: Cross sectional study in a sample of 214 olderadults. The Mini Nutritional Assessment (MNA) was used torate the nutritional status, the functional assessment usingthe Lawton Instrumental Activities of Daily Living Scala, thePfeiffer test for the measurement of mental status, prevalence of depresion using the Yesavage scale and the socio family risk with the test of Gijón. For the association betweenthe risk factors with the MNA, the crude Odds Ratio (OR) andadjusted Odds Ratio (ORa) were calculated, the latter using abinary logistic regression model, with 95% confidence intervals (CI95%). Results: Of the total of subjects studied, 88,3% arewomen and 11,7% men. 51% presented risk of malnutritionand 2% malnutrition. The risk factors associated with malnutrition or nutritional risk were: age (OR=3,2; 95% CI [1,6-6,2]), previous pathologies (OR=3,9; 95% CI [1,7- 8,8]),functional dependency (OR = 3,8; 95% CI [2,0-7,4]) and beat social risk (OR= 3,1; 95% CI [1,8-5,5]). Adjusted ORsidentified the same risk factors with the exception of func-tional dependence (ORa = 1,7; 95% CI [0.6-4.5]). Conclusions: These findings showed a high percentage ofolder adults with nutritional risk or undernutrition associatedwith age, previous pathologies, functional dependence andsocial risk.(AU)

Clinical and histopathological profile of melanoma patients seen at the Philippine General Hospital: A six-year retrospective study from 2004 to 2009

BACKGROUND: Melanoma is a malignant tumor ranked as the top cause of skin cancer death and is increasing in incidence in most races. Rarity and atypical presentation in Non-Caucasians lead to delayed diagnosis and poor survival rates in these populations. This is the first study in the Philippines to document and describe both clinical and histopathologic profile of melanoma in Filipinos. Data gathered and analyzed may be used as basis for future research on prevention and treatment of this deadly disease among Filipinos.OBJECTIVE: To determine the epidemiology, clinical and histopathologic characteristics of melanoma patients in the Philippine General Hospital.METHODS: Melanoma patient records and biopsies from the Department of Laboratories-Pathology Services and Section of Dermatology- Dermatopathology Unit of the Philippine General Hospital from 2004 to 2009 were reviewed. RESULTS: Fifty-eight melanoma cases were identified. Based on the medical records retrieved, 35% were males and 23% females, while 42% had missing information. Most were in the fifth decade with a mean age of 52.8 years. The most common sites were the feet and trunk. Seven patients had recorded metastasis. The most common histopathologic characteristics noted was presence of angiolymphoid spread (70%), followed by presence of tumor-infiltrating lymphocytes (42%), ulceration (37%), high mitotic rate (35%), neurotropism (14%) and co-existing nevus (2%). Vertical growth phase was seen in 49% while 16% had a radial growth phase.CONCLUSION: Melanoma has a lower prevalence rate in the population studied, but most presented with clinical and histopathologic features consistent with advanced stages.

Randomized controlled trial on the efficacy and safety of virgin coconut oil compared to mineral oil in the treatment of uremic xerosis

BACKGROUND: Uremic xerosis is the most common dermatologic condition present in patients with chronic kidney disease. Emollients were shown to be beneficial and are considered to be the first-line of treatment.OBJECTIVE: To assess the efficacy and safety of virgin coconut oil (VCO) compared to mineral oil as a therapeutic mosturizer for uremic xerosis.METHODS: Adult patients undergoing hemadialysis who have uremic xerosis were randomized using a computer-generated list and were instructed to apply either VCO or mineral oil twice daily on the legs for 4 weeks. Primary outcome measures included investigator-assessed clinical efficacy based on overall dry skin score (ODSS), change in skin hydration (corneometer readings), change in skin lipids (sebumeter readings), and quality of life scores. Secondary outcome measures included patient-assessed efficacy and advent of adverse effects. Overall therapeutic response was determined in which treatment success was defined as total clearance of xerosis or reduction of ODSS score and increased objective measurements (i.e., corneometer and sebumeter readings) plus moderate to marked patient-assessed efficacy, while treatment failure was defined as failure in any one of these parameters.RESULTS: A total of 45 (22 VCO group, 23 mineral oil group) were recruited and 36 (18 VCO group, 18 mineral oil group) completed the study. The majority of patients in both treatment groups showed improved ODSS, corneometer readings, and quality of life scores. Most patients considered both treatment oils to be moderately to markedly effective. Analysis of overall therapeutic response revealed treatment success of 4 out of 22 in the VCO group and 4 out of 23 in the mineral oil group. VCO demostrated a trend to benefit in improving xerotic skin (RRR = 1.0%, 95% CI: -30, 26.3; RR = 0.99, 95% CI: 0.76, 1.3) but results are inconclusive due to the wide confidence interval.CONCLUSION: The application of VCO or mineral oil for 4 weeks may be equally beneficial and safe in improving uremic xerosis. VCO showed a trend to benefit compared to mineral oil in terms of overall therapeutic response but this needs to be confirmed in larger randomized controlled trials.