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Surgical site infections (SSI) substantially increase costs for healthcare providers because of additional treatments and extended patient recovery. The objective of this study was to assess the cost and health‐related quality of life impact of SSI, from the perspective of a large teaching hospital in England. Data were available for 144 participants undergoing clean or clean‐contaminated vascular surgery. SSI development, length of hospital stay, readmission, and antibiotic use were recorded over a 30‐day period. Patient‐reported EQ‐5D scores were obtained at baseline, day 7 and day 30. Linear regressions were used to control for confounding variables. A mean SSI‐associated length of stay of 9.72 days resulted in an additional cost of £3776 per patient (including a mean antibiotic cost of £532). Adjusting for age, smoking status, and procedure type, SSI was associated with a 92% increase in length of stay (P < 0.001). The adjusted episode cost was £3040. SSI reduced patient utility between baseline and day 30 by 0.156 (P = 0.236). Readmission rates were higher with SSI (P = 0.017), and the rate to return to work within 90 days was lower. Therefore, strategies to reduce the risk of surgical site infection for high‐risk vascular patients should be investigated. [ABSTRACT FROM AUTHOR]

Aim: This study aims to examine the effect of concurrent mild and mild‐to‐moderate cognitive impairment with chronic diseases on hospital admission (HA) among community‐dwelling older adults. Method: The National Health and Aging Trends Study (2011–2018), with 1225 respondents (each wave), were used. The number of HAs within 1 year was the outcome. Clock drawing test, delayed word recall test, self‐reported chronic diseases and their interactions were the independent variables. Results: The effect of cognitive impairment on the frequency of HAs varies for executive function and memory impairment. Executive function impairment concurrent with the history of heart attack or diabetes mellitus (DM) can increase the risk of HAs. Memory impairment concurrent with hypertension, DM or stroke can increase the chance of HAs. Conclusion: Screening to identify mild and mild‐to‐moderate cognitive impairment at the time of admission can help to reduce the risk of rehospitalization, particularly for patients with DM, hypertension, stroke and heart attack. Geriatr Gerontol Int 2020; 20: 1213–1220. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project is a successful, multicomponent demonstration project to reduce potentially avoidable hospitalizations of long‐stay nursing facility residents. To continue to reduce hospital transfers, a more detailed understanding of these transfer events is needed. The purpose of this study was to describe differences in transfer events that result in treatment in the hospital versus emergency department (ED) only. DESIGN OPTIMISTIC project nurses collected data on residents who transferred. Transfer events that resulted in treatment in ED versus hospitalization were compared using t‐tests and chi‐square tests. A generalized estimating equations regression model was used to assess the associations between hospital admission and transfer characteristics. PARTICIPANTS A total of 867 long‐stay nursing facility residents enrolled in OPTIMISTIC, January 2015 to June 2016. MEASUREMENTS Resident and transfer characteristics from Minimum Data Set and project REDCap (Research Electronic Data Capture) database, including demographics, cognitive status, comorbidities, symptoms at time of transfer, and diagnoses. RESULTS: The most common symptoms associated with treatment in the ED only were falls, trauma, or fracture (38% vs 10% admitted). Residents with cognitive impairment were more likely to be admitted to the hospital (odds ratio (OR) = 1.47; 95% confidence interval (CI) = 1.09–1.98; P =.011). Residents with respiratory complaints were more likely to be admitted (OR = 2.098; 95% CI = 1.198–3.675; P =.009); residents with hematological/bleeding (nongastrointestinal) (OR = 0.23; 95% CI = 0.107–0.494; P =.0002), pain (OR = 0.421; 95% CI = 0.254–0.698; P =.0008), or fall/trauma/fracture (OR = 0.181; 95% CI = 0.12–0.272; P <.001) were less likely to be admitted to the hospital. CONCLUSION: Some presenting symptoms and other characteristics are more associated with ED only treatment versus hospitalization. A knowledge of who is likely to receive ED only care could prompt adoption of targeted resources and protocols to further reduce these types of transfer events. Opportunity may exist in the ED as well to reduce hospitalizations and increase discharges back to the facility. [ABSTRACT FROM AUTHOR]

Objective: To describe the characteristics of hospital admissions for dental conditions, by Australian Statistical Geography Standard remoteness area for the 5 years 2010/2011 to 2014/2015. Design: Retrospective analysis of preventable hospital admissions due to dental conditions. Setting: National data set provided by the Australian Institute of Health and Welfare. Participants: Every hospital admission for patients who were admitted for dental conditions over five financial years, from 2010/2011 to 2014/2015. Main outcome measures: The number (and rate per 1000 population) of hospital admissions due to dental conditions in each Australian Statistical Geography Standard remoteness area (major city, inner regional, outer regional, remote and very remote). Results: There were 316 937 hospital admissions for dental conditions over the 5‐year period. The rate of potentially preventable dental hospital admissions ranged from an average of 2.5 per 1000 population in major cities to 3.2 in inner regional areas, 3.1 in outer regional areas, and 4.1 per 1000 in remote and very remote areas. The rate of admissions was highest among those aged 0‐14 years living in remote (9.0‐10.0 per 1000) and very remote (9.8‐12.5 per 1000) areas. Dental caries was the most common reason for admissions. Conclusions: There is an urgent need to address the social determinants of oral health in children aged 0‐14 years living in remote and very remote Australia. The delivery of mobile primary dental care services needs to be expanded in remote and very remote areas to prevent and treat dental caries. [ABSTRACT FROM AUTHOR]

This article examines whether the public holds biased perceptions of public organizations (in this case, hospitals) in the United States and whether organizations get credit for positive results from program evaluations. Using an experimental design that replicates Hvidman and Andersen's 2016 Danish study, the study finds no negative public sector biases in the United States, but organizations are not given any credit for positive program evaluations. These results hold in two experimental replications. The implications of the findings for the measurement of public perceptions of government programs and for effective democratic governance are discussed. [ABSTRACT FROM AUTHOR]

Purpose: In rural areas, the management of hospitalizations and emergency department (ED) visits is an important issue, and it is compounded by factors such as the long distance to secondary care facilities, funding difficulties in many rural medical institutions, and shortage of medical staff. While better patient experience (PX) has been shown to reduce hospitalizations and ED visits, previous studies have not considered the differences between urban and rural areas. In addressing this gap, this study examines the association between PX and hospitalizations/ED visits on isolated islands. Methods: This prospective cohort study was conducted on 5 isolated islands in Okinawa, Japan. We assessed the PX of primary care using the Japanese version of the Primary Care Assessment Tool (JPCAT), which comprises 6 domains: first contact, longitudinality, coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. The primary outcome was hospitalizations and ED visits in a year. We used a mixed effect model to adjust clustering within islands and individual covariates. Findings: Of 1,258 residents, 740 responded to a questionnaire for PX measurement. There were 73 hospitalizations and 62 ED visits. Adjusting for confounding and geographical clustering, hospitalizations had significant positive association with the PX score of each patient. ED visits were not associated with the total score of the JPCAT. Conclusion: On the isolated islands, PX in primary care had positive correlation with hospitalizations. The contrast of our findings to those of previous studies may be due to the close patient‐doctor relationship on isolated islands. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To assess adverse effects of pharmacologic antidepressants for treatment of major depressive disorder (MDD) in adults 65 years of age or older. DESIGN: Systematic review and meta‐analysis. SETTING: Specialist or generalist outpatient setting, rehabilitation facility, and nursing facilities. PARTICIPANTS: Persons 65 years and older with MDD. INTERVENTION: Selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), bupropion, mirtazapine, trazodone, vilazodone, or vortioxetine compared with another antidepressant, placebo, or nonpharmacologic therapy. MEASUREMENTS: Adverse events, arrhythmias, cognitive impairment, falls, fractures, hospitalization, mortality, QTc prolongation, serious adverse events, and withdrawals due to adverse events. RESULTS: Nineteen randomized controlled trials and two observational studies were included. Most studies evaluated treatment of the acute phase (<12 wk) of MDD of moderate severity. SSRIs led to a statistically similar frequency of overall adverse events vs placebo (moderate strength of evidence [SOE]), but SNRIs caused more overall adverse events vs placebo (high SOE) during the acute treatment phase. Both SSRIs and SNRIs led to more study withdrawals due to adverse events vs placebo (SSRIs low SOE; SNRIs moderate SOE). Duloxetine led to a more falls vs placebo (moderate SOE) during 24 weeks of acute and continuation treatment of MDD. CONCLUSION: In patients 65 years of age or older with MDD, treatment of the acute phase of MDD with SNRIs, but not SSRIs, was associated with a statistically greater number of overall adverse events vs placebo. SSRIs and SNRIs led to a greater number of study withdrawals due to adverse events vs placebo. Duloxetine increased the risk of falls that as an outcome was underreported in the literature. Few studies examined head‐to‐head comparisons, most trials were not powered to evaluate adverse events, and results of observational studies may be confounded. Comparative long‐term studies reporting specific adverse events are needed to inform clinical decision making regarding choice of antidepressants in this population. J Am Geriatr Soc 67:1571–1581, 2019 See related editorial by Lenze and Ajam Oughli [ABSTRACT FROM AUTHOR]

Background: Immunoglobulin A vasculitis (IgAV) is a systemic small‐vessel vasculitis of unknown aetiology. Although commonest in children, onset in adulthood is not unusual. Aim: As Australian data are lacking, we investigated longitudinal hospitalisation rates and characteristics for both adult and paediatric IgAV patients in Western Australia (WA). Methods: Data were extracted from a state‐wide register for all first hospital contacts in WA between 1980 and 2015 for patients with a primary diagnosis of IgAV. Paediatric cases were defined as those <20 years and compared with adult cases for admission rates per 100 000, demographics, complications, length of stay (LOS) and readmission rates. Results: The study cohort included 476 children (median age 5 years; interquartile range (IQR) 3–7) and 144 adults (median age 50 years; IQR 36–77). Childhood admission rates declined from 3.85 to 0.31 over time (P < 0.001) but age at admission and LOS remained unchanged. For adults, admission rates declined from 0.40 to 0.17 (P = 0.02) while age at admission (43 vs 63 years, P = 0.01) and LOS (5 vs 9 days, P = 0.02) increased. More adults had renal (11.8 vs 1.3%, P < 0.01), intestinal (3.5 vs 0.8%, P = 0.04) and infectious (14.6% vs 5.3%, P < 0.01) complications. Readmission was more frequent in childhood cases (23.1% vs 7.6%, P < 0.05) occurring mostly within 30 days of discharge. Conclusion: Hospitalisation rates for adults with IgAV now nearly equal those in children as adult IgAV leads to more complications. The sharp decline in childhood IgAV admissions suggests that confidence to manage children with IgAV outside the hospital setting has increased. [ABSTRACT FROM AUTHOR]

The article discusses research which aimed to determine the characteristics of severe bereavement-related depression (BRD) in the elderly population in Japan. Topics covered include the clinical features of individuals with BRD, the rates of hospitalization for severe deterioration of social functioning, and a comparison of their hospitalization rates with that in individuals with non-bereavement related depression (NBRD).

Aim To examine discharges of octogenarians, nonagenarians and centenarians from Portuguese public hospitals, namely admission type, principal diagnoses, comorbidities and length of stay. Methods The present study used administrative data from public acute care hospitals in the Portuguese National Health Service. All discharges of persons aged ≥80 years between 2000 and 2014 were analyzed. HCUP Clinical Classifications Software was considered to aggregate principal diagnosis, and comorbidities were assessed using the Charlson Comorbidity Index computed using International Classification of Diseases 9th Revision Clinical Modification codes. Results A total of 2 494 924 discharges of persons aged 80 years or older were registered. Most (73.7%) referred to inpatient episodes, of which 73% were unplanned and medical (non-surgical). Pneumonia (12.2%), acute cerebrovascular disease (7.1%) and non-hypertensive cardiac heart failure (5.3%) were the most common principal diagnoses among inpatient episodes. Congestive heart failure and diabetes without chronic complications were the two most frequent comorbidities (16.6%), and discharge diagnoses with higher median length of stay were tuberculosis, burns, and infective arthritis and osteomyelitis. Conclusions The number of hospitalizations of the oldest old has suffered a significant increase in the past few years, reinforcing the need for healthcare services being prepared to the specificities of the oldest old population. Geriatr Gerontol Int 2017; 17: 2255-2265. [ABSTRACT FROM AUTHOR]

The authors comment on a study published within the issue which concluded that the quality of recovery only has a marginal supplementary effect on patient satisfaction. Topics covered include the suggestion of the study that satisfaction would be a poor global measure to assess quality of recovery outcomes, and vice-versa, the difference of quality of recovery outcomes from satisfaction outcomes, and recovery scales and approaches to measure either satisfaction or quality of recovery.

Objectives Behavioral health-related emergency department ( ED) visits have been linked with ED overcrowding, an increased demand on limited resources, and a longer length of stay ( LOS) due in part to patients being admitted to the hospital but waiting for an inpatient bed. This study examines factors associated with the likelihood of hospital admission for ED patients with behavioral health conditions at 16 hospital-based EDs in a large urban area in the southern United States. Methods Using Andersen's Behavioral Model of Health Service Use for guidance, the study examined the relationship between predisposing (characteristics of the individual, i.e., age, sex, race/ethnicity), enabling (system or structural factors affecting healthcare access), and need (clinical) factors and the likelihood of hospitalization following ED visits for behavioral health conditions ( n = 28,716 ED visits). In the adjusted analysis, a logistic fixed-effects model with blockwise entry was used to estimate the relative importance of predisposing, enabling, and need variables added separately as blocks while controlling for variation in unobserved hospital-specific practices across hospitals and time in years. Results Significant predisposing factors associated with an increased likelihood of hospitalization following an ED visit included increasing age, while African American race was associated with a lower likelihood of hospitalization. Among enabling factors, arrival by emergency transport and a longer ED LOS were associated with a greater likelihood of hospitalization while being uninsured and the availability of community-based behavioral health services within 5 miles of the ED were associated with lower odds. Among need factors, having a discharge diagnosis of schizophrenia/psychotic spectrum disorder, an affective disorder, a personality disorder, dementia, or an impulse control disorder as well as secondary diagnoses of suicidal ideation and/or suicidal behavior increased the likelihood of hospitalization following an ED visit. Conclusion The block of enabling factors was the strongest predictor of hospitalization following an ED visit compared to predisposing and need factors. Our findings also provide evidence of disparities in hospitalization of the uninsured and racial and ethnic minority patients with ED visits for behavioral health conditions. Thus, improved access to community-based behavioral health services and an increased capacity for inpatient psychiatric hospitals for treating indigent patients may be needed to improve the efficiency of ED services in our region for patients with behavioral health conditions. Among need factors, a discharge diagnosis of schizophrenia/psychotic spectrum disorder, an affective disorder, a personality disorder, an impulse control disorder, or dementia as well as secondary diagnoses of suicidal ideation and/or suicidal behavior increased the likelihood of hospitalization following an ED visit, also suggesting an opportunity for improving the efficiency of ED care through the provision of psychiatric services to stabilize and treat patients with serious mental illness. [ABSTRACT FROM AUTHOR]

Objectives There is evidence that HIV-positive patients are suffering from a greater burden of morbidity as they age due to non AIDS-related complications. To date it has been difficult to determine what part of this excess risk is due to the health effects of HIV, its treatment or to lifestyle factors common to gay and bisexual men ( GBM). We calculated overall and cause-specific hospitalisation rates and risk factors for hospitalisations in HIV-negative and HIV-positive cohorts of GBM and compare these with rates in the general male population. Methods We conducted a record linkage study, linking two cohorts of HIV-negative ( n = 1325) and HIV-positive ( n = 557) GBM recruited in Sydney, New South Wales ( NSW), Australia with the NSW hospital discharge data register. We compared rates of hospitalisation in the two cohorts and risk factors for hospitalisation using random-effects Poisson regression methods. Hospitalisation rates for each cohort were further compared with those in the general male population using indirect standardisation. Results We observed 2032 hospitalisations in the HIV-negative cohort during 13 016 person-years ( PYs) [crude rate: 15.6/100 PYs (95% CI: 14.9-16.3)] and 2130 hospitalisations in the HIV-positive cohort during 5571 PYs [crude rate: 38.2/100 PYs (95% CI: 36.6-39.9)]. HIV-positive individuals had an increased risk of hospitalisation compared with the HIV-negative individuals [adjusted- IRR: 2.34 (95% CI: 1.91-2.86)] and the general population [ SHR: 1.45 (95% CI: 1.33-1.59)]. Hospitalisation rates were lower in the HIV-negative cohort compared with the general population [ SHR: 0.72 (95% CI: 0.67-0.78)]. The primary causes of hospitalisation differed between groups. Conclusions HIV-positive GBM continue to experience excess morbidity compared with HIV-negative GBM men and the general population. HIV-negative GBM had lower morbidity compared with the general male population suggesting that GBM identity does not confer excess risk. [ABSTRACT FROM AUTHOR]

Background Previous studies have found that adults with intellectual disabilities (ID) are hospitalised more often than the general population (GP). This study investigates hospital discharge rates and main diagnostic causes for hospitalisation among administratively defined people with ID compared with the GP in Norway. Method Data from the Norwegian Labour and Welfare Service was combined with data from the Norwegian Patient Register ( Ntotal = 1 764 072 and NID = 7573) for the period 2008-2011. Data from a Norwegian patient report generator and Statistics Norway are also analysed. Results During the study period, 11% of people with ID and 11.5% of the GP were admitted to hospitals. The length of the average hospital stay was just over 4 days for both groups. Among those who were hospitalised, the majority were only admitted to hospital once during the study period: ID 66% and GP 70%. People with ID were admitted somewhat more often than people in the GP. Contrary to the GP, adults with ID were more frequently hospitalised at a younger age and less frequently at old age. The most common International Classification of Diseases diagnostic group for hospitalisation among people with ID is injury, poisoning and certain other consequences of external causes, whereas for the GP, it is diseases of the circulatory system. Conclusion This study finds that the proportion of people being hospitalised per year is statistically, but only slightly, different among adult people with ID and the GP. The results must be interpreted in light of the organisation of the health care system in Norway. [ABSTRACT FROM AUTHOR]

A longitudinal observational study on a convenience sample was conducted between 4 January and 31 December of 2010 to evaluate clinical outcomes that occur when a new Interprofessional Diabetes Foot Ulcer Team (IPDFUT) helps in the management of diabetes-related foot ulcers (DFUs) in patients living in a small urban community in Ontario, Canada. Eighty-three patients presented to the IPDFUT with 114 DFUs of average duration of 19·5±2·7 weeks. Patients were 58·4±1·4 years of age and 90% had type 2 diabetes, HbA1c of 8·3±2·0%, with an average diabetes duration of 22·3±3·4 years; in 69% of patients, 78 DFUs healed in an average duration of 7·4±0·7 weeks, requiring an average of 3·8 clinic visits. Amputation of a toe led to healing in three patients (4%) and one patient required a below-knee amputation. Six patients died and three withdrew. Adding a skilled IPDFUT that is trained to work together resulted in improved healing outcomes. The rate of healing, proportion of wounds closed and complication rate were similar if not better than the results published previously in Canada and around the world. The IPDFUT appears to be a successful model of care and could be used as a template to provide effective community care to the patients with DFU in Ontario, Canada. [ABSTRACT FROM AUTHOR]

Aims To evaluate the impact of an integrated model of care for patients with complex Type 2 diabetes mellitus on potentially preventable hospitalizations. Methods A prospective controlled trial was conducted comparing a multidisciplinary, community-based, integrated primary-secondary care diabetes service with usual care at a hospital diabetes outpatient clinic. Study and hospital admissions data were linked for the period from 12 months before to 24 months after commencement of the trial. The primary outcome was the number of potentially preventable hospitalizations with diabetes-related principal diagnoses. Length of stay once hospitalized was also reported. Results Of 327 adult participants, 206 were hospitalized and accounted for 667 admissions during the study period. Compared with the usual care group, patients in the integrated model of care group were nearly half as likely to be hospitalized for a potentially preventable diabetes-related principal diagnosis in the 24 months after study commencement (incidence rate ratio 0.53, 95% CI 0.29, 0.96; P = 0.04). The magnitude of the result remained similar after adjusting for age, sex, education and baseline HbA1c concentration (incidence rate ratio 0.54, 95% CI 0.29, 1.01; P = 0.05).When hospitalized, patients in the integrated care group had a similar length of stay compared with those in the usual care group (median difference -2 days, 95% CI -6.5, 2.3; P = 0.33). Conclusions Patients receiving the integrated model of care had a reduction in the number of hospitalizations when the principal diagnosis for admission was a diabetes-related complication. Integrated models of care for people with complex diabetes can reduce hospitalizations and help attempts to curtail increasing demand on finite health services. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to compare the degree of care dependency between hospitalised patients with chronic heart failure ( CHF) and patients with chronic obstructive pulmonary disease ( COPD). Methods Secondary data analysis of five German prevalence studies from 2007 to 2011. Care dependency was measured using the Care Dependency Scale. Results Hospitalised patients with CHF or COPD are to a limited extent care dependent, and their overall care dependency does not differ (p = 0.56). Care dependency items with the lowest mean were mobility, hygiene, getting (un)dressed, continence, avoidance of danger and daily activities. Patients with CHF or COPD did not differ statistically significantly in those items. Only the items 'eating and drinking' almost achieved statistical significance (p = 0.06). Conclusion Patients with CHF or COPD did not differ in levels of care dependency. Both patient populations are restricted in engaging in activities potentially associated with physical condition and possibly influenced by perceived dyspnoea. Furthermore, comorbidities like incontinence and cognitive impairment seem to play an important role regarding the degree of care dependency. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the prevalence of polypharmacy and potentially inappropriate medication ( PIM) use and the association between these and chemotherapy-related adverse events in older adults with cancer undergoing chemotherapy. Design Secondary analysis of prospectively collected data. Setting Outpatient oncology clinics in seven academic medical centers. Participants Adults aged 65 and older with cancer undergoing chemotherapy. Measurements Measures included number of daily medications (polypharmacy); PIM use based on three indices (Beers, Zhan, and Drugs to Avoid in the Elderly criteria), and use of six 'high risk' medication classes for adverse drug events (anticoagulants, antiplatelet agents, opioids, insulin, oral hypoglycemics, antiarrhythmics). Using multivariate logistic regression, the relations were evaluated between these criteria and Grade 3 to 5 chemotherapy-related toxicity and between these criteria and hospitalization during chemotherapy. Results Participants (N = 500; mean age 73, 61% Stage IV disease) took a mean of 5 ± 4 daily medications (range 0-23). PIM use was common (up to 29% according to Beers criteria). No association was found between number of daily medications (reference 0-3 medications) and toxicity (4-9 medications, odds ratio ( OR) = 1.34, 95% confidence interval ( CI)=0.92-1.97; ≥10 medications, OR=0.82, 95% CI=0.45-1.49) or hospitalization (≥4 medications, OR=1.34, 95% CI=0.82-2.18, P = .24). There was also no association between PIM use and toxicity ( P = .93) or hospitalization ( P = .98). No medication class was associated with either outcome. Conclusions Polypharmacy and PIM use were common but were not associated with chemotherapy-related toxicity or hospitalization in older adults with cancer. [ABSTRACT FROM AUTHOR]

Aim To evaluate the nutritional status of hospitalized children in Belgian hospitals and to analyse the impact of undernutrition on the degree of weight loss and duration of hospitalization. Methods In each hospital (one tertiary and three secondary hospitals), 100 consecutively hospitalized children were eligible for inclusion. Of these, 379 were included for analysis. Body weight, length and mid-upper arm circumference were measured at admission and body weight also at discharge. Results The median (range) age was 2.1 (0.8-17) years. On admission, 29 (7.7%) children were chronically malnourished and, depending on the parameter, between 2.4% and 9.8% acutely undernourished, while 12.1% had at least one subnormal parameter. Median (range) duration of hospitalization was four (1-64) days. Median (range) weight change was 0.0% (−15.6% - +13.9%). Weight loss of >2% was significantly (p < 0.05) more prevalent in tertiary (20.0%) than in secondary (10.2%) hospitals. Median hospital duration was 50% longer for chronically malnourished children (6.0 vs 4.0 days; p < 0.01). Only 36 children received a nutritional intervention. Conclusion Acute undernutrition and chronic undernutrition remain frequent findings in hospitalized children in Belgium. Children with chronic undernutrition had a 50% longer hospital stay. Hospital-related undernutrition is an often unrecognized problem, because only one-third of the acutely malnourished children received nutritional support. [ABSTRACT FROM AUTHOR]

Aims The ADVANCE trial recruited participants from 20 countries worldwide. We analyse here regional variations and causes of hospitalization for people with Type 2 diabetes from Asia, Established Market Economies and Eastern Europe. Methods A cohort analysis examining the effects of region on causes of first hospitalization, and the association of participant characteristics on all-cause first hospitalization across regions, using multivariable (adjusted for clinical, physiological, behavioural and socio-demographic factors) Cox models. Results Of 11 140 individuals (6407 men), all-cause hospitalization rates were highest in Established Market Economies, followed by Eastern Europe then Asia. Eastern Europe had rates of hospitalization for diabetic causes four times greater than Established Market Economies [multivariable-adjusted hazard ratio 4.02 (95% CI 2.86-5.63)]. There were no significant regional variations in hospitalization rates for cardiovascular disease ( P = 0.534), but much lower rates for musculoskeletal and non-specific causes in Eastern Europe [multivariable-adjusted hazard ratio 0.44 (95% CI 0.32-0.60) and 0.19 (95% CI 0.12-0.29)] and Asia [hazard ratio 0.21 (95% CI 0.16-0.29) and 0.09 (95% CI 0.06-0.14)] compared with Established Market Economies. In all regions, participants hospitalized for any cause were more likely to be older, male, hypertensive, smokers, have higher glycated haemoglobin and a history of macrovascular or macrovascular disease. Conclusions Across three markedly different regions of the world, regional rates and causes of hospitalization varied widely in patients with Type 2 diabetes. Adjustment for a range of patient characteristics did not explain these regional differences in hospitalization, which appear to be attributable to health system factors. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives The aim of this study was to compare acute hospital utilization and costs for patients with refractory angina pectoris undergoing spinal cord stimulation (SCS) versus enhanced external counterpulsation (EECP). Method Seventy-three persons were included in this register study. The acute hospital utilization and costs for SCS and EECP were followed over a period from 12 months before treatment to 24 months after treatment using Patient Administrative Support in Skåne for publicly organized care. Results SCS was significantly more expensive than EECP ( P < 0.001). Both SCS and EECP entailed fewer days of hospitalization for coronary artery disease in the 12-month follow-up compared with the 12 months preceding treatment. Patients treated with EECP showed an association between reduced hospital admissions and an improved Canadian Cardiovascular Society classification class compared with 1 year before treatment. A significant reduction in cost was seen in both the SCS group ( P = 0.018 and P = 0.001, respectively) and the EECP group ( P = 0.002 and P = 0.045, respectively) during 12 and 24 months of follow-up compared with before treatment. There were no significant differences between the groups for hospitalization days or admissions, including costs, at the different follow-ups. Conclusions Cost-effective treatment modalities such as SCS and EECP are valuable additions to medical and revascularization therapy in patients with refractory angina pectoris. Pre-existing conditions and the patient's preferences should be taken in consideration when clinicians choose between treatments for this group of patients. [ABSTRACT FROM AUTHOR]

Candiduria is common in hospitalised patients, but the clinical relevance is still unclear. This study was done to further our knowledge on detection of and host responses to candiduria. Urines and clinical data from 136 patients in whom presence of yeast was diagnosed by microscopic urinalysis were collected. Diagnosis by standard urine culture methods on blood and MacConkey agar as well as on fungal culture medium (Sabouraud dextrose agar) was compared. Inflammatory parameters (IL-6 and IL-17, Ig) were quantified in the urine and compared with levels in control patients without candiduria. Standard urine culture methods detected only 37% of Candida spp. in urine. Sensitivity was especially low (23%) for C. glabrata and was independent of fungal burden. Candida specific IgG but not IgA was significantly elevated when compared with control patients ( P < 0.0001 and 0.07 respectively). In addition, urine levels of IL-6 and IL-17 were significantly higher in candiduric patients when compared with control patients ( P < 0.001). Multivariate analysis documented an independent association between an increased IgG (odds ratio (OR) 136.0, 95% confidence interval (CI) 25.7-719.2; P < 0.0001), an increased IL-17 (OR 17.4, 95% CI 5.3-57.0; P < 0.0001) and an increased IL-6 level (OR 4.9, 95% CI 1.9-12.4; P = 0.001) and candiduria. In summary, our data indicate that clinical studies on candiduria should include fungal urine culture and that inflammatory parameters may be helpful to identify patients with clinically relevant candiduria. [ABSTRACT FROM AUTHOR]

Background The Patient Journey Record system ( Pa JR) is an application of a complex adaptive chronic care model in which early detection of adverse changes in patient biopsychosocial trajectories prompts tailored care, constitute the cornerstone of the model. Aims To evaluate the Pa JR system's impact on care and the experiences of older people with chronic illness, who were at risk of repeat admissions over 12 months. Design Community-based cohort study - random assignment into intervention and usual care group, with process and outcome evaluation. Study population Adult and older patients with multiple morbidity, one or more chronic diseases with one or more overnight hospitalizations, and seven or more general practice visits in the past 6 months. Complex intervention Pa JR lay care guides/advocates call patients and their caregivers. The care guides summarize their semi-structured conversations about health concerns and well-being. Predictive modelling and rules-based algorithms trigger alerts in relation to online call summaries. Alerts are acted upon according to agreed guidelines. Analysis Descriptive and comparative statistics. Outcomes Impact on unplanned emergency ambulatory care sensitive admissions ( ACSC) with an overnight stay; sensitivity of alerts and predictions; rates of care guides-supported activities. Findings Five part-time lay care guides and a care manager monitored 153 intervention patients for 500 person months with 5050 phone calls. The 153 patients in the intervention group were comparable to the 61 controls. The intervention group reported in 50% of calls that their health limited their social activities; and one-third of calls reported immediate health concerns. Predictive analytics were highly sensitive to risk of hospitalization. ACSC admissions were reduced by 50% compared to controls across the sites. Discussion The initial implementation of a complex patient-centred adaptive chronic care model using lay care guides, supported by machine learning, appeared sensitive to risk of hospitalization and capable of stabilizing illness journeys in older patients with multi-morbidity. Conclusion Actions based on alerts produced in this study appeared to significantly reduce hospitalizations. This paves the way for further testing of the model. [ABSTRACT FROM AUTHOR]

Family-centred service (FCS) provision has long since been acknowledged as the 'best-practice' model within paediatric rehabilitation with numerous reported benefits for both the child and their family. Although family-centred care continues to be investigated worldwide using the Measure of Processes of Care (MPOC) survey, to date only two published studies have been conducted within an Australian context, neither of which were within a hospital setting. As a large number of Australian children attend hospital clinics to receive rehabilitation services, research that investigates FCS within this type of environment is required. This study investigated parent and service providers' perceptions of FCS provision within a large Australian metropolitan children's teaching hospital using the MPOC survey. A total of 100 parents/caregivers (34% response rate) whose child had accessed hospital paediatric rehabilitation services over a 12-month period completed the MPOC-20 survey. Thirty-two completed MPOC-SP surveys (80% response rate) were received from the hospital's rehabilitation service providers. Qualitative data were sourced from service providers on their understanding of the term FCS. Parents' perceptions of FCS provision were generally positive, rating Respectful and Supportive Care the highest and Providing General Information the lowest. No significant differences were indentified in relation to location of residence, type of disability or number of disabilities per child. Service providers also rated Providing General Information the lowest and felt Treating People Respectfully was strength in the provision of services. Extended responses from service providers indicated that although they possessed a sound understanding of the meaning of FCS, delivering flexible and accessible services and fostering effective communication among all partners were not widely expressed themes. These results show consistent strengths and weaknesses in FCS provision to children with disabilities and their families and the need to further address the demand for adequate provision of general information. [ABSTRACT FROM AUTHOR]

Aims and objectives. This paper describes the development and preliminary psychometric testing of an instrument that evaluates the emotional care experienced by patients during hospitalisation. Background. Previous qualitative work using the Grounded Theory method identified the characteristics of interpersonal interactions that hospitalised patients perceived to be therapeutic. Three conditions were associated with the patient's experience of emotional comfort: the patient's perceived Level of Security, Level of Knowing and Level of Personal Value. Questions relating to each of these conditions were included in this new instrument. Design. Instrument development and psychometric testing. Method. Preliminary psychometric testing was carried out in four phases: construction of the instrument; assessment of face and content validity; testing for clarity and feasibility for use with hospitalised patients; assessment of reliability, construct validity of the tool and assessment of the internal structure. Conclusions. A hospital-wide survey was carried out and the instrument was completed by a total sample of 132 patients. Two of the three sub-scales achieved an internal consistency estimate of at least 0·70. The construct validity of the tool confirmed the previously identified characteristics of patients in need of additional emotional care. Exploratory factor analysis established two of the sub-scales and identified a fourth sub-scale which was named 'Level of Connection'. Encouraging reliability and validity estimates were obtained and the instrument was improved. Further testing with larger samples is recommended. Relevance to clinical practice. This questionnaire, which is completed by hospitalised patients, differs from other instruments because it evaluates the interactions of all hospital staff rather than only nursing staff. This instrument can be used to identify patients who may be in need of additional emotional care and to evaluate the effectiveness of interventions directed at improving the emotional well-being of patients. [ABSTRACT FROM AUTHOR]

Background: Recent studies from predominantly rural areas in Germany show that neonatal outcome of very low birth weight (VLBW) neonates is (on average) inferior with lower NICU (neonatal intensive care unit) volume. However, there are no data available which show that study results of one specific region can be transferred to other areas with possibly different medical infrastructure and needs. Aim: It was investigated whether a systematic difference of treatment quality between smaller (1000–2000 births/year; ≤20 neonatal beds) vs. larger neonatal centres in Berlin (>3000 births/year; >20 neonatal beds) exists. Furthermore, the results are compared to data from a rural region in order to discuss transferability between regions. Methods: Retrospectively, completely, and for the first time, the data of all centres which treat VLBW neonates (≤1500 g birth weight) in the city-state of Berlin, Germany, from the years 2003/2004 were reviewed. Results: Our study showed no difference in the treatment quality of smaller vs. larger neonatal units in Berlin. This result differs from those of a study in Baden-Württemberg, a predominately rural state, with different medical infrastructure than Berlin. Conclusion: The present study suggests that regional investigations on the infrastructure vs. treatment outcome are not transferable between areas. Patient volume/unit appears inadequate for predicting the future treatment quality of neonatal departments. Direct quality indicators are stable for the assessed departments and should be preferably used to organize medical infrastructure. [ABSTRACT FROM AUTHOR]

Aim: To describe paediatric hospitalization in a West African capital in relation to overall childhood mortality in the community and to evaluate the potential impact of improved management at the hospital. Methods: Hospital data on child admissions in a 6-year period were linked to information in a community-based longitudinal surveillance system. Paediatric hospitalization rates, risk factors for hospitalizations, community mortality, in-hospital mortality and the proportion of deaths occurring at hospital were examined. Results: Almost 15% of infants and 45% of children less than 5 years of age had been hospitalized, and 24% of all deaths in the community occurred in-hospital. Community infant and under-three mortality rates were 110 and 207 per 1 000 person-years, respectively. In-hospital mortality remained persistently high from 1991 to 1996 and the overall in-hospital mortality was 12%. It was found that wet season, lack of maternal schooling and living in a specific district were significant risk factors for both community and in-hospital death, whereas higher hospitalization rates were associated with better-off families. Conclusion: In populations with high hospitalization rates, even minor improvements in acute case management of sick children attending the hospital would be expected to result in substantial reduction in overall childhood mortality. Persistently high acute in-hospital mortality reflects the need of immediate and appropriate care at the hospital. Treatment should be free of charge, in order to minimize the impact of social inequality. [ABSTRACT FROM AUTHOR]

This paper describes a 7.5 year retrospective study of all patients discharged from inpatient forensic services to forensic community team (FCT) follow-up from the Auckland Regional Forensic Psychiatry Service. Patients' files were studied for clinical, criminal, and risk data, type of service delivered, and final level of function achieved in the community. Rearrest, re-hospitalization, and reimprisonment data were obtained from clinical, court, and prison records. 105 patients were included. The most common diagnosis was a psychotic disorder, and index offending behaviour was typically violent. The median period of inpatient stay was 36 months and mean subsequent FCT follow-up 21.7 months (SD 17.8). The majority of patients were from Maori and Pacific Island ethnic groups. At the end of the study, half were in independent living, half were in some form of employment, and 19% were readmitted to a forensic hospital. One patient was rearrested but not reimprisoned whilst under forensic community team care. However, 9 of the 48 who were discharged to general mental health services were rearrested and 5 reimprisoned. Only two offences were as serious as the original index offence. Broad based assertive, mandated, and committed forensic rehabilitation can achieve high quality outcomes. These levels of function may not be sustained under less assertive care. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In this study we describe the development of the Individualized Care Scale (ICS) and evaluate its validity, psychometric properties and feasibility. The ICS was designed to measure patients’ views on how individuality is supported through specific nursing interventions (ICA) and how they perceive individuality in their own care (ICB) during hospitalization.Three different data sets were collected among patients being discharged from hospital (n1 = 203,n2 = 279,n3 = 454). This bipartite 38-item ICS promises to be a brief, timely, easy to administer and useful self-completion measure for evaluating clinical nursing practice from the patient's point of view.The findings supported the internal consistency reliability of the ICS (alpha 0.94 for ICA and ICB 0.93) and the three subscales (alphas 0.85–0.90). Item analysis supported the item construction of each scale. Content validity was furthered by a critical literature review and four expert analyses. Principal component analysis (Promax with Kaiser normalization) among earlier factor analyses supported construct validity by generating a three-factor solution which accounted for 65% of the variance in the ICA and 61% in the ICB. Pearson's correlation coefficients were at least 0.88 between the subscales and the total domain ICA or ICB.The ICS has demonstrated promise as a tool for measuring patients’ evaluations of their hospital experience and individuality in care. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editor discusses the comprehensive understanding of emergency department (ED) transfer patterns in the U.S.

Explores the relationship between quality of care and investment in property, plant and equipment (PPE) in a hospital. Correlation of PPE investments in Massachusetts hospitals with Generic Quality Screen (GQS); Prediction of quality care in hospitals using the PPE.

This was a qualitative study, the design of which was based on ideas from the grounded theory approach to data collection and analysis. The study examined the concept of human needs from the perspectives of individuals who have an ileostomy or a colostomy and attempted to ascertain their evaluation of the way in which their needs were fulfilled during the time they spent in hospital. Respondents consisted of a convenience sample of six individuals who had recent experience of surgery involving the formation of a stoma. Data were collected through unstructured, non-directive interviews. Analysis of data involved identification of themes and categories that emerged from the transcripts of the interviews. Findings indicated that while individuals' physical needs were met, their psychological and sociocultural needs were not identified. This seems to imply that nurses may not be aware of the relevance of these needs to individuals who have an ileostomy or a colostomy. Since respondents identified the existence of a good relationship with nurses as being conducive to the fulfilment of these needs, it could be inferred that nurses may lack the skills that are necessary to develop a good relationshp with those who are in their care. [ABSTRACT FROM AUTHOR]

The article provides an overview of the day hospital admissions in the U.S. One of the more impressive advantages cited by early proponents of the psychiatric day center was the ability of such programs to circumvent full-time hospitalization. Day center patients have been found to differ from average inpatient admissions both in symptomatology and in demographic characteristics. Clinical differences between day center and hospital admissions were found primarily in ideational symptoms. Day centers were less ideationally disturbed than their full-time counterparts.

The authors discuss the importance of risk stratification tool to identify emergency department (ED) patients with acute heart failure (AHF). They comment on the limitations that should be considered for interpreting the results. They suggest that recalibration of approach towards an implementation of risk-stratification tool is needed for ED patients with AHF.