Full Text Available One of the key climate change factors, temperature, has potentially grave implications for human health. We report the first attempt to investigate the association between the daily 3-hour maximum apparent temperature (Tapp(max and respiratory (RD, cardiovascular (CVD, and cerebrovascular (CBD emergency hospital admissions in Copenhagen, controlling for air pollution. The study period covered 1 January 2002-31 December 2006, stratified in warm and cold periods. A case-crossover design was applied. Susceptibility (effect modification by age, sex, and socio-economic status was investigated. For an IQR (8°C increase in the 5-day cumulative average of Tapp(max, a 7% (95% CI: 1%, 13% increase in the RD admission rate was observed in the warm period whereas an inverse association was found with CVD (-8%, 95% CI: -13%, -4%, and none with CBD. There was no association between the 5-day cumulative average of Tapp(max during the cold period and any of the cause-specific admissions, except in some susceptible groups: a negative association for RD in the oldest age group and a positive association for CVD in men and the second highest SES group. In conclusion, an increase in Tapp(max is associated with a slight increase in RD and decrease in CVD admissions during the warmer months.
Full Text Available Abstract Background Although the association between exposure to particulate matter and health is well established, there remains uncertainty as to whether certain chemical components are more harmful than others. We explored whether the association between cause-specific hospital admissions and PM2.5 was modified by PM2.5 chemical composition. Methods We estimated the association between daily PM2.5 and emergency hospital admissions for cardiac causes (CVD, myocardial infarction (MI, congestive heart failure (CHF, respiratory disease, and diabetes in 26 US communities, for the years 2000-2003. Using meta-regression, we examined how this association was modified by season- and community-specific PM2.5 composition, controlling for seasonal temperature as a surrogate for ventilation. Results For a 10 μg/m3 increase in 2-day averaged PM2.5 concentration we found an increase of 1.89% (95% CI: 1.34- 2.45 in CVD, 2.25% (95% CI: 1.10- 3.42 in MI, 1.85% (95% CI: 1.19- 2.51 in CHF, 2.74% (95% CI: 1.30- 4.2 in diabetes, and 2.07% (95% CI: 1.20- 2.95 in respiratory admissions. The association between PM2.5 and CVD admissions was significantly modified when the mass was high in Br, Cr, Ni, and Na+, while mass high in As, Cr, Mn, OC, Ni, and Na+ modified MI, and mass high in As, OC, and SO42- modified diabetes admissions. For these species, an interquartile range increase in their relative proportion was associated with a 1-2% additional increase in daily admissions per 10 μg/m3 increase in mass. Conclusions We found that PM2.5 mass higher in Ni, As, and Cr, as well as Br and OC significantly increased its effect on hospital admissions. This result suggests that particles from industrial combustion sources and traffic may, on average, have greater toxicity.
Wichmann, Janine; Andersen, Zorana; Ketzel, Matthias
) emergency hospital admissions in Copenhagen, controlling for air pollution. The study period covered 1 January 2002-31 December 2006, stratified in warm and cold periods. A case-crossover design was applied. Susceptibility (effect modification) by age, sex, and socio-economic status was investigated...
Full Text Available Background: Diurnal temperature range (DTR is an important index of climate change and variability. It is also a risk factor affecting human health. However, limited evidence is available to illustrate the effect of DTR modification on cause-specific cardiovascular disease among the elderly. Methods: A semi-parametric generalized additive model (GAM was used to analyze the exposure-effect relationship between DTR and daily emergency room (ER admissions for cause-specific cardiovascular diseases among the elderly from 2009 to 2011 in Beijing. We examined the effects of DTR for stratified groups by gender and age, and examined the effects of DTR in the warm season and cold season for cause-specific cardiovascular diseases. Results: Significant associations were found between DTR and ER admissions for all cardiovascular and cerebrovascular disease among elderly males, while DTR was significantly associated with ER admissions for all cardiovascular disease, ischemic heart disease and cerebrovascular disease among elderly females. People aged 75 years and older were more vulnerable to DTR. DTR caused greater adverse effects on both genders in the warm season, whereas the effect estimates on females were higher in cold season than in warm season. Conclusions: A short-term increase of DTR was significantly associated with ER admissions for cause-specific cardiovascular disease among the elderly in Beijing. Gender, age and season may modify the acute health effect of DTR. Some prevention programs that target the high risk subgroups in the elderly for impending large temperature changes may reduce the impact of DTR on people’s health.
Henneman, Philip L; Lemanski, Michael; Smithline, Howard A; Tomaszewski, Andrew; Mayforth, Janice A
We compare the contribution margin per case per hospital day of emergency department (ED) admissions with non-ED admissions in a single hospital, a 600-bed, academic, tertiary referral, Level I trauma center with an annual ED census of 100,000. This was a retrospective comparison of the contribution margin per case per day for ED and non-ED inpatient admissions for fiscal years 2003, 2004, and 2005 (October 1 through September 30). Contribution margin is defined as net revenue minus total direct costs; it is then expressed per case per hospital day. Service lines are a set of linked patient care services. Observation admissions and outpatient services are not included. Resident expenses (eg, salary and benefits) and revenue (ie, Medicare payment of indirect medical expenses and direct medical expenses) are not included. Overhead expenses are not included (eg, building maintenance, utilities, information services support, administrative services). For fiscal year 2003 through fiscal year 2005, there were 51,213 ED and 57,004 non-ED inpatient admissions. Median contribution margin per day for ED admissions was higher than for non-ED admissions: ED admissions $769 (interquartile range $265 to $1,493) and non-ED admissions $595 (interquartile range $178 to $1,274). Median contribution margin per day varied by site of admissions, by diagnosis-related group, by service line, and by insurance type. In summary, ED admissions in our institution generate a higher contribution margin per day than non-ED admissions.
% of expenditure. ... (i.e. capital costs and overhead costs) were obtained from a costing audit of HIV/. AIDS admissions to GFJH in .... cost-effective strategies that improve the quality of inpatient care and outcome of admissions.
Mesgarpour, Mohsen; Chaussalet, Thierry; Chahed, Salma
About half of hospital readmissions can be avoided with preventive interventions. Developing decision support tools for identification of patients' emergency readmission risk is an important area of research. Because, it remains unclear how to design features and develop predictive models that can adjust continuously to a fast-changing healthcare system and population characteristics. The objective of this study was to develop a generic ensemble Bayesian risk model of emergency readmission. We produced a decision support tool that predicts risk of emergency readmission using England's Hospital Episode Statistics inpatient database. Firstly, we used a framework to develop an optimal set of features. Then, a combination of Bayes Point Machine (BPM) models for different cohorts was considered to create an optimised ensemble model, which is stronger than the individual generative and non-linear classifications. The developed Ensemble Risk Model of Emergency Admissions (ERMER) was trained and tested using three time-frames: 1999-2004, 2000-05 and 2004-09, each of which includes about 20% of patients in England during the trigger year. Comparisons are made for different time-frames, sub-populations, risk cut-offs, risk bands and top risk segments. The precision was 71.6-73.9%, the specificity was 88.3-91.7% and the sensitivity was 42.1-49.2% across different time-frames. Moreover, the Area Under the Curve was 75.9-77.1%. The decision support tool performed considerably better than the previous modelling approaches, and it was robust and stable with high precision. Moreover, the framework and the Bayesian model allow the model to continuously adjust it to new significant features, different population characteristics and changes in the system. Copyright © 2017 Elsevier B.V. All rights reserved.
A five-year review of the pattern and outcome of paediatric admissions in the Children Emergency Room (CHER) of the University of Nigeria Teaching Hospital (UNTH) Enugu, showed a total of 10,267 admissions, a discharge rate of 50.4 percent, a transfer-out rate of 44.3 percent, and a mortality of 5.1 percent.
Atkins, Sam O.
A one-year study was conducted on the impact of emergency admissions to the 125-bed Southwest Community Hospital in Atlanta, Georgia. During the study in 1979, 70 urological emergency room admissions were made, of which 44 (62.8 percent) were males and 26 (37.2 percent) were females. In comparison, 93 admissions were made directly from the private office. The study considered the timeliness of diagnosis and treatment, surgical procedures performed, impact on urological emergency room nursing and medical personnel, physician response to notification, cost containment, and implied legal ramifications and organization structure. Thus, an immediate close scrutiny of urological emergency admission at the nonuniversity affiliated Southwest Community Hospital was permitted. PMID:6876189
Cournane, Seán; Byrne, Declan; Conway, Richard; O'Riordan, Deirdre; Coveney, Seamus; Silke, Bernard
Patients from deprived backgrounds have a higher in-patient mortality following an emergency medical admission. How deprivation relates to the admission or readmission incidence rates, episode length of stay (LOS) and ancillary resource utilization is less clear. All emergency medical admissions (66,861 episodes in 36,214 patients) between 2002 and 2013, categorized by quintile of Irish National Deprivation Index were assessed against admission or readmission incidence rates (/1000 local population by electoral division), LOS and utilization of five ancillary services. Univariate and multi-variable risk estimates (odds ratios (OR) or incidence rate ratios (IRR)) were calculated, using truncated Poisson regression. The deprivation index quintile was strongly correlated with the emergency medical admission rate with IRR (as compared with quintile 1) as follows: Q2 1.99 (95% CI: 1.96, 2.01), Q3 3.45 (95% CI: 3.41, 3.49), Q4 3.27 (95% CI: 3.23, 3.31) and Q5 4.29 (95% CI: 4.23, 4.35). LOS was not influenced by deprivation status; although increasing deprivation resulted in increased utilization of social services (OR 1.04: 95% CI: 1.03, 1.06), with a lower requirement for occupational therapy (OR 0.94: 95% CI: 0.93, 0.96) and speech/language services (OR 0.83: 95% CI: 0.80, 0.86). There was a rather decreased use of ancillary services with increasing deprivation; however, the readmission rate was strongly predicted by deprivation status. Deprivation status strongly influenced the admission and readmission rates for medical patients admitted as emergencies; however, ancillary resource utilization was not increased. Deprivation index will increase demand on hospital resources due to the aggregate effect on both admission and readmission incidence rates. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
Pun, Vivian C.; Tian, Linwei; Ho, Kin-fai
While contribution from non-exhaust particulate matter (PM) emissions towards traffic-related emissions is increasing, few epidemiologic evidence of their health impact is available. We examined the association of short-term exposure to PM10 apportioned to re-suspended mineral dust with emergency hospitalizations for three major respiratory causes in Hong Kong between 2001 and 2008. Time-series regression model was constructed to examine association of PM10 from re-suspended mineral dust with emergency hospitalizations for upper respiratory infection (URI), chronic obstructive pulmonary disease (COPD) and asthma at exposure lag 0-5 days, adjusting for time trends, seasonality, temperature and relative humidity. An interquartile range (6.8 μg/m3) increment in re-suspended mineral dust on previous day was associated with 0.66% (95% CI: 0.12, 0.98) increase in total respiratory hospitalizations, and 1.01% (95% CI: 0.14, 1.88) increase in URI hospitalizations. A significant 0.66%-0.80% increases in risk of COPD hospitalizations were found after exposure to re-suspended mineral dust at lag 3 or later. Exposure to mineral dust at lag 4 was linked to 1.71% increase (95% CI: 0.14, 2.22) in asthma hospitalizations. Associations from single-pollutant models remained significant in multi-pollutant models, which additionally adjusted for PM10 contributing from vehicle exhaust, regional combustion, residual oil, fresh sea salt, aged sea salt, secondary nitrate and secondary sulfate, or gaseous pollutants (i.e., nitrogen dioxide, sulfur dioxide, or ozone), respectively. Our findings provide insight into the biological mechanism by which non-exhaust pollution may be associated with risk of adverse respiratory outcomes, and also stress the needs for strategies to reduce emission and re-suspension of mineral dust. More research is warranted to assess the health effects of different non-exhaust PM emissions under various roadway conditions and vehicle fleets.
Chotirmall, Sanjay H; Callaly, Elizabeth; Lyons, Judith; O'Connell, Brian; Kelleher, Mary; Byrne, Declan; O'Riordan, Deirdre; Silke, Bernard
Blood cultures are performed in the emergency room when sepsis is suspected, and a cohort of patients is thereby identified. The present study investigated the outcomes (mortality and length of hospital stay) in this group following an emergency medical admission. Prospective assessment of all emergency medical admissions presenting to the emergency department at St James's Hospital, Dublin, over an 11-year period (2002-2012) was carried out. Outcomes including 30-day in-hospital mortality and length of stay were explored in the context of an admission blood culture. Generalized estimating equations, logistic or zero-truncated Poisson multivariate models were used, with adjustment for confounding variables including illness severity, comorbidity, and chronic disabling disease, to assess the effect of an urgent blood culture on mortality and length of stay. A total of 60 864 episodes were recorded in 35 168 patients admitted over the time period assessed. Patients more likely to undergo blood cultures in the emergency department were male, younger, and had more comorbidity. Univariate and multivariate analyses showed that those who had a blood culture, irrespective of result, had increased mortality and a longer in-hospital stay. This was highest for those with a positive culture, irrespective of the organism isolated. A clinical decision to request a blood culture identified a subset of emergency admissions with markedly worse outcomes. This patient cohort warrants close monitoring in the emergency setting.
Cournane, Seán; Conway, Richard; Byrne, Declan; O'Riordan, Deirdre; Silke, Bernard
The community level of disability and social deprivation may result in an emergency hospitalisation; we have examined the annual admission incidence rate for emergency medical conditions in relation to the community prevalence of such factors. All emergency medical admissions (96,305 episodes in 50,612 patients) within the institution's catchment area were examined between 2002 and 2016. The frequency of disability, level of full-time carers and unemployment for the 74 electoral divisions of the catchment area was regressed against admission rates; incidence rate ratios (IRR) were calculated using truncated Poisson regression. Disability was present in 12.1% of the catchment area population (95% CI = 9.7-15.0). The annual admission incidence rates/1000 population across disability quintiles for the more affluent areas increased from Q1 7.6 (95% CI = 7.4-7.8) to Q5 27.3 (95% CI = 27.0-27.5) and for the more deprived area from Q1 16.6 (95% CI = 16.4, 16.8) to and Q5 40.4 (95% CI = 40.1-40.7). Disability status influenced the overall admission IRR (compared with Q1/Q3) for Q4/Q5 1.11 (95% CI = 1.09-1.13) showing an increased rate of hospitalisation for the more deprived areas. Community disability levels interacted with local area unemployment and frequency of full-time carers; as they increased, a linear relationship between disability and the admission rate incidence was demonstrated. Local catchment area disability prevalence rates in addition to social deprivation factors are an important determinant of the annual incidence rate of emergency medical admissions.
Thomas C Sauter
Full Text Available INTRODUCTION: Somnambulism is a state of dissociated consciousness, in which the affected person is partially asleep and partially awake. There is pervasive public opinion that sleepwalkers are protected from hurting themselves. There have been few scientific reports of trauma associated with somnambulism and no published investigations on the epidemiology or trauma patterns associated with somnambulism. METHODS: We included all emergency department (ED admissions to University Hospital Inselspital, Berne, Switzerland, from January 1, 2000, until August 11, 2015, when the patient had suffered a trauma associated with somnambulism. Demographic data (age, gender, nationality and medical data (mechanism of injury, final diagnosis, hospital admission, mortality and medication on admission were included. RESULTS: Of 620,000 screened ED admissions, 11 were associated with trauma and sleepwalking. Two patients (18.2% had a history of known non-rapid eye movement parasomnias. The leading cause of admission was falls. Four patients required hospital admission for orthopedic injuries needing further diagnostic testing and treatment (36.4%. These included two patients with multiple injuries (18.2%. None of the admitted patients died. CONCLUSION: Although sleepwalking seems benign in the majority of cases and most of the few injured patients did not require hospitalization, major injuries are possible. When patients present with falls of unknown origin, the possibility should be evaluated that they were caused by somnambulism.
Sauter, Thomas C; Veerakatty, Sajitha; Haider, Dominik G; Geiser, Thomas; Ricklin, Meret E; Exadaktylos, Aristomenis K
Somnambulism is a state of dissociated consciousness, in which the affected person is partially asleep and partially awake. There is pervasive public opinion that sleepwalkers are protected from hurting themselves. There have been few scientific reports of trauma associated with somnambulism and no published investigations on the epidemiology or trauma patterns associated with somnambulism. We included all emergency department (ED) admissions to University Hospital Inselspital, Berne, Switzerland, from January 1, 2000, until August 11, 2015, when the patient had suffered a trauma associated with somnambulism. Demographic data (age, gender, nationality) and medical data (mechanism of injury, final diagnosis, hospital admission, mortality and medication on admission) were included. Of 620,000 screened ED admissions, 11 were associated with trauma and sleepwalking. Two patients (18.2%) had a history of known non-rapid eye movement parasomnias. The leading cause of admission was falls. Four patients required hospital admission for orthopedic injuries needing further diagnostic testing and treatment (36.4%). These included two patients with multiple injuries (18.2%). None of the admitted patients died. Although sleepwalking seems benign in the majority of cases and most of the few injured patients did not require hospitalization, major injuries are possible. When patients present with falls of unknown origin, the possibility should be evaluated that they were caused by somnambulism.
Bai, Li; Cirendunzhu; Woodward, Alistair; Dawa; Zhaxisangmu; Chen, Bin; Liu, Qiyong
Tibet of China, with an average altitude of over 4000 m, has experienced noticeable changes in its climate over the last 50 years. The association between temperature and morbidity (most commonly represented by hospital admissions) has been documented mainly in developed countries. Little is known about patterns in China; nor have the health effects of temperature variations been closely studied in highland areas, worldwide. We investigated the temperature-morbidity association in Lhasa, the capital city of Tibet, using sex- and age-specific hospitalizations, excluding those due to external causes. A distributed lag non-linear model (DLNM) was applied to assess the nonlinear and delayed effects of temperature on morbidity (including total emergency room visits, total and cause-specific hospital admissions, sex- and age-specific non-external admissions). High temperatures are associated with increases in morbidity, to a greater extent than low temperatures. Lag effects of high and low temperatures were cause-specific. The relative risks (RR) of high temperature for total emergency room visits and non-external hospitalizations were 1.162 (95% CI: 1.002-1.349) and 1.161 (95% CI: 1.007-1.339) respectively, for lag 0-14 days. The strongest cumulative effect of heat for lag 0-27 days was on admissions for infectious diseases (RR: 2.067, 95% CI: 1.026-4.027). Acute heat effects at lag 0 were related with increases of renal (RR: 1.478, 95% CI: 1.005-2.174) and respiratory diseases (RR: 1.119, 95% CI: 1.010-1.240), whereas immediate cold effects increased admission for digestive diseases (RR: 1.132, 95% CI: 1.002-1.282). Those ≥65 years of age and males were more vulnerable to high temperatures. We provide a first look at the temperature-morbidity relationship in Tibet. Exposure to both hot and cold temperatures resulted in increased admissions to hospital, but the immediate causes varied. We suggest that initiatives should be taken to reduce the adverse effects of
Leary, Alison; Baxter, Jane
Clinical nurse specialists (CNS) in cancer perform a range of complex activities, including the management of care. However, they often report a high administrative burden for services, which makes providing expert nursing care challenging. Administrative work for a service can be seen as a priority for non-nurses, yet a high administrative burden allows less time for complex nursing care. A London trust admitted a mean of four lung cancer patients per month for symptom control in progressive disease or end-of-life care, with a mean stay of 6 days. This was often a default location: the acute hospital was not always the patient's preferred place of care for end of life. The CNS negotiated away the administrative burden, which occupied 38% of their working time, and adopted standard proactive case management in line with national standards. The CNS were also able to build a collaborative relationship with others, such as local GPs and community palliative care teams. Their proactive and vigilant case management resulted in fewer admissions for non-acute problems: a mean of four emergency admissions per month fell to a mean of fewer than one (0.3). For this service, the mean length of emergency admission was 6 days, so a reduction in the admission rate represented a significant saving in bed days (266 a year) and a higher rate of achieving the preferred place of end-of-life care. In conclusion, CNS who practise proactive case management and refocus services in line with best practice represent a good return on investment (ROI).
Symons, N R A; Moorthy, K; Almoudaris, A M; Bottle, A; Aylin, P; Vincent, C A; Faiz, O D
There is increasing evidence of variable standards of care for patients undergoing emergency general surgery in the National Health Service (NHS). The aim of this study was to quantify and explore variability in mortality amongst high-risk emergency general surgery admissions to English NHS hospital Trusts. The Hospital Episode Statistics (HES) database was used to identify high-risk emergency general surgery diagnoses (greater than 5 per cent national 30-day mortality rate). Adults admitted to English NHS Trusts with these diagnoses between 2000 and 2009 were included in the study. Thirty-day in-hospital mortality was adjusted for patient and hospital factors. Trusts were grouped into high- and low-mortality outliers, and resource availability was compared between high- and low-mortality outlier institutions. Some 367 796 patients admitted to 145 hospital Trusts were included in the study; the 30-day mortality rate was 15·6 per cent (institutional range 9·2-18·2 per cent). Fourteen and 24 hospital Trusts were identified as high- and low-mortality outlier institutions respectively. Intensive care and high-dependency bed resources, as well as greater institutional use of computed tomography (CT), were independent predictors of reduced mortality (P emergency general surgery patients. Equitable access to essential hospital resources may reduce variability in outcomes. © 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.
Ernst, Amy A; Jones, Jaime; Weiss, Steven J; Silva, Otono
Inclusion of select orthopedic problems in the orthopedics observation unit (OOU) may reduce hospital admissions. Our system allows OOU status for 24 hours, but the effect on admissions is unknown. Our primary hypothesis was that we could predict which OOU patients required admission based on the presence of uncontrolled pain. Data were prospectively collected for all OOU patients in this prospective observational study, including data on extremity cellulitis, fractures, and spine injuries awaiting brace placement.The primary outcome variable was admission to the hospital versus discharge home. The a priori hypotheses were that patients with more persistent or worsening pain would require admission more often and that the OOU would result in fewer patients needing a costlier inpatient admission to the hospital. An a priori power analysis showed adequate power of 80% to detect a difference between admitted and discharged patients. Data were prospectively collected from August 2011 to August 2012 for 199 consecutive OOU patients, 62% of whom were men. Diagnoses included infection (cellulitis or abscess of extremity) in 76%, fracture in 15% and other in 9% of the patients. Sixty-two patients (31%) were admitted and 7 patients (4%) made return visits for the same problem within a 30-day period. No significant relations existed between any of the independent variables and admission on bivariate analysis. Multivariable logistic regression found no significant predictors of hospital admission. Logistic regression was not performed on 30-day returns because of the low event rate (4%). An OOU prevented 138 of 199 (69%) patients from being admitted to a hospital. There were no significant predictors of which patients would require admission. Pain was not a predictor of need for admission. The lack of significant predictors is important in suggesting that without the ability to predict which patients require admission, a system using an OOU can reduce admissions by more than
Jeffrey J. Guterman
Full Text Available Introduction: Attending physician judgment is the traditional standard of care for emergency department (ED admission decisions. The extent to which variability in admission decisions affect cost and quality is not well understood. We sought to determine the impact of variability in admission decisions on cost and quality. Methods: We performed a retrospective observational study of patients presenting to a university-affiliated, urban ED from October 1, 2007, through September 30, 2008. The main outcome measures were admission rate, fiscal indicators (Medicaid-denied payment days, and quality indicators (15- and 30-day ED returns; delayed hospital admissions. We asked each Attending to estimate their inpatient admission rate and correlated their personal assessment with actual admission rates. Results: Admission rates, even after adjusting for known confounders, were highly variable (15.2%-32.0% and correlated with Medicaid denied-payment day rates (p=0.038. There was no correlation with quality outcome measures (30-day ED return or delayed hospital admission. There was no significant correlation between actual and self-described admission rate; the range of mis-estimation was 0% to 117%. Conclusion: Emergency medicine attending admission rates at this institution are highly variable, unexplained by known confounding variables, and unrelated to quality of care, as measured by 30-day ED return or delayed hospital admission. Admission optimization represents an important untapped potential for cost reduction through avoidable hospitalizations, with no apparent adverse effects on quality.
Kao, Li-Ting; Tsai, Ming-Chieh; Lin, Herng-Ching; Pai, Femi; Lee, Cha-Ze
To investigate variations in the incidence of peptic ulcers (PUs) in Taiwan by day of the week within age subgroups. Ambulatory care data were retrieved from the Longitudinal Health Insurance Database 2000. There were 7204 subjects ≥ 18 years-old with an emergency room admission claim for the treatment of PUs, resulting in a total of 9234 emergency room visits for PUs between 2009 and 2011. Data was divided into the seven days of the week and an additional variable for holidays. One-way analysis of variance was used to examine associations among the daily mean number of PU emergency room admissions and holidays/weekends/weekdays. One-way analysis of variance showed that there was a significant difference in emergency room admissions for PUs by the day of the week (P < 0.001), with admission more likely to occur on Sundays or holidays than weekdays within the total and working populations. The weekday patterns of admission were similar for the patients aged 18-64 years and ≥ 65 years of age. Holidays, followed by Sundays, had higher PU admissions than the mean daily PU emergency room admissions. Furthermore, inclusion of only those treated for PUs with hemorrhage or perforation, Sundays and holidays had higher mean emergency room admissions than other days. Inclusion of patients who diagnosed with Helicobacter pylori infection, only holidays had higher mean emergency room admissions than other days. Inclusion of patients who had been prescribed non-steroidal anti-inflammatory drugs (NSAIDs) for over 30 d, Sundays and holidays had higher mean PU ER admissions than other non-holiday weekdays. There is a higher incidence of emergency room admission for PUs on weekends than on weekdays for the total and working populations.
Chin, Jun Liong
Both physiological- and laboratory-derived variables, alone or in combination, have been used to predict mortality among acute medical admissions. Using the Modification of Diet in Renal Disease (MDRD) not as an estimate of glomerular filtration rate but as an outcome predictor for hospital mortality, we examined the relationship between the MDRD value and in-hospital death during an emergency medical admission.
Apr 4, 2011 ... kidney disease. In the past, infectious disease accounted for most of the morbidities and mortality among medical admission facilities across Africa. However, as a result of the epidemiologic transition, chronic diseases especially cardiovascular diseases including stroke, hypertension, and diabetes are ...
Heaney, R M; Reynolds, I; Ryan, R S; Khan, I; Khan, W; Waldron, R; Barry, K
Financial sustainability is an area of sharp ongoing focus across the broad spectrum of the Irish Health Service. Recent attention has been drawn to the financial implications of non-operative surgical admissions, suggesting that some of these may be unnecessary. In this study, we aim to determine the volume of emergency surgical admissions to Mayo University Hospital (MUH), in particular, to identify the scale of non-operative admissions and to assess the wider inherent implications for acute hospital services. An electronic handover system for emergency surgical admissions was introduced in MUH in September 2014. All surgical admissions from September 1st 2014 to August 31st 2015 were identified from this prospectively maintained database. HIPE (Hospital Inpatient Enquiry) data were not used in this study. Theatre logbooks confirmed those patients who required operative intervention. 1466 patients were admitted as emergencies during the study period. 58 % (850) were male and median age was 48 years (0-100). Average length of stay was 5 days (range 1-125). 327 patients (22.3 %) required operative intervention. The most commonly performed procedure was appendicectomy (52.5 %). 48 (3.3 %) patients were transferred to other hospitals. 131 (8.9 %) admissions related to the acute urological conditions. Of the 1466 admissions, 546 underwent a CT scan, while 342 patients proceeded to ultrasound. Almost 80 % of all surgical emergency admissions were discharged without undergoing a formal operative procedure while generating a significant workload for the radiology department. Changes in working practices and hospital network structures will be required to reduce the burden of non-operative emergency admissions.
Full Text Available Medical records of equine after-hours admissions from 1998 to 2007 are reviewed. Data extracted from the medical records included signalment, reason for admission, pre-admission treatment, clinical presentation, procedures performed, final diagnoses, complications occurring in hospital, length of stay and outcome. Eight hundred and twenty after-hours admissions were available of which 75 % were classified as emergencies. Most horses originated from Gauteng province (82 %, with Thoroughbred, Arabian, and Warmbloods representing 46 %, 10 % and 7 % of horses. Horses had a median age of 7 years and were predominantly male (60 %. Gastrointestinal (64 % and musculoskeletal (19 % disorders were the primary reasons for admission. Anti-inflammatories, sedation and antibiotics were given in 51 %, 20 % and 15 % of cases respectively prior to referral. On admission, 23 % of horses had surgical intervention. Intravenous catheterisation (64 %, rectal examination (61 %, nasogastric intubation (56 %, abdominocentesis (33 % and ultrasonography (19 % were the procedures performed most frequently. Surgical and medical colics constituted 28 % and 27 % respectively of the overall diagnoses, while piroplasmosis was diagnosed in 5 % of horses. Post-admission complications occurred in <2 % of horses. The median length of stay was 4 days (95 % CI: 1 to 21 days. Overall survival to discharge was 74 %. This study demonstrates that the majority of after-hours equine admissions to a university referral hospital required medical intervention and were mostly due to gastrointestinal disorders. Information obtained from this study can be used in emergency referral planning.
Yosef H Al-Olah; Khalifa M Al Thiab
Hospital admissions due to drug-related problems (DRPs) have been studied internationally, but local data are limited. Therefore, we undertook a prospective, observational study of all admissions through the emergency department (ED) at a tertiary referral hospital in Saudi Arabia to determine the incidence of admissions through the ED due to DRPs, types of DRPs, length of stay (LOS) in the hospital after ED admissions due to DRPs, and assessment of preventability of admissions due to DRPs.All admissions through the ED over a period of 28 consecutive days were evaluated to determine if they were due to definite or possible DRPs. Data was collected on a daily basis for each admission over the previous 24 hours. Each incident was assessed by three investigators Of 557 patients admitted through the ED, 82 (14.7%) admissions were due to DRP (53 definite, 29 possible). The most common types of DRP were failure to receive medication in 25 cases (47.2%), an adverse drug reaction in 13 cases (24.5%), and drug overdose in 6 cases (11.3%). In the definite DRP group, 83.0% were definitely preventable, 3.8% were possibly preventable and 13.2% were definitely non-preventable.DRPs are a serious and costly issue facing health care professionals and health care systems. Most admissions due to DRPs are avoidable (Author).
Conway, R; Byrne, D; O'Riordan, D; Cournane, S; Coveney, S; Silke, B
Patients from deprived backgrounds have a higher in-patient mortality following emergency medical admission. To evaluate the influence of Deprivation Index, overcrowding and family structure on hospital admission rates. Retrospective cohort study. All emergency medical admissions from 2002 to 2013 were evaluated. Based on address, each patient was allocated to an electoral division, whose small area population statistics were available from census data. Patients were categorized by quintile of Deprivation Index, overcrowding and family structure, and these were evaluated against hospital admission rate, calculated as rate/1000 population. Univariate and multivariable risk estimates (Odds Ratios or Incidence Rate Ratios) were calculated, using logistic or zero truncated Poisson regression as appropriate. There were 66 861 admissions in 36 214 patients over the 12-year study period. Deprivation Index quintile independently predicted the admission rate, with rates of Q1 12.0 (95% CI 11.8-12.2), Q2 19.5 (95% CI 19.3-19.6), Q3 33.7 (95% CI 33.3-34.0), Q4 31.4 (95% CI 31.2-31.6) and Q5 38.1 (95% CI 37.7-38.5). Similarly the proportions of families with children overcrowding was only predictive in the univarate model. Deprivation Index and family structure strongly predict emergency medical hospital admission rates. © The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: email@example.com.
Having information on the main causes of childhood morbidity and mortality enables ... To describe the disease pattern of patients admitted in the pediatric emergency unit at Tikur Anbessa Specialized .... **Malignancies-include leukemia, Wilms tumor, neuroblastoma, lymphoma, rhabdomyosarcoma, osteosarcoma,.
Cuddeback, Gary; Patterson, P Daniel; Moore, Charity Galena; Brice, Jane H
Emergency medical services transport and emergency department misuse among persons with behavioral health conditions is a concern. Administrative data were used to examine medical transports and hospital admissions among persons with behavioral health conditions. Data on 70,126 medical transports to emergency departments in three southeastern counties were analyzed. Compared with general medical transports, fewer behavioral health transports resulted in a hospital admission. Among behavioral health transports, persons with schizophrenia were 2.62 times more likely than those with substance use disorders to be admitted, and persons with mood disorders were 4.36 times more likely than those with substance use disorders to be admitted. Also, among behavioral health transports, rural transports were less likely than more urban transports to result in a hospital admission. More training of emergency medical services personnel and more behavioral health crisis resources, especially targeting rural areas and substance use disorders, are needed.
The main objective of this study is to describe the spectrum of medical conditions presenting at the emergency department of the Federal Medical Centre, Abeokuta, Nigeria over a two year period. This is a retrospective analysis of a prospectively collected data. Data was collected from the emergency room admission ...
Tammes, Peter; Purdy, Sarah; Salisbury, Chris; MacKichan, Fiona; Lasserson, Daniel; Morris, Richard W
Secondary health care services have been under considerable pressure in England as attendance rates increase, resulting in longer waiting times and greater demands on staff. This study's aim was to examine the association between continuity of care and risk of emergency hospital admission among older adults. We analyzed records from 10,000 patients aged 65 years and older in 2012 within 297 English general practices obtained from the Clinical Practice Research Datalink and linked with Hospital Episode Statistics. We used the Bice and Boxerman (BB) index and the appointed general practitioner index (last general practitioner consulted before hospitalization) to quantify patient-physician continuity. The BB index was used in a prospective cohort approach to assess impact of continuity on risk of admission. Both indices were used in a separate retrospective nested case-control approach to test the effect of changing physician on the odds of hospital admission in the following 30 days. In the prospective cohort analysis, the BB index showed a graded, non-significant inverse relationship of continuity of care with risk of emergency hospital admission, although the hazard ratio for patients experiencing least continuity was 2.27 (95% CI, 1.37-3.76) compared with those having complete continuity. In the retrospective nested case-control analysis, we found a graded inverse relationship between continuity of care and emergency hospital admission for both BB and appointed general practitioner indices: for the latter, the odds ratio for those experiencing least continuity was 2.32 (95% CI, 1.48-3.63) relative to those experiencing most continuity. Marked discontinuity of care might contribute to increased unplanned hospital admissions among patients aged 65 years and older. Schemes to enhance continuity of care have the potential to reduce hospital admissions. © 2017 Annals of Family Medicine, Inc.
Luo, Gang; Stone, Bryan L; Johnson, Michael D; Nkoy, Flory L
In young children, bronchiolitis is the most common illness resulting in hospitalization. For children less than age 2, bronchiolitis incurs an annual total inpatient cost of $1.73 billion. Each year in the United States, 287,000 emergency department (ED) visits occur because of bronchiolitis, with a hospital admission rate of 32%-40%. Due to a lack of evidence and objective criteria for managing bronchiolitis, ED disposition decisions (hospital admission or discharge to home) are often made subjectively, resulting in significant practice variation. Studies reviewing admission need suggest that up to 29% of admissions from the ED are unnecessary. About 6% of ED discharges for bronchiolitis result in ED returns with admission. These inappropriate dispositions waste limited health care resources, increase patient and parental distress, expose patients to iatrogenic risks, and worsen outcomes. Existing clinical guidelines for bronchiolitis offer limited improvement in patient outcomes. Methodological shortcomings include that the guidelines provide no specific thresholds for ED decisions to admit or to discharge, have an insufficient level of detail, and do not account for differences in patient and illness characteristics including co-morbidities. Predictive models are frequently used to complement clinical guidelines, reduce practice variation, and improve clinicians' decision making. Used in real time, predictive models can present objective criteria supported by historical data for an individualized disease management plan and guide admission decisions. However, existing predictive models for ED patients with bronchiolitis have limitations, including low accuracy and the assumption that the actual ED disposition decision was appropriate. To date, no operational definition of appropriate admission exists. No model has been built based on appropriate admissions, which include both actual admissions that were necessary and actual ED discharges that were unsafe. The
Conti, Matthew S
To determine the impact of state Medicaid diabetes disease management programs on emergency admissions and inpatient costs. National InPatient Sample sponsored by the Agency for Healthcare Research and Quality Project for the years from 2000 to 2008 using 18 states. A difference-in-difference methodology compares costs and number of emergency admissions for Washington, Texas, and Georgia, which implemented disease management programs between 2000 and 2008, to states that did not undergo the transition to managed care (N = 103). Costs and emergency admissions were extracted for diabetic Medicaid enrollees diagnosed in the reform and non-reform states and collapsed into state and year cells. In the three treatment states, the implementation of disease management programs did not have statistically significant impacts on the outcome variables when compared to the control states. States that implemented disease management programs did not achieve improvements in costs or the number of emergency of admissions; thus, these programs do not appear to be an effective way to reduce the burden of this chronic disease. © Health Research and Educational Trust.
Carey, Iain M; Hosking, Fay J; Harris, Tess; DeWilde, Stephen; Beighton, Carole; Shah, Sunil M; Cook, Derek G
Annual health checks for adults with intellectual disability (ID) have been incentivised by National Health Service (NHS) England since 2009, but it is unclear what impact they have had on important health outcomes such as emergency hospitalisation. An evaluation of a 'natural experiment', incorporating practice and individual-level designs, to assess the effectiveness of health checks for adults with ID in reducing emergency hospital admissions using a large English primary care database. For practices, changes in admission rates for adults with ID between 2009-2010 and 2011-2012 were compared in 126 fully participating versus 68 non-participating practices. For individuals, changes in admission rates before and after the first health check for 7487 adults with ID were compared with 46 408 age-sex-practice matched controls. Incident rate ratios (IRRs) comparing changes in admission rates are presented for: all emergency, preventable emergency (for ambulatory care sensitive conditions (ACSCs)) and elective emergency. Practices with high health check participation showed no change in emergency admission rate among patients with ID over time compared with non-participating practices (IRR=0.97, 95% CI 0.78 to 1.19), but emergency admissions for ACSCs did fall (IRR=0.74, 0.58 to 0.95). Among individuals with ID, health checks had no effect on overall emergency admissions compared with controls (IRR=0.96, 0.87 to 1.07), although there was a relative reduction in emergency admissions for ACSCs (IRR=0.82, 0.69 to 0.99). Elective admissions showed no change with health checks in either analysis. Annual health checks in primary care for adults with ID did not alter overall emergency admissions, but they appeared influential in reducing preventable emergency admissions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Fusco, Marco; Buja, Alessandra; Piergentili, Paolo; Golfetto, Maria Teresa; Serafin, Gianni; Gallo, Silvia; Dalla Barba, Livio; Baldo, Vincenzo
The appropriate use of health care is an important issue in developed countries. The purpose of this study was to ascertain the extent of potentially inappropriate hospital admissions and their individual, clinical and hospital-related determinants. Medical records were analyzed for the year 2014 held by the Local Heath Unit n. 13 in the Veneto Region of north-east Italy (19,000 records). The outcomes calculated were: admissions for conditions amenable to day hospital care; brief medical admissions; outlier lengths of stay for elderly patients' medical admissions; and medical admissions to surgical wards. Univariate analyses and logistic regression models were used to test associations with demographic, clinical and hospital ward covariates, including organizational indicators. Inappropriate reliance on acute care beds ranged from 6% to 28%, depending on the type of quality indicator analyzed. Some individual features, and wards' specific characteristics were associated with at least one of the phenomena of inappropriate hospital resource usage. In particular, male gender, younger age and transferals seemed to affect inappropriate admissions to surgical wards. Potentially avoidable admissions featuring inpatients amenable to day hospital care were associated with subjects with fewer comorbidities and lower case-mix wards, while inappropriately short medical stays were influenced by patients' higher functional status and local residency and by lower bed occupancy rates. In conclusion, inappropriately long hospital stays for elderly cases were associated with patients with multiple pathologies in wards with a low bed-occupancy. Education level and citizenship did not seem to influence inappropriate admissions. Some individual, clinical ad structural characteristics of patients and wards emerging from administrative records could be associated with inappropriate reliance on acute hospital beds. Analyzing the indicators considered in this study could generate
Goulden, Robert; Hoyle, Marie-Claire; Monis, Jessie; Railton, Darran; Riley, Victoria; Martin, Paul; Martina, Reynaldo; Nsutebu, Emmanuel
The third international consensus definition for sepsis recommended use of a new prognostic tool, the quick Sequential Organ Failure Assessment (qSOFA), based on its ability to predict inhospital mortality and prolonged intensive care unit (ICU) stay in patients with suspected infection. While several studies have compared the prognostic accuracy of qSOFA to the Systemic Inflammatory Response Syndrome (SIRS) criteria in suspected sepsis, few have compared qSOFA and SIRS to the widely used National Early Warning Score (NEWS). This was a retrospective cohort study carried out in a UK tertiary centre. The study population comprised emergency admissions in whom sepsis was suspected and treated. The accuracy for predicting inhospital mortality and ICU admission was calculated and compared for qSOFA, SIRS and NEWS. Among 1818 patients, 53 were admitted to ICU (3%) and 265 died in hospital (15%). For predicting inhospital mortality, the area under the receiver operating characteristics curve for NEWS (0.65, 95% CI 0.61 to 0.68) was similar to qSOFA (0.62, 95% CI 0.59 to 0.66) (test for difference, P=0.18) and superior to SIRS (PSIRS≥2 (80%, 95% CI 74% to 84%) and higher than qSOFA≥2 (37%, 95% CI 31% to 43%). The specificity of NEWS≥5 (43%, 95% CI 41% to 46%) was higher than SIRS≥2 (21%, 95% CI 19% to 23%) and lower than qSOFA≥2 (79%, 95% CI 77% to 81%). The negative predictive value was 88% (86%-90%) for qSOFA, 86% (82%-89%) for SIRS and 91% (88%-93%) for NEWS. Results were similar for the secondary outcome of ICU admission. NEWS has equivalent or superior value for most test characteristics relative to SIRS and qSOFA, calling into question the rationale of adopting qSOFA in institutions where NEWS is already in use. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Shahi, Ali Mohammad; Omraninava, Ali; Goli, Mitra; Soheilarezoomand, Hamid Reza; Mirzaei, Nader
Today, air pollution is one of the critical problems in metropolitans and necessary preparations are needed for confronting this crisis. The present study was based on the goal of determining the relationship of air pollutant levels with the rate of emergency admissions for respiratory and cardiovascular patients. In the present retrospective cross-sectional study, all respiratory and cardiovascular patients, referred to emergency department during 2012, were assessed. The meteorological and air pollution data were collected. Information regarding the numbers and dates (month, day) of admission for respiratory and cardiovascular diseases was achieved from the hospital's electronic registration system. The relation of air pollution and respiratory and cardiovascular admissions were analyzed by generalize additive model (GAM). 5922 patients were assessed which included 4048 (68.36%) cardiovascular and 1874 (31.64%) respiratory. Carbon monoxide (CO) level was an independent risk factor of cardiovascular disease on the same day (RR=1.49; 95% CI: 1.25- 1.77; Pcauses a rise in respiratory admissions to emergency department.
López-Picazo Ferrer, J J; Tomás García, N; Cubillana Herrero, J D; Gómez Company, J A; de Dios Cánovas García, J
To measure the appropriateness of hospital admissions, to classify its Clinical Services (CS) according to the level of inappropriateness, and to determine the usefulness of applying rapid assessment techniques (lot quality assurance sampling) in these types of measurements. A descriptive, retrospective study was conducted in a tertiary hospital to assess the clinical records of emergency admissions to the 12 CS with a higher volume of admissions, using the Appropriateness Evaluation Protocol (AEP). A four-level («A» to «D») increasingly inadequate admissions scale was constructed setting both standard and threshold values in every stratum. Every CS was classified in one of them using lot quality assurance sampling (LQAS). A total of 156 cases (13 cases from every CS) were assessed. The assessment effort (devoted time) was also estimated. There were 22.4±6.3% of inadequate admissions. In the CS classification, 9 (75%) got a good or acceptable appropriateness level, and only 1 (8%) got an inacceptable level. The time devoted was estimated at 17 hours. AEP is useful to assess the admission appropriateness and may be included in the «Emergencies» process management, although its variability prevents the use for external comparisons. If both LQAS and the appropriateness classification level and the global estimation (by unifying lot samples) are combined, the monitoring is affordable without a great effort. To extend these tools to other quality indicators requiring direct observation or clinical records, manual assessment could improve the monitoring efficiency. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.
Qiu, Hong; Yu, Ignatius Tak-Sun; Wang, Xiaorong; Tian, Linwei; Tse, Lap Ah; Wong, Tze Wai
Associations between ambient pollution and cardiovascular morbidity including ischemic heart disease (IHD) have been confirmed. Weather factors such as temperature, season and relative humidity (RH) may modify the effects of pollution. We conducted this study to examine the effects of air pollution on emergency IHD hospital admissions varied across seasons and RH levels, and to explore the possible joint modification of weather factors on pollution effects. Daily time series of air pollution concentrations, mean temperature and RH were collected from IHD hospital admissions from 1998 to 2007 in Hong Kong. We used generalized additive Poisson models with interaction term to estimate the pollution effects varied across seasons and RH levels, after adjusting for time trends, weather conditions, and influenza outbreaks. An increase in the detrimental effects of air pollution in cool season and on low humidity days was observed. In the cool and dry season, a 10 μg/m(3) increment of lag03 exposure was associated with an increase of emergency IHD admissions by 1.82% (95% CI: 1.24-2.40%), 3.89% (95% CI: 3.08-4.70%), and 2.19% (95% CI: 1.33-3.06%) for particles with an aerodynamic diameter less than 10 μm (PM10), nitrogen dioxide (NO2), and ozone (O3), respectively. The effects of pollutants decreased greatly and lost statistical significance in the warm and humid season. We found season and RH jointly modified the associations between ambient pollution and IHD admissions, resulting in increased IHD admissions in the cool and dry season and reduced admissions in the warm and humid season. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Li, Xue; Srasuebkul, Preeyaporn; Reppermund, Simone; Trollor, Julian
To use linked administrative datasets to assess factors associated with emergency department (ED) presentation and psychiatric readmission in three distinctive time intervals after the index psychiatric admission. A retrospective data-linkage study. Cohort study using four linked government minimum datasets including acute hospital care from July 2005 to June 2012 in New South Wales, Australia. People who were alive and aged ≥18 years on 1 July 2005 and who had their index admission to a psychiatric ward from 1 July 2007 to 30 June 2010. ORs of factors associated with psychiatric admission and ED presentation were calculated for three intervals: 0-1 month, 2-5 months and 6-24 months after index separation. Index admission was identified in 35 056 individuals (51% -males) with a median age of 42 years. A total of 12 826 (37%) individuals had at least one ED presentation in the 24 months after index admission. Of those, 3608 (28%) presented within 0-1 month, 6350 (50%) within 2-5 months and 10 294 (80%) within 6-24 months after index admission. A total of 14 153 (40%) individuals had at least one psychiatric readmission in the first 24 months. Of those, 6808 (48%) were admitted within 0-1 month, 6433 (45%) within 2-5 months and 7649 (54%) within 6-24 months after index admission. Principal diagnoses and length of stay at index admission, sociodemographic factors, Charlson Comorbidity Index score, drug and alcohol comorbidity, intellectual disability and other inpatient service use were significantly associated with ED presentations and psychiatric readmissions, and these relationships varied somewhat over the intervals studied. Social determinants of service use, drug and alcohol intervention, addressing needs of individuals with intellectual disability and recovery-oriented whole-person approaches at index admission are key areas for investment to improve trajectories after index admission. © Article author(s) (or their employer(s) unless otherwise
Emergency medicine is subjected worldwide to financial stringencies and organizational evaluations of cost-effectiveness. The various links in the chain of survival are affected differently. Bystander assistance or bystander CPR is available in only 30% of the emergencies, response intervals--if at all required by legislation--are observed to only a limited degree or are too extended for survival in cardiac arrest. A single emergency telephone number is lacking. Too many different phone numbers for emergency reporting result in confusion and delays. Organizational realities are not fully overcome and impair efficiency. The position of the emergency physician in the EMS System is inadequately defined, the qualification of too many emergency physicians are unsatisfactory. In spite of this, emergency physicians are frequently forced to answer out-of-hospital emergency calls. Conflicts between emergency physicians and EMTs may be overcome by providing both groups with comparable qualifications as well as by providing an explicit definition of emergency competence. A further source of conflict occurs at the juncture of prehospital and inhospital emergency care in the emergency department. Deficiencies on either side play a decisive role. At least in principle there are solutions to the deficiencies in the EMSS and in intensive care medicine. They are among others: Adequate financial compensation of emergency personnel, availability of sufficient numbers of highly qualified personnel, availability of a central receiving area with an adjacent emergency ward, constant information flow to the dispatch center on the number of available emergency beds, maintaining 5% of all beds as emergency beds, establishing intermediate care facilities. Efficiency of emergency physician activities can be demonstrated in polytraumatized patients or in patients with ventricular fibrillation or acute myocardial infarction, in patients with acute myocardial insufficiency and other emergency
Credé, Sarah H; O'Keeffe, Colin; Mason, Suzanne; Sutton, Anthea; Howe, Emma; Croft, Susan J; Whiteside, Mike
Globally, the rate of emergency hospital admissions is increasing. However, little evidence exists to inform the development of interventions to reduce unplanned Emergency Department (ED) attendances and hospital admissions. The objective of this evidence synthesis was to review the evidence for interventions, conducted during the patient's journey through the ED or acute care setting, to manage people with an exacerbation of a medical condition to reduce unplanned emergency hospital attendance and admissions. A rapid evidence synthesis, using a systematic literature search, was undertaken in the electronic data bases of MEDLINE, EMBASE, CINAHL, the Cochrane Library and Web of Science, for the years 2000-2014. Evidence included in this review was restricted to Randomised Controlled Trials (RCTs) and observational studies (with a control arm) reported in peer-reviewed journals. Studies evaluating interventions for patients with an acute exacerbation of a medical condition in the ED or acute care setting which reported at least one outcome related to ED attendance or unplanned admission were included. Thirty papers met our inclusion criteria: 19 intervention studies (14 RCTs) and 11 controlled observational studies. Sixteen studies were set in the ED and 14 were conducted in an acute setting. Two studies (one RCT), set in the ED were effective in reducing ED attendance and hospital admission. Both of these interventions were initiated in the ED and included a post-discharge community component. Paradoxically 3 ED initiated interventions showed an increase in ED re-attendance. Six studies (1 RCT) set in acute care settings were effective in reducing: hospital admission, ED re-attendance or re-admission (two in an observation ward, one in an ED assessment unit and three in which the intervention was conducted within 72 h of admission). There is no clear evidence that specific interventions along the patient journey from ED arrival to 72 h after admission benefit ED
Allaudeen, Nazima; Vashi, Anita; Breckenridge, Julia S; Haji-Sheikhi, Farnoosh; Wagner, Sarah; Posley, Keith A; Asch, Steven M
The practice of boarding admitted patients in the emergency department (ED) carries negative operational, clinical, and patient satisfaction consequences. Lean tools have been used to improve ED workflow. Interventions focused on reducing ED length of stay (LOS) for admitted patients are less explored. To evaluate a Lean-based initiative to reduce ED LOS for medicine admissions. Prospective quality improvement initiative performed at a single university-affiliated Department of Veterans Affairs (VA) medical center from February 2013 to February 2016. We performed a Lean-based multidisciplinary initiative beginning with a rapid process improvement workshop to evaluate current processes, identify root causes of delays, and develop countermeasures. Frontline staff developed standard work for each phase of the ED stay. Units developed a daily management system to reinforce, evaluate, and refine standard work. The primary outcome was the change in ED LOS for medicine admissions pre- and postintervention. ED LOS at the intervention site was compared with other similar VA facilities as controls over the same time period using a difference-in-differences approach. ED LOS for medicine admissions reduced 26.4%, from 8.7 to 6.4 hours. Difference-in-differences analysis showed that ED LOS for combined medicine and surgical admissions decreased from 6.7 to 6.0 hours (-0.7 hours, P = .003) at the intervention site compared with no change (5.6 hours, P = .2) at the control sites. We utilized Lean management to significantly reduce ED LOS for medicine admissions. Specifically, the development and management of standard work were key to sustaining these results.
Aldiania Carlos Balbino
Full Text Available We aimed to investigate the care in thermoregulation of the newborn during the admission in a High Complexity Pediatric Emergency Unit. Retrospective documentary study, carried out in a teaching hospital of Ceará, Brazil. Data collection was performed through a form, 149 medical records of newborns with a request for transfer to neonatal intensive care unit. There was prevalence of males, at term, weighing between 2,500 and 3,999 grams, and born vaginally in hospitals. Among the main causes that led to the unit transfer request, 44.3% presented respiratory disorders. Most (85.9% was Normothermic, and the most evident care was checking the axillary temperature and the use of heat sources (incubator, radiant heat source. We concluded that mild hypothermia was the most present risk indicator and that cares concerning the thermoregulation in the admission of the newborn are consistent with the clinical manifestations presented.
Ortuño, Noèlia; Cobo, Jesús; González, Espe; García, Imma; Ferrer, María-Dolores; Campos, Carmen; Planet, Núria; Oliva, Joan-Carles; Suárez, Mónica; Iglesias-Lepine, María-Luisa; García-Parés, Gemma
There is increasing evidence relating the presence of depression in seniors and the risk of hospital admission in medical departments from the Emergency Services. To determine the impact of antidepressant treatment (ATD) as a protective factor for emergency hospitalization in older people. All patients aged 65 and over who required urgent attention for medical reasons at the Emergency Department of the Corporació Sanitària i Universitària Parc Taulí (Sabadell, Barcelona, Spain) for the period between January and October 2012 were included in the study. Sociodemographic variables, alcohol and tobacco use, medical history and psychopharmacological treatment were obtained. The necessary sample size was calculated and a simple randomization was performed. Subsequently, a descriptive statistical analysis and parametric tests were conducted. A total of 674 patients (53% women) were evaluated, with a mean age of 78.45 years, and 27.6% of the cases (71% women) were receiving ATD. Among the 333 admitted patients (50%), 83 individuals (24.6%) had previously received ATD; this contrasts with the 103 cases (30.6%) of prior ATD treatment among the patients who were not admitted. After comparative analysis, the relationship between previous use of ATD and being admitted to hospital was not statistically significant in our global sample. This relationship was only statistically significant among the group aged 75 and over (neg. sig. 0.012). In our study, ATD was associated with a decreased risk of hospital admission for urgent medical conditions in people aged 75 and over. Treating depression may protect the elderly against admission to the Emergency department and may potentially be a quality criterion in preventing complications in this population. Copyright © 2014 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.
Full Text Available Abstract Background Air pollution can cause respiratory symptoms or exacerbate pre-existing respiratory diseases, especially in children. This study looked at the short-term association of air pollution concentrations with Emergency Room (ER admissions for respiratory reasons in pediatric age (0–18 years. Methods Daily number of ER admissions in a children’s Hospital, concentrations of urban-background PM2.5, NO2, O3 and total aeroallergens (Corylaceae, Cupressaceae, Gramineae, Urticaceae, Ambrosia, Betula were collected in Turin, northwestern Italy, for the period 1/08/2008 to 31/12/2010 (883 days. The associations between exposures and ER admissions were estimated, at time lags between 0 and 5 days, using generalized linear Poisson regression models, adjusted for non-meteorological potential confounders. Results In the study period, 21,793 ER admissions were observed, mainly (81 % for upper respiratory tract infections. Median air pollution concentrations were 22.0, 42.5, 34.1 μg/m3 for urban-background PM2.5, NO2, and O3, respectively, and 2.9 grains/m3 for aeroallergens. We found that ER admissions increased by 1.3 % (95 % CI: 0.3-2.2 % five days after a 10 μg/m3 increase in NO2, and by 0.7 % (95 % CI: 0.1-1.2 % one day after a 10 grains/m3 increase in aeroallergens, while they were not associated with PM2.5 concentrations. ER admissions were negatively associated with O3 and aeroallergen concentrations at some time lags, but these association shifted to the null when meteorological confounders were adjusted for in the models. Conclusions Overall, these findings confirm adverse short-term health effects of air pollution on the risk of ER admission in children and encourage a careful management of the urban environment to health protection.
Sharoky, Catherine E; Bailey, Elizabeth A; Sellers, Morgan M; Kaufman, Elinore J; Sinnamon, Andrew J; Wirtalla, Christopher J; Holena, Daniel N; Kelz, Rachel R
Emergency general surgery during hospitalization has not been well characterized. We examined emergency operations remote from admission to identify predictors of postoperative 30-day mortality, postoperative duration of stay >30 days, and complications. Patients >18 years in The American College of Surgeons National Surgical Quality Improvement Program (2011-2014) who had 1 of 7 emergency operations between hospital day 3-18 were included. Patients with operations >95th percentile after admission (>18 days; n = 581) were excluded. Exploratory laparotomy only (with no secondary procedure) represented either nontherapeutic or decompressive laparotomy. Multivariable logistic regression was used to identify predictors of study outcomes. Of 10,093 patients with emergency operations, most were elderly (median 66 years old [interquartile ratio: 53-77 years]), white, and female. Postoperative 30-day mortality was 12.6% (n = 1,275). Almost half the cohort (40.1%) had a complication. A small subset (6.8%) had postoperative duration of stay >30 days. Postoperative mortality after exploratory laparotomy only was particularly high (>40%). In multivariable analysis, an operation on hospital day 11-18 compared with day 3-6 was associated with death (odds ratio 1.6 [1.3-2.0]), postoperative duration of stay >30 days (odds ratio 2.0 [1.6-2.6]), and complications (odds ratio 1.5 [1.3-1.8]). Exploratory laparotomy only also was associated with death (odds ratio 5.4 [2.8-10.4]). Emergency general surgery performed during a hospitalization is associated with high morbidity and mortality. A longer hospital course before an emergency operation is a predictor of poor outcomes, as is undergoing exploratory laparotomy only. Copyright © 2017 Elsevier Inc. All rights reserved.
Carter-Storch, Rasmus; Frydkjær-Olsen, Ulrik; Mogensen, Christian Backer
INTRODUCTION: In the emergency departments (ED), a heterogeneous mix of patients is seen. The aim of this study was to establish a limited number of categories of complaints and symptoms covering the majority of admissions in a Danish ED and to quantify the volume of cases in each category...... covering all patient complaints was produced. Presumptive diagnoses and categories with frequencies less than 1% were pooled with other groups, unless keeping them was clinically relevant. RESULTS: Among the 9,863 patients, 49% were medical, 31% surgical, 15% orthopaedic and 5% vascular surgical patients...
Stuck, Amy R; Crowley, Christopher; Killeen, James; Castillo, Edward M
Emergency departments (EDs) in the United States play a prominent role in hospital admissions, especially for the growing population of older adults. Home-based care, rather than hospital admission from the ED, provides an important alternative, especially for older adults who have a greater risk of adverse events, such as hospital-acquired infections, falls, and delirium. The objective of the survey was to understand emergency physicians' (EPs) perspectives on home-based care alternatives to hospitalization from the ED. Specific goals included determining how often EPs ordered home-based care, what they perceive as the barriers and motivators for more extensive ordering of home-based care, and the specific conditions and response times most appropriate for such care. A group of 1200 EPs nationwide were e-mailed a six-question survey. Participant response was 57%. Of these, 55% reported ordering home-based care from the ED within the past year as an alternative to hospital admission or observation, with most doing so less than once per month. The most common barrier was an "unsafe or unstable home environment" (73%). Home-based care as a "better setting to care for low-acuity chronic or acute disease exacerbation" was the top motivator (79%). Medical conditions EPs most commonly considered for home-based care were cellulitis, urinary tract infection, diabetes, and community-acquired pneumonia. Results suggest that EPs recognize there is a benefit to providing home-based care as an alternative to hospitalization, provided they felt the home was safe and a process was in place for dispositioning the patient to this setting. Better understanding of when and why EPs use home-based care pathways from the ED may provide suggestions for ways to promote wider adoption. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.
Stuck, Amy; Crowley, Christopher; Martinez, Tracy; Wittgrove, Alan; Brennan, Jesse J; Chan, Theodore C; Castillo, Edward M
The study objective was to explore emergency physicians' (EP) awareness, willingness, and prior experience regarding transitioning patients to home-based healthcare following emergency department (ED) evaluation and treatment; and to explore patient selection criteria, processes, and services that would facilitate use of home-based healthcare as an alternative to hospitalization. We provided a five-question survey to 52 EPs, gauging previous experience referring patients to home-based healthcare, patient selection, and motivators and challenges when considering home-based options as an alternative to admission. In addition, we conducted three focus groups and four interviews. Of participating EPs, 92% completed the survey, 38% reported ordering home-based healthcare from the ED as an alternative to admission, 90% ranked cellulitis among the top three medical conditions for home-based healthcare, 90% ranked "reduce unnecessary hospitalizations and observation stays" among their top three perceived motivators for using home-based care, and 77% ranked "no existing process in place to refer to home-based care" among their top three perceived barriers. Focus group and interview themes included the need for alternatives to admission; the longer-term benefits of home-based healthcare; the need for streamlined transition processes; and the need for highly qualified home-care staff capable of responding the same day or within 24 hours. The study found that EPs are receptive to referring patients for home-based healthcare following ED treatment and believe people with certain diagnoses are likely to benefit, with the dominant barrier being the absence of an efficient referral process.
Shin, Tae Gun; Jo, Ik Joon; Sim, Min Seob; Park, Seung-Jung
Purpose The evaluation of syncope is often disorganized and ineffective. The objective of this study was to examine whether implementation of a standardized emergency department (ED) protocol improves the quality of syncope evaluation. Materials and Methods This study was a prospective, non-randomized study conducted at a 1900-bed, tertiary teaching hospital in South Korea. We compared two specific periods, including a 12-month observation period (control group, January-December 2009) and a 10-month intervention period after the implementation of standardized approaches, comprising risk stratification, hospital order sets and establishment of a syncope observational unit (intervention group, March-December 2010). Primary end points were hospital admission rates and medical costs related to syncope evaluation. Results A total of 244 patients were enrolled in this study (116 patients in the control group and 128 patients in the intervention group). The admission rate decreased by 8.3% in the intervention group (adjusted odds ratio 0.31, 95% confidence interval 0.13-0.70, p=0.005). There was a cost reduction of about 30% during the intervention period [369000 Korean won (KRW), interquartile range (IQR) 240000-602000 KRW], compared with the control period (542000 KRW, IQR 316000-1185000 KRW). The length of stay in the ED was also reduced in the intervention group (median: 4.6 hours vs. 3.4 hours). Conclusion Standardized approaches to syncope evaluation reduced hospital admissions, medical costs and length of stay in the overcrowded emergency department of a tertiary teaching hospital in South Korea. PMID:23918559
Elena Urbieta Sanz
Full Text Available Target: To evaluate the results of the implementation of a therapeutic reconciliation procedure (TRP at admission by the emergency department (ED Methods: Prospective observational study conducted in the ED of a Referral Hospital Area. We collected the results of the implementation of a TRP from September to December 2012. A pharmacist attended daily to emergency department meeting and reviewed medical history to select those patients with high risk of reconciliation error (RE according TRP. Afterwards, home medication history was elaborated with emergency department and primary care records and interview with the patient or caregiver. Therapeutic reconciliation took place with the emergency physician, considering RE any discrepancies not justified by the doctor. The potential severity of RE was assessed by emergency physicians outside the study using NCCMERP’S categorization Results: The pharmacist collected an avarage of 1,3±2,2 home medication more than the emergency physician finding 564 discrepancies with the emergency record in 95,8% of the patients. 167 were RE affecting 69 patients (71,9%. Most of the errors were due to omissions of the drugs. Acceptance by emergency physicians of the reconciliation interventions was 73,9%. 58% of the RE were considered clinically relevants. Other interventions were also performed with an acceptance of 97%. Greater compliance with risk criteria, polypharmacy and pluripathology were associated with present RE and prescription of high-risk medications with the need for intervention Conclusions: The application of TRP avoided any error in most of the patients. TRP should extend to all patients at risk who admitted by the ED.
Horwitz, Leora I.; Parwani, Vivek; Shah, Nidhi R.; Schuur, Jeremiah D.; Meredith, Thom; Jenq, Grace Y.; Kulkarni, Raghavendra G.
Background Communication failures contribute to errors in the transfer of patients from the emergency department (ED) to inpatient medicine units. Oral (synchronous) communication has numerous benefits but is costly and time-consuming. Taped (asynchronous) communication may be more reliable and efficient, but lacks interaction. We evaluated a new asynchronous physician-physician sign-out compared to the traditional synchronous sign-out. Methods A voicemail-based, semi-structured sign-out for routine ED admissions to internal medicine was implemented in October, 2007 at an urban, academic medical center. Outcomes were obtained by pre- and post-intervention surveys of ED and IM housestaff, physician assistants and hospitalist attendings; and by examination of access logs and administrative data. Outcome measures included utilization; physician perceptions of ease, accuracy, content, interaction and errors; and rate of transfers to intensive care from the floor within 24 hours of ED admission. Results were analyzed both quantitatively, and qualitatively using standard qualitative analytic techniques. Results During September-October, 2008 (one year post-intervention), voicemails were recorded regarding 90.5% of medicine admissions; 69.7% of these were accessed at least once by admitting physicians. The median length of each sign-out was 2.6 minutes (IQR 1.9 to 3.5). We received 117/197 responses (59%) to the pre-intervention survey and 113/206 responses (55%) to the post-intervention survey. A total of 73/101 (72%) respondents reported dictated sign-out was easier than oral sign-out and 43/101 (43%) reported it was more accurate. However, 70/101 (69%) reported interaction among participants was worse. There was no change in the rate of ICU transfer within 24 hours of admission from the ED in April-June, 2007 (65/6,147; 1.1%) versus April-June 2008 (70/6,263; 1.1%); difference of 0%, 95% CI, −0.4% to 0.3%. The proportion of internists reporting at least one perceived
Reid, Robert J; Johnson, Eric A; Hsu, Clarissa; Ehrlich, Kelly; Coleman, Katie; Trescott, Claire; Erikson, Michael; Ross, Tyler R; Liss, David T; Cromp, DeAnn; Fishman, Paul A
The patient-centered medical home (PCMH) is being rapidly deployed in many settings to strengthen US primary care, improve quality, and control costs; however, evidence supporting this transformation is still lacking. We describe the Group Health experience in attempting to replicate the effects on health care use seen in a PCMH prototype clinic via a systemwide spread using Lean as the change strategy. We used an interrupted time series analysis with a patient-month unit of analysis over a 4-year period that included baseline, implementation, and stabilization periods for 412,943 patients. To account for secular trends across these periods, we compared changes in use of face-to-face primary care visits, emergency department visits, and inpatient admissions with those of a nonequivalent comparison group of patients served by community network practices. After accounting for secular trends among network patients, patients empaneled to the PCMH clinics had 5.1% and 6.7% declines in primary care office visits in early and later stabilization years, respectively, after the implementation year. This trend was accompanied by a 123% increase in the use of secure electronic message threads and a 20% increase in telephone encounters. Declines were also seen in emergency department visits at 1 and 2 years (13.7% and 18.5%) compared with what would be expected based on secular trends in network practices. No statistically significant changes were found for hospital admissions. The Group Health experience shows it is possible to reduce emergency department use with PCMH transformation across a diverse set of clinics using a clear change strategy (Lean) and sufficient resources and supports.
Nanayakkara, Shane; Weiss, Heike; Bailey, Michael; van Lint, Allison; Cameron, Peter; Pilcher, David
Time spent in the emergency department (ED) before admission to hospital is often considered an important key performance indicator (KPI). Throughout Australia and New Zealand, there is no standard definition of 'time of admission' for patients admitted through the ED. By using data submitted to the Australian and New Zealand Intensive Care Society Adult Patient Database, the aim was to determine the differing methods used to define hospital admission time and assess how these impact on the calculation of time spent in the ED before admission to an intensive care unit (ICU). Between March and December of 2010, 61 hospitals were contacted directly. Decision methods for determining time of admission to the ED were matched to 67,787 patient records. Univariate and multivariate analyses were conducted to assess the relationship between decision method and the reported time spent in the ED. Four mechanisms of recording time of admission were identified, with time of triage being the most common (28/61 hospitals). Reported median time spent in the ED varied from 2.5 (IQR 0.83-5.35) to 5.1 h (2.82-8.68), depending on the decision method. After adjusting for illness severity, hospital type and location, decision method remained a significant factor in determining measurement of ED length of stay. Different methods are used in Australia and New Zealand to define admission time to hospital. Professional bodies, hospitals and jurisdictions should ensure standardisation of definitions for appropriate interpretation of KPIs as well as for the interpretation of studies assessing the impact of admission time to ICU from the ED. WHAT IS KNOWN ABOUT THE TOPIC?: There are standards for the maximum time spent in the ED internationally, but these standards vary greatly across Australia. The definition of such a standard is critically important not only to patient care, but also in the assessment of hospital outcomes. Key performance indicators rely on quality data to improve decision
Simon, Erin L; Dark, Cedric; Kovacs, Mitch; Shakya, Sunita; Meek, Craig A
Recently, freestanding emergency departments (FSEDs) have grown significantly in number. Critics have expressed concern that FSEDs may increase healthcare costs. We determined whether admission rates for identical diagnoses varied among the same group of physicians according to clinical setting. This was a retrospective comparison of adult admission rates (n=3230) for chest pain, chronic obstructive pulmonary disease (COPD), asthma, and congestive heart failure (CHF) between a hospital-based ED (HBED) and two FSEDs throughout 2015. Frequency distribution and proportions were reported for categorical variables stratified by facility type. For categories with cell frequency less or equal to 5, Fisher's Exact test was used to calculate a P value. Chi square tests were used to assess difference in proportions of potential predictor variables between the HBED and FSEDs. For continuous variables, the mean was reported and Student's t-test assessed the difference in means between HBED and FSED patients. Multivariate logistic regression analyses were performed to estimate the unadjusted and adjusted prevalence odds ratio with 95% confidence interval (CI) for patient disposition outcomes associated with type of ED facility visited. Of 3230 patients, 53% used the HBED and 47% used the FSED. Patients visiting the HBED and FSED varied significantly in gender, acuity levels, diagnosis, and number of visits. Age was not significantly different between facilities. Multivariable adjusted estimated prevalence odds ratio for patients admitted were 1.2 [95%CI: 1.0-1.4] in the HBED facility compared to patients using FSEDs. In our healthcare system, FSEDs showed a trend towards a 20% lower admission rate for chest pain, COPD, asthma and CHF. Copyright © 2017 Elsevier Inc. All rights reserved.
Symons, Nicholas R A; Moorthy, Krishna; Vincent, Charles A
Emergency general surgery (EGS) is responsible for 80-90% of surgical in-hospital deaths and the early management of these unwell patients is critical to improving outcomes. Unfortunately care for EGS patients is often fragmented and important care processes are frequently omitted. This study aimed to define a group of important processes during EGS admission and assess their reliability. Literature review and semi-structured interviews were used to define a draft list of processes, which was refined and validated using the Delphi consensus methodology. A prospective cohort study of the 22 included processes was performed in 315 patients across 5 acute hospitals. Prospective study of the 22 selected processes demonstrated omission of 1130/5668 (19.9%) processes. Only 6 (1.9%) patients had all relevant processes performed correctly. Administration of oxygen to hypoxic patients (82/129, 64%), consultant review (202/313, 65%) and administration of antibiotics within 3 h for patients with severe sepsis (41/60, 68%) were performed particularly poorly. There were significant differences in the mean number of omissions per patient between hospitals ( F = 11.008, p surgical team and the implementation of multiple interventions to improve the effectiveness of the admission phase of care. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.
Full Text Available Introduction: Use of alternative venues to manage uncomplicated vaso-occlusive crisis (VOC, such as a day hospital (DH or ED observation unit, for patients with sickle cell anemia, may significantly reduce admission rates, which may subsequently reduce 30-day readmission rates. Methods: In the context of a two-institution quality improvement project to implement best practices for management of patients with sickle cell disease (SCD VOC, we prospectively compared acute care encounters for utilization of 1 emergency department (ED; 2 ED observation unit; 3 DH, and 4 hospital admission, of two different patient cohorts with SCD presenting to our two study sites. Using a representative sample of patients from each institution, we also tabulated SCD patient visits or admissions to outside hospitals within 20 miles of the patients’ home institutions. Results: Over 30 months 427 patients (297 at Site 1 and 130 at Site 2 initiated 4,740 institutional visits, totaling 6,627 different acute care encounters, including combinations of encounters. The range of encounters varied from a low of 0 (203 of 500 patients [40.6%] at Site 1; 65 of 195 patients [33.3%] at Site 2, and a high of 152 (5/month acute care encounters for one patient at Site 2. Patients at Site 2 were more likely to be admitted to the hospital during the study period (88.4% vs. 74.4%, p=0.0011 and have an ED visit (96.9% vs. 85.5%, p=0.0002. DH was used more frequently at Site 1 (1.207 encounters for 297 patients at Site 1, vs. 199 encounters for 130 patients at Site 2, and ED observation was used at Site 1 only. Thirty-five percent of patients visited hospitals outside their home academic center. Conclusion: In this 30-month assessment of two sickle cell cohorts, healthcare utilization varied dramatically between individual patients. One cohort had more hospital admissions and ED encounters, while the other cohort had more day hospital encounters and used a sickle cell disease
James M. Walston
Full Text Available Introduction: Rapid-response teams (RRTs are interdisciplinary groups created to rapidly assess and treat patients with unexpected clinical deterioration marked by decline in vital signs. Traditionally emergency department (ED disposition is partially based on the patients’ vital signs (VS at the time of hospital admission. We aimed to identify which patients will have RRT activation within 12 hours of admission based on their ED VS, and if their outcomes differed. Methods: We conducted a case-control study of patients presenting from January 2009 to December 2012 to a tertiary ED who subsequently had RRT activations within 12 hours of admission (early RRT activations. The medical records of patients 18 years and older admitted to a non-intensive care unit (ICU setting were reviewed to obtain VS at the time of ED arrival and departure, age, gender and diagnoses. Controls were matched 1:1 on age, gender, and diagnosis. We evaluated VS using cut points (lowest 10%, middle 80% and highest 10% based on the distribution of VS for all patients. Our study adheres to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology guidelines for reporting observational studies. Results: A total of 948 patients were included (474 cases and 474 controls. Patients who had RRT activations were more likely to be tachycardic (odds ratio [OR] 2.02, 95% CI [1.25-3.27], tachypneic (OR 2.92, 95% CI [1.73-4.92], and had lower oxygen saturations (OR 2.25, 95% CI [1.42-3.56] upon arrival to the ED. Patients who had RRT activations were more likely to be tachycardic at the time of disposition from the ED (OR 2.76, 95% CI [1.65-4.60], more likely to have extremes of systolic blood pressure (BP (OR 1.72, 95% CI [1.08-2.72] for low BP and OR 1.82, 95% CI [1.19-2.80] for high BP, higher respiratory rate (OR 4.15, 95% CI [2.44-7.07] and lower oxygen saturation (OR 2.29, 95% CI [1.43-3.67]. Early RRT activation was associated with increased healthcare
Javadzadeh, Hamid Reza; Davoudi, Amir; Davoudi, Farnoush; Mahmoodi, Sadrollah; Ghane, Mohammad Reza; Goodarzi, Hasan; Faraji, Mehrdad
The overcrowded hospital is an unsafe one. Overcrowding the emergency department (ED) results in increased patient suffering, prolonged waiting time, deteriorating level of service, and on occasion, a worsened medical condition or even death. This study proposes a strategy to overcome ED overcrowding. The proportion of acute area admitted patients to screened patients (A/S), and the proportion of patients who were finally transferred to inpatient wards (W/A) to those admitted in ED acute area were investigated during 6 consecutive months. Emergency medicine residents were assigned to screen patients before ED admission and afterwards. The average A/S changed from 82.4% to 44.2% (P = 0.028), and the average W/A changed from 28.3% to 51.48% (P = 0.028) before and after screening patients respectively. The initiative resulted in 97 less patients in the acute area per day. Decreased number of acute area admitted patients, and increase W/A proportion showed that the initiative was successful in obviating ED overcrowding while provision of care to those most in need was not altered.
Oct 3, 2013 ... 2011 were analyzed in terms of the time of admission, the season of admission, and the waiting and the stand‑by times in the ER. ... of the admission procedures, the median hospitalization time in the ER was 0.16 h (3 min to 2.58 h). There was no .... been known for years, and the long waiting times and the.
McCabe, J J; Cournane, S; Byrne, D; Conway, R; O'Riordan, D; Silke, B
The ageing of the population may be anticipated to increase demand on hospital resources. We have investigated the relationship between hospital episode costs and age profile in a single centre. All Emergency Medical admissions (33 732 episodes) to an Irish hospital over a 6-year period, categorized into three age groups, were evaluated against total hospital episode costs. Univariate and adjusted incidence rate ratios (IRRs) were calculated using zero truncated Poisson regression. The total hospital episode cost increased with age ( P < 0.001). The multi-variable Poisson regression model demonstrated that the most important drivers of overall costs were Acute Illness Severity-IRR 1.36 (95% CI: 1.30, 1.41), Sepsis Status -1.46 (95% CI: 1.42, 1.51) and Chronic Disabling Disease Score -1.25 (95% CI: 1.22, 1.27) and the Age Group as exemplified for those 85 years IRR 1.23 (95% CI: 1.15, 1.32). Total hospital episode costs are a product of clinical complexity with contributions from the Acute Illness Severity, Co-Morbidity, Chronic Disabling Disease Score and Sepsis Status. However age is also an important contributor and an increasing patient age profile will have a predictable impact on total hospital episode costs. © The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: firstname.lastname@example.org
Farnham, Laura; Harwood, Hannah; Robertson, Meredith
This article explores the effect of a children's at-home nursing team, Hospital at Home (H@H), which aimed to reduce demand on acute hospital beds, support families to improve patient experience, and empower parents to care safely for their unwell children and help prevent emergency department (ED) reattendance. Data on demographics and clinical presentation of H@H and ED attendances were collected and compared. A survey measuring parents' confidence in managing their unwell children was also conducted. Of 72 patients treated by the H@H service between May and July 2016, 32 (44%) would have been admitted to hospital from the ED if the H@H service had not existed. This is equivalent to a saving of 64 bed days. Patients treated by the H@H service had similar demographics to those discharged from the ED to usual care. The H@H service took on patients with higher Bedside Paediatric Early Warning System scores before discharge. Parents reported that they would be more confident caring for their children after discharge from the H@H service. The H@H service decreased the number of unnecessary ED admissions. The service promotes a positive patient experience and increases parents' confidence when caring for unwell children at home. ©2017 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.
Cournane, S; Conway, R; Creagh, D; Byrne, D G; Sheehy, N; Silke, B
To investigate the extent to which the time to completion for computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound could be shown to influence the length of stay and costs incurred while in hospital, while accounting for patient acuity. All emergency admissions, totalling 25,326 imaging investigations between 2010-2014 were evaluated. The 50(th), 75(th), and 90(th) centiles of completion times for each imaging type was entered into a multivariable truncated Poisson regression model predicting the length of hospital stay. Estimates of risk (odds or incidence rate ratios [IRRs]) of the regressors were adjusted for acute illness severity, Charlson comorbidity index, chronic disabling disease score, and sepsis status. Quantile regression analysis was used to examine the impact of imaging on total hospital costs. For all imaging examinations, longer hospital lengths of stay were shown to be related to delays in imaging time. Increased delays in CT and MRI were shown to be associated with increased hospital episode costs, while ultrasound did not independently predict increased hospital costs. The magnitude of the effect of imaging delays on episode costs were equivalent to some measures of illness severity. CT, MRI, and ultrasound are undertaken in patients with differing clinical complexity; however, even with adjustment for complexity, the time delay in a more expeditious radiological service could potentially shorten the hospital episode and reduce costs. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
García-Gigorro, R; de la Cruz Vigo, F; Andrés-Esteban, E M; Chacón-Alves, S; Morales Varas, G; Sánchez-Izquierdo, J A; Montejo González, J C
The favorable evolution of critically ill patients is often dependent on time-sensitive care intervention. The timing of transfer to the intensive care unit (ICU) therefore may be an important determinant of outcomes in critically ill patients. The aim of this study was to analyze the impact upon patient outcome of the length of stay in the Emergency Care Department. A single-center ambispective cohort study was carried out. A general ICU and Emergency Care Department (ED) of a single University Hospital. We included 269 patients consecutively transferred to the ICU from the ED over an 18-month period. Patients were first grouped into different cohorts based on ED length of stay (LOS), and were then divided into two groups: (a) ED LOS ≤5h and (b) ED LOS >5h. Demographic, diagnostic, length of stay and mortality data were compared among the groups. Median ED LOS was 277min (IQR 129-622). Patients who developed ICU complications had a longer ED LOS compared to those who did not (349min vs. 209min, p5h. The odds ratio of dying for patients with ED LOS >5h was 2.5 (95% CI 1.3-4.7). Age and sepsis diagnosis were the risk factors associated to prolongation of ED length of stay. A prolonged ED stay prior to ICU admission is related to the development of time-dependent complications and increased mortality. These findings suggest possible benefit from earlier ICU transfer and the prompt initiation of organ support. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.
Cournane, S.; Conway, R.; Creagh, D.; Byrne, D.G.; Sheehy, N.; Silke, B.
Aim: To investigate the extent to which the time to completion for computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound could be shown to influence the length of stay and costs incurred while in hospital, while accounting for patient acuity. Materials and methods: All emergency admissions, totalling 25,326 imaging investigations between 2010–2014 were evaluated. The 50 th , 75 th , and 90 th centiles of completion times for each imaging type was entered into a multivariable truncated Poisson regression model predicting the length of hospital stay. Estimates of risk (odds or incidence rate ratios [IRRs]) of the regressors were adjusted for acute illness severity, Charlson comorbidity index, chronic disabling disease score, and sepsis status. Quantile regression analysis was used to examine the impact of imaging on total hospital costs. Results: For all imaging examinations, longer hospital lengths of stay were shown to be related to delays in imaging time. Increased delays in CT and MRI were shown to be associated with increased hospital episode costs, while ultrasound did not independently predict increased hospital costs. The magnitude of the effect of imaging delays on episode costs were equivalent to some measures of illness severity. Conclusion: CT, MRI, and ultrasound are undertaken in patients with differing clinical complexity; however, even with adjustment for complexity, the time delay in a more expeditious radiological service could potentially shorten the hospital episode and reduce costs. - Highlights: • There are differing clinical complexities for patients depending on the modality. • A predictive risk model, incorporating advanced imaging, was devised. • Inpatients delays in radiology imaging associated with longer LOS. • Inpatients who underwent radiology imaging associated with increased hospital costs.
Friščić, M; Šantek-Zlatar, G; Žulec, M
Patients with pressure ulcers usually arrive to the Unified Emergency Admission Department (UEAD) due to other illnesses, from the family or social care institutions. After triage and treatment at UEAD, the patient is hospitalized or discharged from the hospital. The objective of this study was to examine the incidence, reasons for presenting to UEAD and further procedure that patients with pressure ulcers admitted to UEAD were subjected to. Data in the Hospital Information System on patients with pressure ulcers admitted to UEAD, Dr Tomislav Bardek General Hospital in Koprivnica in the period between January 1, 2016 and May 31, 2016 were retrospectively analyzed. The analysis included demographic data, location from which the patient arrived, triage category and further procedure the patient was subjected to. Data were analyzed by using the methods of descriptive statistics. A total of 18 patients with pressure ulcers were admitted to UEAD, 13 (72%) women and five (28%) men. Five (28%) patients were referred from social care institutions and 13 (72%) from the family. Triage category 2 included 7 (38.8%) patients, four (22%) patients were included in triage categories 3 and 4, while three (16%) patients were included in triage category 5. Ten (55.5%) patients were hospitalized, while eight (44.4%) patients were discharged from the hospital. Only one patient was admitted primarily due to pressure ulcer complications. Contrary to our assumptions, a lower number of patients were referred from social care institutions, i.e. more patients were referred from the family. These data resulted from a long lasting active training of nurses and implementation of the nurse’s discharge letter.
Nordahl, Helene; Lange, Theis; Osler, Merete
vulnerability. METHODS: In a cohort study of 76,294 participants 30 to 70 years of age, we estimated educational differences in cause-specific mortality from 1980 through 2009 and the mediating role of behavioral risk factors (smoking, alcohol intake, physical activity, and body mass index). With the use......BACKGROUND: Differential exposures to behavioral risk factors have been shown to play an important mediating role on the education-mortality relation. However, little is known about the extent to which educational attainment interacts with health behavior, possibly through differential...... of marginal structural models and three-way effect decomposition, we simultaneously regarded the behavioral risk factors as intermediates and clarified the role of their interaction with educational exposure. RESULTS: Rate differences in mortality comparing participants with low to high education were 1...
Scheike, Thomas H.; Zhang, Mei-Jie
cumulative incidence probability; cause-specific hazards; subdistribution hazard; binomial modelling......cumulative incidence probability; cause-specific hazards; subdistribution hazard; binomial modelling...
Mastour S Alghamdy
Full Text Available Background and Aim: Medication Errors can result in drug-related problems (DRPs. Insight into the frequency, type, and severity of DRPs could help reduce their incidence. The aim of the present study was to estimate the prevalence of admissions as a result of DRPs at the Emergency Department (ED of a university hospital in the Kingdom of Saudi Arabia. Materials and Methods: Files of suspected cases of DRPs reporting to ED in the year 2012 were scrutinized. Suspicion arose from the hospital record system based on Diagnosis Code Numbers (ICD-9-CM, Professional 2010 and from triggers, such as some drugs, laboratory tests, and signs and symptoms pointing to DRPs. Results: Of 5574 admissions, 253 (4.5% were DRPs and were categorized as: Overdose toxicity and side effects of drugs 50 (19.8%, drug-interactions 29 (11.5%, accidental and suicidal drug ingestions 26 (10.3%, drug abuse 18 (7.1%, drug allergy 10 (4%, super-infections 8 (3.2%, and noncompliance to treatment 112 (44.3%. About 70% of DRPs were preventable; 67 (26.5% required hospital admission for 7-102 days and 10 (4% died. Conclusions: Noncompliance to treatment, overdose toxicity, drug interactions, and drug abuse are important causes of hospital admissions as a result of DRPs. Awareness of prescribers to the problem and their education would help to prevent them and improve patient care.
Sullivan, Clair; Staib, Andrew; Eley, Rob; Griffin, Bronwyn; Cattell, Rohan; Flores, Judy; Scott, Ian
Objective The aim of the present study was to identify patient and non-patient factors associated with reduced mortality among patients admitted from the emergency department (ED) to in-patient wards in a major tertiary hospital that had previously reported a near halving in mortality in association with a doubling in National Emergency Access Target (NEAT) compliance over a 2-year period from 2012 to 2014. Methods We retrospectively analysed routinely collected data from the Emergency Department Information System (EDIS) and hospital discharge abstracts on all emergency admissions during calendar years 2011 (pre-NEAT interventions) and 2013 (post-NEAT interventions). Patients admitted to short-stay wards and then discharged home, as well as patients dying in the ED, were excluded. Patients included in the study were categorised according to age, time and day of arrival to the ED, mode of transport to the ED, emergency triage category, type of clinical presentation and major diagnostic codes. Results The in-patient mortality rate for emergency admissions decreased from 1.9% (320/17022) in 2011 to 1.2% (202/17162) in 2013 (PNEAT compliance as a result of clinical redesign is associated with improved in-patient mortality among particular subgroups of emergency admissions, namely older patients with complex medical conditions, those presenting after hours and on weekends and those presenting with time-sensitive acute cardiorespiratory conditions. What is known about the topic? Clinical redesign aimed at improving compliance with NEAT and reducing time spent within the ED of acutely admitted patients has been associated with reduced mortality. To date, no study has attempted to identify subgroups of patients who potentially derive the greatest benefit from improved NEAT compliance in terms of reduced risk of in-patient death. It also remains unclear as to what extent non-patient factors (e.g. admission practices and differences in coding of palliative care patients
Vencloviene, J.; Antanaitiene, J.; Babarskiene, R.
A number of studies have established the effects of space weather on the human cardio-vascular system. We investigated whether geomagnetic storms (GS), solar proton events (SPEs), and X-class solar flare affect the risk of emergency hospitalization for acute myocardial infarction (MI) separately during declining (2004-2006) and rising (2010-2012) phases of solar activity. The data on hospital admissions for MI were obtained from the computer database of Lithuanian University of Health sciences from January 1, 2004 to December 31, 2012. We evaluated the associations between space weather conditions and the daily number of emergency admissions for MI by Poisson regression, controlling for seasonal variation and weekdays. During 2004-2006, an increase in the risk of hospital admission for MI was observed on days of the daily mean proton >10 MeV flux >100 pfu (by 63%, p10 MeV flux >100 pfu (by 52%, p=0.015) and on days of GS and 1-2 days after GS (by 17%, p=0.024). These findings suggest that the impact of hazardous space weather conditions on human health depends of the strength of space storm during the investigated period.
Oct 3, 2013 ... Objective: There are many factors affecting the mortality of patients admitted to the intensive care unit (ICU). Among these are the patients' age, diagnosis, and concomitant pathology. The aim of this retrospective study was to investigate whether there is an adverse effect of the time between admission to ...
Staib, Andrew; Sullivan, Clair; Jones, Matt; Griffin, Bronwyn; Bell, Anthony; Scott, Ian
Patients who require emergency admission to hospital require complex care that can be fragmented, occurring in the ED, across the ED-inpatient interface (EDii) and subsequently, in their destination inpatient ward. Our hospital had poor process efficiency with slow transit times for patients requiring emergency care. ED clinicians alone were able to improve the processes and length of stay for the patients discharged directly from the ED. However, improving the efficiency of care for patients requiring emergency admission to true inpatient wards required collaboration with reluctant inpatient clinicians. The inpatient teams were uninterested in improving time-based measures of care in isolation, but they were motivated by improving patient outcomes. We developed a dashboard showing process measures such as 4 h rule compliance rate coupled with clinically important outcome measures such as inpatient mortality. The EDii dashboard helped unite both ED and inpatient teams in clinical redesign to improve both efficiencies of care and patient outcomes. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Sheringham, Jessica; Asaria, Miqdad; Barratt, Helen; Raine, Rosalind; Cookson, Richard
Objectives Reducing health inequalities is an explicit goal of England's health system. Our aim was to compare the performance of English local administrative areas in reducing socioeconomic inequality in emergency hospital admissions for ambulatory care sensitive chronic conditions. Methods We used local authority area as a stable proxy for health and long-term care administrative geography between 2004/5 and 2011/12. We linked inpatient hospital activity, deprivation, primary care, and population data to small area neighbourhoods (typical population 1500) within administrative areas (typical population 250,000). We measured absolute inequality gradients nationally and within each administrative area using neighbourhood-level linear models of the relationship between national deprivation and age-sex-adjusted emergency admission rates. We assessed local equity performance by comparing local inequality against national inequality to identify areas significantly more or less equal than expected; evaluated stability over time; and identified where equity performance was steadily improving or worsening. We then examined associations between change in socioeconomic inequalities and change in within-area deprivation (gentrification). Finally, we used administrative area-level random and fixed effects models to examine the contribution of primary care to inequalities in admissions. Results Data on 316 administrative areas were included in the analysis. Local inequalities were fairly stable between consecutive years, but 32 areas (10%) showed steadily improving or worsening equity. In the 21 improving areas, the gap between most and least deprived fell by 3.9 admissions per 1000 (six times the fall nationally) between 2004/5 and 2011/12, while in the 11 areas worsening, the gap widened by 2.4. There was no indication that measured improvements in local equity were an artefact of gentrification or that changes in primary care supply or quality contributed to changes in
Kiermeier, Andreas; Babidge, Wendy J; McCulloch, Glenn A J; Maddern, Guy J; Watters, David A; Aitken, R James
The Western Australian Audit of Surgical Mortality was established in 2002. A 10-year analysis suggested it was the primary driver in the subsequent fall in surgeon-related mortality. Between 2004 and 2010 the Royal Australasian College of Surgeons established mortality audits in other states. The aim of this study was to examine national data from the Australian Institute of Health and Welfare (AIHW) to determine if a similar fall in mortality was observed across Australia. The AIHW collects procedure and outcome data for all surgical admissions. AIHW data from 2005/2006 to 2012/2013 was used to assess changes in surgical mortality. Over the 8 years surgical admissions increased by 23%, while mortality fell by 18% and the mortality per admission fell by 33% (P audit was associated with a sharp decline in perioperative mortality. In the absence of any influences from other changes in clinical governance or new quality programmes it is probable it had a causal effect. The reduced mortality was most evident in high-risk patients. This study adds to the evidence that national audits are associated with improved outcomes. © 2017 Royal Australasian College of Surgeons.
Zhao, Desheng; Zhang, Xulai; Xu, Zhiwei; Cheng, Jian; Xie, Mingyu; Zhang, Heng; Wang, Shusi; Li, Kesheng; Yang, Huihui; Wen, Liying; Wang, Xu; Su, Hong
Diurnal temperature range (DTR) and temperature change between neighboring days (TCN) are important meteorological indicators closely associated with global climate change. However, up to date, there have been no studies addressing the impacts of both DTR and TCN on emergency hospital admissions for schizophrenia. We conducted a time-series analysis to assess the relationship between temperature variability and daily schizophrenia onset in Hefei, an inland city in southeast China. Daily meteorological data and emergency hospital admissions for schizophrenia from 2005 to 2014 in Hefei were collected. After stratifying by season of birth, Poisson generalized linear regression combined with distributed lag nonlinear model (DLNM) was used to examine the relationship between temperature variability and schizophrenia, adjusting for long-term trend and seasonality, mean temperature, and relative humidity. Our analysis revealed that extreme temperature variability may increase the risk for schizophrenia onset among patients born in spring, while no such association was found in patients born in summer and autumn. In patients born in spring, the relative risks of extremely high DTR comparing the 95th and 99th percentiles with the reference (50th, 10 °C) at 3-day lag were 1.078 (95 % confidence interval (CI) 1.025-1.135) and 1.159 (95 % CI 1.050-1.279), respectively. For TCN effects, only comparing 99th percentile with reference (50th, 0.7 °C) was significantly associated with emergency hospital admissions for schizophrenia (relative risk (RR) 1.111, 95 % CI 1.002-1.231). This study suggested that exposure to extreme temperature variability in short-term may trigger later days of schizophrenia onset for patients born in spring, which may have important implications for developing intervention strategies to prevent large temperature variability exposure.
Zhao, Desheng; Zhang, Xulai; Xu, Zhiwei; Cheng, Jian; Xie, Mingyu; Zhang, Heng; Wang, Shusi; Li, Kesheng; Yang, Huihui; Wen, Liying; Wang, Xu; Su, Hong
Diurnal temperature range (DTR) and temperature change between neighboring days (TCN) are important meteorological indicators closely associated with global climate change. However, up to date, there have been no studies addressing the impacts of both DTR and TCN on emergency hospital admissions for schizophrenia. We conducted a time-series analysis to assess the relationship between temperature variability and daily schizophrenia onset in Hefei, an inland city in southeast China. Daily meteorological data and emergency hospital admissions for schizophrenia from 2005 to 2014 in Hefei were collected. After stratifying by season of birth, Poisson generalized linear regression combined with distributed lag nonlinear model (DLNM) was used to examine the relationship between temperature variability and schizophrenia, adjusting for long-term trend and seasonality, mean temperature, and relative humidity. Our analysis revealed that extreme temperature variability may increase the risk for schizophrenia onset among patients born in spring, while no such association was found in patients born in summer and autumn. In patients born in spring, the relative risks of extremely high DTR comparing the 95th and 99th percentiles with the reference (50th, 10 °C) at 3-day lag were 1.078 (95 % confidence interval (CI) 1.025-1.135) and 1.159 (95 % CI 1.050-1.279), respectively. For TCN effects, only comparing 99th percentile with reference (50th, 0.7 °C) was significantly associated with emergency hospital admissions for schizophrenia (relative risk (RR) 1.111, 95 % CI 1.002-1.231). This study suggested that exposure to extreme temperature variability in short-term may trigger later days of schizophrenia onset for patients born in spring, which may have important implications for developing intervention strategies to prevent large temperature variability exposure.
Ma, Yuxia; Zhao, Yuxin; Yang, Sixu; Zhou, Jianding; Xin, Jinyuan; Wang, Shigong; Yang, Dandan
Ambient air pollution has been a major global public health issue. A number of studies have shown various adverse effects of ambient air pollution on cardiovascular diseases. In the current study, we investigated the short-term effects of ambient air pollution on emergency room (ER) admissions due to cardiovascular causes in Beijing from 2009 to 2012 using a time-series analysis. A total of 82430 ER cardiovascular admissions were recorded. Different gender (male and female) and age groups (15yrs ≤ age pollutant model. Three major pollutants (SO 2 , NO 2 and PM 10 ) had lag effects of 0-2 days on cardiovascular ER admissions. The relative risks (95% CI) of per 10 μg/m 3 increase in PM 10 , SO 2 and NO 2 were 1.008 (0.997-1.020), 1.008(0.999-1.018) and 1.014(1.003-1.024), respectively. The effect was more pronounced in age ≥65 and males in Beijing. We also found the stronger acute effects on the elderly and females at lag 0 than on the younger people and males at lag 2. Copyright © 2017 Elsevier Ltd. All rights reserved.
Relationships between deprivation and duration of children's emergency admissions for breathing difficulty, feverish illness and diarrhoea in North West England: an analysis of hospital episode statistics
Kyle Richard G
Full Text Available Abstract Background In the United Kingdom there has been a long term pattern of increases in children's emergency admissions and a substantial increase in short stay unplanned admissions. The emergency admission rate (EAR per thousand population for breathing difficulty, feverish illness and diarrhoea varies substantially between children living in different Primary Care Trusts (PCTs. However, there has been no examination of whether disadvantage is associated with short stay unplanned admissions at PCT-level. The aim of this study was to determine whether differences between emergency hospital admission rates for breathing difficulty, feverish illness and diarrhoea are associated with population-level measures of multiple deprivation and child well-being, and whether there is variation by length of stay and age. Methods Analysis of hospital episode statistics and secondary analysis of Index of Multiple Deprivation (IMD 2007 and Local Index of Child Well-being (CWI 2009 in ten adjacent PCTs in North West England. The outcome measure for each PCT was the emergency admission rate to hospital for breathing difficulty, feverish illness and diarrhoea. Results 23,496 children aged 0-14 were discharged following emergency admission for breathing difficulty, feverish illness and/or diarrhoea during 2006/07. The emergency admission rate ranged from 27.9 to 62.7 per thousand. There were no statistically significant relationships between shorter (0 to 3 day hospitalisations and the IMD or domains of the CWI. The rate for hospitalisations of 4 or more days was associated with the IMD (Kendall's taub = 0.64 and domains of the CWI: Environment (taub = 0.60; Crime (taub = 0.56; Material (taub = 0.51; Education (taub = 0.51; and Children in Need (taub = 0.51. This pattern was also evident in children aged under 1 year, who had the highest emergency admission rates. There were wide variations between the proportions of children discharged on the day of admission
Fuda, John R
This study determined, evaluated, and proposed ways to mitigate factors contributing to overcrowding and wait times experienced by patients admitted through the Brooke Army Medical Center Emergency Department...
Preventing and controlling methicillin-resistant Staphylococcus aureus (MRSA) includes early detection and isolation. In the emergency department (ED), such measures have to be balanced with the requirement to treat patients urgently and transfer quickly to an acute hospital bed. We assessed, in a busy and overcrowded ED, the contribution made to a patient\\'s stay by previous MRSA risk group identification and by selective rescreening of those patients who were previously documented in the research hospital as being MRSA positive. Patients with a previous diagnosis of MRSA colonisation were flagged automatically as \\'risk group\\' (RG) on their arrival in the ED and were compared with \\'non-risk group\\' (NRG), i.e. not previously demonstrated in the research hospital to be infected or colonised with MRSA. Over an 18 month period, there were 16 456 admissions via the ED, of which 985 (6%) were RG patients. The expected median times to be admitted following a request for a ward bed for NRG and RG patients were 10.4 and 12.9h, respectively. Female sex, age >65 years, and RG status all independently predicted a statistically significantly longer stay in the ED following a request for a hospital bed. We consider that national and local policies for MRSA need to balance the welfare of patients in the ED with the need to comply with best practice, when there are inadequate ED and inpatient isolation facilities. Patients with MRSA requiring emergency admission must have a bed available for them.
Grossman, Atira M; Volz, Katherine A; Shapiro, Nathan I; Salem, Roee; Sanchez, Leon D; Smulowitz, Peter; Grossman, Shamai A
In an era of increasing health care costs, the need for hospitalization is being scrutinized. In particular, 1-day hospitalizations are thought to be especially costly and unnecessary, and, increasingly, emergency department observation units (EDOUs) are being used as alternatives. Our aim was to determine the differences in outcomes and diagnoses between 1-day inpatient and EDOU stays for syncope. We retrospectively reviewed a cohort of patients with syncope who were seen in an urban ED with 1-day admission to an inpatient ward, EDOU, or full hospitalization. Etiology of syncope was classified as benign (vasovagal, dehydration), serious (dysrhythmia, sepsis, stroke/intracranial bleed, hemorrhage, valvular, ischemia, pulmonary embolism), or unknown. Data were analyzed using Fisher's exact test and t-test. One hundred and seventy-two of 351 patients were >1-day admissions, 152 (85%) were admitted for 1 day, and 27 (15%) were admitted to EDOU. The mean (standard deviation [SD]) age when admitted to the hospital was significantly higher at 72 (18.4) years for > 1-day admissions and 68.8 (19.6) years for 1-day admissions vs. 53.0 (18.9) years for EDOU patients (p syncope and 38% had serious causes of syncope; in 1-day admitted patients, 48% had benign etiologies and 14% had serious causes. Among EDOU patients, 44% had benign etiologies and none were serious. One-day patients were more likely to have unknown causes of syncope at discharge (36%; 95% confidence interval 0.28 to 0.43) when compared with admitted patients (26%; 95% CI 0.2 to 0.33); similarly, observation patients were more likely to be discharged without a diagnosis (56%; 95% CI 0.37 to 0.74; p ≤ 0.05). EDOU patients were less likely than patients admitted to the hospital to be discharged with an etiology of their syncope. Future EDOU protocols can benefit from set admission criteria and standardized evaluation protocols to facilitate maximal use of EDOU for syncope. Copyright © 2016 Elsevier Inc. All
Pinna, Giuliano; Pascale, Claudio; Fornengo, Paolo; Arras, Sebastiana; Piras, Carmela; Panzarasa, Pietro; Carmosino, Gianpaolo; Franza, Orietta; Semeraro, Vincenzo; Lenti, Salvatore; Pietrelli, Susanna; Panzone, Sergio; Bracco, Christian; Fiorini, Roberto; Rastelli, Giovanni; Bergandi, Daniela; Zampaglione, Bruno; Musso, Roberto; Marengo, Claudio; Santoro, Giancarlo; Zamboni, Sergio; Traversa, Barbara; Barattini, Maddalena; Bruno, Graziella
Epidemiological data on the impact of hypertensive crises (emergencies and urgencies) on referral to the Emergency Departments (EDs) are lacking, in spite of the evidence that they may be life-threatening conditions. We performed a multicenter study to identify all patients aged 18 years and over who were admitted to 10 Italian EDs during 2009 for hypertensive crises (systolic blood pressure ≥220 mmHg and/or diastolic blood pressure ≥120 mmHg). We classified patients as affected by either hypertensive emergencies or hypertensive urgencies depending on the presence or the absence of progressive target organ damage, respectively. Logistic regression analysis was then performed to assess variables independently associated with hypertensive emergencies with respect to hypertensive urgencies. Of 333,407 patients admitted to the EDs over the one-year period, 1,546 had hypertensive crises (4.6/1,000, 95% CI 4.4-4.9), and 23% of them had unknown hypertension. Hypertensive emergencies (n = 391, 25.3% of hypertensive crises) were acute pulmonary edema (30.9%), stroke (22.0%,), myocardial infarction (17.9%), acute aortic dissection (7.9%), acute renal failure (5.9%) and hypertensive encephalopathy (4.9%). Men had higher frequency than women of unknown hypertension (27.9% vs 18.5%, phypertensive patients, a larger proportion of men than women reported not taking anti-hypertensive drug (12.6% among men and 9.4% among women (phypertensive emergencies than urgencies (OR = 1.34, 95% CI 1.06-1.70), independently of presenting symptoms, creatinine, smoking habit and known hypertension. This study shows that hypertensive crises involved almost 5 out of 1,000 patients-year admitted to EDs. Sex differences in frequencies of unknown hypertension, compliance to treatment and risk of hypertensive emergencies might have implications for public health programs.
Fuentes, Eva; Shields, Jean-Francois; Chirumamilla, Nandan; Martinez, Myriam; Kaafarani, Haytham; Yeh, Daniel Dante; White, Benjamin; Filbin, Michael; DePesa, Christopher; Velmahos, George; Lee, Jarone
Emergency department (ED) overcrowding remains a significant problem in many hospitals, and results in multiple negative effects on patient care outcomes and operational metrics. We sought to test whether implementing a quality improvement project could decrease ED LOS for trauma patients requiring an ICU admission from the ED, specifically by directly admitting critically ill trauma patients from the ED CT scanner to an ICU bed. This was a retrospective study comparing patients during the intervention period (2013-2014) to historical controls (2011-2013). Critically ill trauma patients requiring a CT scan, but not the operating room (OR) or Interventional Radiology (IR), were directly admitted from the CT scanner to the ICU, termed the "One-way street (OWS)". Controls from the 2011-2013 Trauma Registry were matched 1:1 based on the following criteria: Injury Severity Score; mechanism of injury; and age. Only patients who required emergent trauma consult were included. Our primary outcome was ED LOS, defined in minutes. Our secondary outcomes were ICU LOS, hospital LOS and mortality. Paired t test or Wilcoxon signed rank test were used for continuous univariate analysis and Chi square for categorical variables. Logistic regression and linear regressions were used for categorical and continuous multivariable analysis, respectively. 110 patients were enrolled in this study, with 55 in the OWS group and 55 matched controls. Matched controls had lower APACHE II score (12 vs. 15, p = 0.03) and a higher GCS (14 vs. 6, p = 0.04). ED LOS was 229 min shorter in the OWS group (82 vs. 311 min, p < 0.0001). The time between CT performed and ICU disposition decreased by 230 min in the OWS arm (30 vs. 300 min, p < 0.001). There was no difference in ED arrival to CT time between groups. Following multivariable analysis, mortality was primarily predicted by the APACHE II score (OR 1.29, p < 0.001), and not ISS, mechanism of injury, or age. After controlling for APACHE
Tramuto, Fabio; Cusimano, Rosanna; Cerame, Giuseppe; Vultaggio, Marcello; Calamusa, Giuseppe; Maida, Carmelo M; Vitale, Francesco
Air pollution from vehicular traffic has been associated with respiratory diseases. In Palermo, the largest metropolitan area in Sicily, urban air pollution is mainly addressed to traffic-related pollution because of lack of industrial settlements, and the presence of a temperate climate that contribute to the limited use of domestic heating plants. This study aimed to investigate the association between traffic-related air pollution and emergency room admissions for acute respiratory symptoms. From January 2004 through December 2007, air pollutant concentrations and emergency room visits were collected for a case-crossover study conducted in Palermo, Sicily. Risk estimates of short-term exposures to particulate matter and gaseous ambient pollutants including carbon monoxide, nitrogen dioxide, and sulfur dioxide were calculated by using a conditional logistic regression analysis. Emergency departments provided data on 48,519 visits for respiratory symptoms. Adjusted case-crossover analyses revealed stronger effects in the warm season for the most part of the pollutants considered, with a positive association for PM10 (odds ratio = 1.039, 95% confidence interval: 1.020 - 1.059), SO2 (OR = 1.068, 95% CI: 1.014 - 1.126), nitrogen dioxide (NO2: OR = 1.043, 95% CI: 1.021 - 1.065), and CO (OR = 1.128, 95% CI: 1.074 - 1.184), especially among females (according to an increase of 10 μg/m3 in PM10, NO2, SO2, and 1 mg/m3 in CO exposure). A positive association was observed either in warm or in cold season only for PM10. Our findings suggest that, in our setting, exposure to ambient levels of air pollution is an important determinant of emergency room (ER) visits for acute respiratory symptoms, particularly during the warm season. ER admittance may be considered a good proxy to evaluate the adverse effects of air pollution on respiratory health.
Full Text Available Abstract Background Air pollution from vehicular traffic has been associated with respiratory diseases. In Palermo, the largest metropolitan area in Sicily, urban air pollution is mainly addressed to traffic-related pollution because of lack of industrial settlements, and the presence of a temperate climate that contribute to the limited use of domestic heating plants. This study aimed to investigate the association between traffic-related air pollution and emergency room admissions for acute respiratory symptoms. Methods From January 2004 through December 2007, air pollutant concentrations and emergency room visits were collected for a case-crossover study conducted in Palermo, Sicily. Risk estimates of short-term exposures to particulate matter and gaseous ambient pollutants including carbon monoxide, nitrogen dioxide, and sulfur dioxide were calculated by using a conditional logistic regression analysis. Results Emergency departments provided data on 48,519 visits for respiratory symptoms. Adjusted case-crossover analyses revealed stronger effects in the warm season for the most part of the pollutants considered, with a positive association for PM10 (odds ratio = 1.039, 95% confidence interval: 1.020 - 1.059, SO2 (OR = 1.068, 95% CI: 1.014 - 1.126, nitrogen dioxide (NO2: OR = 1.043, 95% CI: 1.021 - 1.065, and CO (OR = 1.128, 95% CI: 1.074 - 1.184, especially among females (according to an increase of 10 μg/m3 in PM10, NO2, SO2, and 1 mg/m3 in CO exposure. A positive association was observed either in warm or in cold season only for PM10. Conclusions Our findings suggest that, in our setting, exposure to ambient levels of air pollution is an important determinant of emergency room (ER visits for acute respiratory symptoms, particularly during the warm season. ER admittance may be considered a good proxy to evaluate the adverse effects of air pollution on respiratory health.
Thyssen, Jacob P; Skov, Lone; Egeberg, Alexander
BACKGROUND: Adult atopic dermatitis (AD) has been associated with several co-morbidities, but cause-specific mortality risk is unknown. OBJECTIVES: To examine cause-specific death rates and risk in adults with AD. METHODS: We performed cross-linkage of nationwide health care and cause of death re...
Mackelprang, Jessica L; Qiu, Qian; Rivara, Frederick P
Individuals under age 25 years are estimated to comprise one third of the homeless population nationally. Understanding the reasons for utilization of hospitals by homeless youth is important for optimizing disposition planning. Objectives of the present study were to: (1) report prevalence of emergency department (ED) and inpatient admissions among homeless and unstably housed youth; (2) describe demographic characteristics of those youth who seek hospital care; (3) describe their patterns of injury, illness, psychiatric, and substance use conditions; and (4) identify demographic and diagnostic predictors of ED visit or hospital readmission. Retrospective cohort study of 15-25-year-olds (N=402) who were admitted to the ED or inpatient floors of 2 urban teaching hospitals in King County, WA between July 1, 2009 and June 30, 2012 and whose address was "homeless" or "none" or a homeless shelter or service agency (ie, homeless or unstably housed), during any recorded encounter between July 1, 2009 and June 30, 2012. A total of 1151 ED visits and 227 inpatient admissions were documented. Fifty percent of patients had an ED visit or hospital readmission within 1 year, with 43.1% receiving care within 30 days of discharge. Cox regression showed that female individuals with an injury diagnosis (hazard ratio=1.74, 95% confidence interval=1.06, 2.85) and male individuals with an acute medical condition (hazard ratio=1.59, 95% confidence interval=1.09, 2.32) at index visit were more likely to have an ED visit or hospital readmission during the following year, as were patients who provided a private address at their index visit. Homeless young people who seek hospital care demonstrate a high rate of ED visits and hospital readmissions, with unique predictors of utilization associated with sex and housing status. Additional research is necessary to determine how best to transition these young people from hospital-based to community-based care.
Full Text Available OBJECTIVE: We investigated the association between a child's birth order and emergency room (ER visits and hospital admissions following 2-,4-,6- and 12-month pediatric vaccinations. METHODS: We included all children born in Ontario between April 1(st, 2006 and March 31(st, 2009 who received a qualifying vaccination. We identified vaccinations, ER visits and admissions using health administrative data housed at the Institute for Clinical Evaluative Sciences. We used the self-controlled case series design to compare the relative incidence (RI of events among 1(st-born and later-born children using relative incidence ratios (RIR. RESULTS: For the 2-month vaccination, the RIR for 1(st-borns versus later-born children was 1.37 (95% CI: 1.19-1.57, which translates to 112 additional events/100,000 vaccinated. For the 4-month vaccination, the RIR for 1(st-borns vs. later-borns was 1.70 (95% CI: 1.45-1.99, representing 157 additional events/100,000 vaccinated. At 6 months, the RIR for 1(st vs. later-borns was 1.27 (95% CI: 1.09-1.48, or 77 excess events/100,000 vaccinated. At the 12-month vaccination, the RIR was 1.11 (95% CI: 1.02-1.21, or 249 excess events/100,000 vaccinated. CONCLUSIONS: Birth order is associated with increased incidence of ER visits and hospitalizations following vaccination in infancy. 1(st-born children had significantly higher relative incidence of events compared to later-born children.
Kılıç Öztürk, Yasemin; Düzenli, Erhan; Karaali, Cem; Öztürk, Faruk
Physical violence is defined as deliberate use of physical force likely to result in trauma, bodily injury, pain, or impairment. Present study is pioneering effort to evaluate mechanisms and sociodemographic features of physical violence targeting the elderly in Turkey and to investigate preventive measures. Database records and forensic reports were analyzed in this retrospective study of 54 elderly patients with trauma as result of physical violence who were admitted to emergency department of Şanlıurfa Training and Research Hospital between January 2012 and July 2013. Of the 54 patients evaluated, 50 (92.4%) were male. History of experiencing previous violence was described by 55.6% (n=30) of the patients. Instances of repeat violence and firearm injuries most often occurred in the home (p=0.006, p=0.007). Need for surgical treatment was also greater among cases that occurred in the home (p=0.016). Firearm injury, recurrent violence, and surgical treatment rates were higher among cases that occurred in the home. Urgent preventive measures are especially needed for the elderly who have already been victims of physical violence.
Lucini, Filipe R; S Fogliatto, Flavio; C da Silveira, Giovani J; L Neyeloff, Jeruza; Anzanello, Michel J; de S Kuchenbecker, Ricardo; D Schaan, Beatriz
Emergency department (ED) overcrowding is a serious issue for hospitals. Early information on short-term inward bed demand from patients receiving care at the ED may reduce the overcrowding problem, and optimize the use of hospital resources. In this study, we use text mining methods to process data from early ED patient records using the SOAP framework, and predict future hospitalizations and discharges. We try different approaches for pre-processing of text records and to predict hospitalization. Sets-of-words are obtained via binary representation, term frequency, and term frequency-inverse document frequency. Unigrams, bigrams and trigrams are tested for feature formation. Feature selection is based on χ 2 and F-score metrics. In the prediction module, eight text mining methods are tested: Decision Tree, Random Forest, Extremely Randomized Tree, AdaBoost, Logistic Regression, Multinomial Naïve Bayes, Support Vector Machine (Kernel linear) and Nu-Support Vector Machine (Kernel linear). Prediction performance is evaluated by F1-scores. Precision and Recall values are also informed for all text mining methods tested. Nu-Support Vector Machine was the text mining method with the best overall performance. Its average F1-score in predicting hospitalization was 77.70%, with a standard deviation (SD) of 0.66%. The method could be used to manage daily routines in EDs such as capacity planning and resource allocation. Text mining could provide valuable information and facilitate decision-making by inward bed management teams. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.
Foks, Kelly A.; Cnossen, Maryse C.; Dippel, Diederik W. J.; Maas, Andrew I. R.; Menon, David; van der Naalt, Joukje; Steyerberg, Ewout W.; Lingsma, Hester F.; Polinder, Suzanne
Previous studies have indicated that there is no consensus about management of mild traumatic brain injury (mTBI) at the emergency department (ED) and during hospital admission. We aim to study variability between management policies for TBI patients at the ED and at the hospital ward across Europe.
Monahan, Caitriona; Coleman, Mathew
Despite research showing higher use of amphetamine-type stimulants (ATS) in rural areas, limited research has examined the epidemiology of ATS-related presentations and admissions to remote regional centres. To determine the epidemiology of ATS-related (a) Emergency Department (ED) presentations and (b) inpatient admissions over a five-year period at the Hedland Health Campus (HHC) in remote Western Australia. A retrospective review of medical records was conducted. Demographic data including gender, age and indigenous status were captured. Four hundred and eighty-two ATS-related hospital presentations were identified during the study period. The most common reason for ED presentation was mental and behavioural problems. Of those presenting, 66% were male and 69% identified as Aboriginal. ATS-related ED presentations increased seven-fold over the study period. Ninety-nine ATS-related inpatient admissions were identified during the study period. Psychotic disorder was the most common reason for admission. Males made up 75% of admissions and 53% identified as Aboriginal. This study showed a disproportionally high burden of ATS-related harm among Aboriginal people. The number of ATS-related ED presentations and inpatient admissions increased significantly over the study period.
Wang, Min-zhen; Zheng, Shan; He, Shi-lin; Li, Bei; Teng, Huai-jin; Wang, Shi-gong; Yin, Ling; Shang, Ke-zheng; Li, Tan-shi
To evaluate the short-term effect of diurnal temperature range (DTR) on emergency room (ER) admissions among elderly adults in Beijing. After controlling the long-time and seasonal trend, weather, air pollution and other confounding factors, a semi-parametric generalized additive model (GAM) was used to analyze the exposure-effect relationship between DTR and daily ER admissions among elderly adults with different lag structures from 2009 to 2011 in Beijing. We examined the effects of DTR for stratified groups by age and gender, and conducted the modifying effect of season on DTR to test the possible interaction. Significant associations were found between DTR and four major causes of daily ER admissions among elderly adults in Beijing. A 1 °C increase in the 8-day moving average of DTR (lag 07) corresponded to an increase of 2.08% (95% CI: 0.88%-3.29%) in respiratory ER admissions and 2.14% (95% CI: 0.71%-3.59%) in digestive ER admissions. A 1 °C increase in the 3-day and 6-day moving average of DTR (lag 02 and lag 05) corresponded to a 0.76% (95% CI: 0.07%-1.46%) increase in cardiovascular ER admissions, and 1.81% (95% CI: 0.21%-3.45%) increase in genitourinary ER admissions, respectively. The people aged 75 years and older were associated more strongly with DTR than the 65-74 age group. The modifying effect of season on DTR was observed and it was various in four causes. This study strengthens the evidence that DTR is an independent risk factor for ER admissions among elderly persons. Some prevention programs that target the elderly and other high risk subgroups for impending large temperature changes may reduce the impact of DTR on people's health. Copyright © 2013 Elsevier B.V. All rights reserved.
Skaaby, Tea; Husemoen, Lise Lotte Nystrup; Pisinger, Charlotta
Vitamin D deficiency is associated with an increased risk of all-cause mortality in observational studies. The specific causes of death underlying this association lack clarity. We investigated the association between vitamin D status and cause-specific mortality....
McLean, Ross C; McCallum, Iain J D; Dixon, Steve; O'Loughlin, Paul
Life expectancies in the UK are increasing and with this there is an increasing elderly population with more complex co-morbidity. Emergency surgery in the elderly is challenging in terms of decision making, managing co-morbidity and post-operative rehabilitation with high morbidity and mortality. To optimise service design and development, it is important to understand the changing pattern of emergency surgical care for this group. After obtaining necessary approvals, we approached each hospital trust in the North of England for details of every emergency admission under a general surgeon from 2000 to 2014. Data for each admission included demographics, co-morbidities, diagnoses, procedures undertaken and outcomes. There were 105 002 elderly (≥70 years) emergency general surgical admissions, and mean age and co-morbidity (defined by Charlson index scores) increased (both p emergency general surgery in the elderly is becoming more complex. This challenge is already being addressed with improvements in outcomes. The data presented here reinforces the need for new models of care with increased multidisciplinary geriatric care input into elderly surgical patient care in the perioperative period. Copyright © 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.
Fone, David; Gartner, Andrea; Bellis, Mark A
Objectives To investigate the risk of emergency hospital admissions for violence (EHAV) associated with demographic and socioeconomic factors in Wales between 2007/2008 and 2013/2014, and to describe the site of injury causing admission. Design Database analysis of 7 years’ hospital admissions using the Patient Episode Database for Wales (PEDW). Setting and participants Wales, UK, successive annual populations ∼2.8 million aged 0–74 years. Primary outcome The first emergency admission for violence in each year of the study, defined by the International Classification of Diseases V.10 (ICD-10) codes for assaults (X85-X99, Y00-Y09) in any coding position. Results A total of 11 033 admissions for assault. The majority of admissions resulted from head injuries. The overall crude admission rate declined over the study period, from 69.9 per 100 000 to 43.2 per 100 000, with the largest decrease in the most deprived quintile of deprivation. A generalised linear count model with a negative binomial log link, adjusted for year, age group, gender, deprivation quintile and settlement type, showed the relative risk was highest in age group 18–19 years (RR=6.75, 95% CI 5.88 to 7.75) compared with the reference category aged 10–14 years. The risk decreased with age after 25 years. Risk of admission was substantially higher in males (RR=4.55, 95% CI 4.31 to 4.81), for residents of the most deprived areas of Wales (RR=3.60, 95% CI 3.32 to 3.90) compared with the least deprived, and higher in cities (RR=1.37, 95% CI 1.27 to 1.49) and towns (RR=1.32, 95% CI 1.21 to 1.45) compared with villages. Conclusions Despite identifying a narrowing in the gap between prevalence of violence in richer and poorer communities, violence remains strongly associated with young men living in areas of socioeconomic deprivation. There is potential for a greater reduction, given that violence is mostly preventable. Recommendations for reducing inequalities in the risk of
Bosede F. Rotimi
Full Text Available Objectives: This study aims to investigate the types and indications of amulets, bands and traditional applications among pediatric emergencies and neonatal admissions into the Federal Medical Centre, Bida, Nigeria.Methods: This was a cross-sectional study conducted between January and July, 2008. Children admitted into the emergency and neonatal units of the institution with traditional applications were recruited. Information on demography, time the application was introduced, the reason, cost implication and belief about the efficacy were obtained using a semi-structured questionnaire. Socio-Economic Class was defined using the Oyedeji Classification.Results: The study was based at Federal Medical Centre, Bida and consisted of 666 children admitted into the hospital via the Emergency pediatric and the Neonatal Unit, with a seven-month period prevalence of 11.4�0(76 patients. Of the 76 cases screened for the use traditional applications, only 64 (84.2�20were recruited, the remaining did not agree to participate in the study. The mean age was 493.1±528.5 days. The study group included 37 males and 27 females (sex ratio 1.4:1 aged 11 days to 2920 days. The applications used included neck band (54.7� ankle band (15.6�20and head paste (15.6� Reasons for the applications included prevention of childhood illnesses (17.2� sutures closure (15.6� as well as warding off evil spirits and convulsions (12.5� The socio-economic classification was I (1.6� II (7.8� III (15.6� IV (45.3� and V (29.7� Sixty (93.0�20parents believed the applications cannot be used with conventional medicine, while 53.1�0of the participants, obtained them free of charge.Conclusion: The use of traditional applications, often for preventive purposes, is common among pediatric patients, especially of low socio-economic classifications. The majority of users considered them incompatible with simultaneous conventional medical care. This has adverse
... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Admissible evidence. 68.9 Section 68.9 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF... admissible. (b) Documentary and oral evidence shall be admissible. (c) Admissibility of non-expert testimony...
Fung, Russell; Hyde, Jensen Hart; Davis, Mike
The process of admitting patients from the emergency department (ED) to an academic internal medicine (AIM) service in a community teaching hospital is one fraught with variability and disorder. This results in an inconsistent volume of patients admitted to academic versus private hospitalist services and results in frustration of both ED and AIM clinicians. We postulated that implementation of a mobile application (app) would improve provider satisfaction and increase admissions to the academic service. The app was designed and implemented to be easily accessible to ED physicians, regularly updated by academic residents on call, and a real-time source of the number of open AIM admission spots. We found a significant improvement in ED and AIM provider satisfaction with the admission process. There was also a significant increase in admissions to the AIM service after implementation of the app. We submit that the implementation of a mobile app is a viable, cost-efficient, and effective method to streamline the admission process from the ED to AIM services at community-based hospitals.
Swenne, Ingemar; Ros, Helena Salonen
This study examined predictors of emergency hospitalisation of adolescent girls with restrictive eating disorders and weight loss treated by a family-based intervention programme. We studied 339 girls aged 10-17 years treated in a specialist unit at Uppsala University Children's Hospital, Sweden, from August 2010 to December 2015. Historical weight data were obtained from school health services, and other weight data were determined at presentation. Weight controlling behaviour was recorded, and patients were evaluated using the Eating Disorder Examination Questionnaire. A family-based intervention started after assessment and the early weight gain after one week, one month and three months was assessed. There were 17 emergency admissions of 15 patients for refusing food, progressive weight loss and medical instability. Logistic regression analysis showed that emergency admissions were predicted by a low body mass index standard deviation score at presentation (odds ratio 2.57), a high rate of weight loss before presentation (odds ratio 4.38) and a low rate of weight gain at the start of treatment (odds ratio 4.59). Poor weight gain at the start of a family-based intervention for adolescent girls with restrictive eating disorders predicted emergency hospital admission. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
Hjortshøj, Cristel M Sørensen; Kempny, Aleksander; Jensen, Annette Schophuus
Aims: Eisenmenger syndrome (ES) is associated with considerable morbidity and mortality. Therapeutic strategies have changed during the 2000s in conjunction with an emphasis on specialist follow-up. The aim of this study was to determine the cause-specific mortality in ES and evaluate any relevant...... changes between 1977 and 2015. Methods and results: This is a retrospective, descriptive multicentre study. A total of 1546 patients (mean age 38.7 ± 15.4 years; 36% male) from 13 countries were included. Cause-specific mortality was examined before and after July 2006, 'early' and 'late', respectively....... Over a median follow-up of 6.1 years (interquartile range 2.1-21.5 years) 558 deaths were recorded; cause-specific mortality was identified in 411 (74%) cases. Leading causes of death were heart failure (34%), infection (26%), sudden cardiac death (10%), thromboembolism (8%), haemorrhage (7%), and peri...
Powell-Bowns, M; Wilson, M S J; Mustafa, A
To determine whether pregnancy status, gynaecological history, date of last menstrual period and contraceptive use are documented in emergency female admissions of reproductive age admitted to general surgery. This is a retrospective study. This study was conducted in the United Kingdom. Females of reproductive age (12-50 years) admitted as an emergency to general surgery with abdominal pain were considered in this study. Retrospective analysis of medical notes of emergency female admissions with abdominal pain between January and September 2012. We recorded whether a pregnancy test result was documented (cycle 1). Results were analysed and a prompt added to the medical clerk-in document. We re-audited (cycle 2) between January and June 2013 looking for improvement. Documented pregnancy status within 24 h of admission and prior to any surgical intervention. 100 case notes were reviewed in stage 1. 30 patients (30 %) had a documented pregnancy status. 32 (32 %), 25 (25 %) and 29 (29 %) had a documented gynaecology history, contraceptive use and date of last menstrual period (LMP), respectively. 24 patients underwent emergency surgery, 6 (25 %) had a documented pregnancy status prior to surgery. Of 50 patients reviewed in stage 2, 37 (75.0 %) had a documented pregnancy status (p surgical admission document has significantly improved the documentation of pregnancy status and gynaecological history in our female patients, particularly in those who require surgical intervention. A number of patient safety concerns were addressed locally, but require a coordinated, interdisciplinary discussion and a national guideline. A minimum standard of care, in females of reproductive age, should include mandatory objective documentation of pregnancy status, whether or not they require surgical intervention.
Wallace, Emma; McDowell, Ronald; Bennett, Kathleen; Fahey, Tom; Smith, Susan M
Background Prospective external validation of the Vulnerable Elder?s Survey (VES-13) in primary care remains limited. The aim of this study is to externally validate the VES-13 in predicting mortality and emergency admission in older community-dwelling adults. Methods Design: Prospective cohort study with 2 years follow-up (2010?2012). Setting: 15 General Practices (GPs) in the Republic of Ireland. Participants: n?=?862, aged ?70?years, community-dwellers Exposure: VES-13 calculated at baseli...
Thyssen, Jacob P; Skov, Lone; Egeberg, Alexander
Adult atopic dermatitis (AD) has been associated with several comorbidities, but cause-specific mortality risk is unknown. To examine cause-specific death rates and risk in adults with AD. We performed cross-linkage of nationwide health care and cause of death registers. Adult patients with AD were matched with 10 controls per study subject. We calculated incidence rates per 1000 person-years and hazard ratios (HRs) of cause-specific death with 95% confidence intervals (95% CIs) using Cox proportional hazards models. A total of 8686 patients and 86,860 matched controls were studied. The risk for death due to any cause was significantly increased in patients with AD (HR 1.27, 95%CI 1.11-1.45). Significant causes included cardiovascular (HR 1.45; 95% CI 1.07-1.96), infectious (HR 3.71; 95% CI 1.43-9.60), and urogenital diseases (HR 5.51; 95% CI 1.54-19.80). No increased risk for death due to cancer, endocrine, neurologic, psychiatric, respiratory, or gastroenterologic disease was observed. The results might not be generalizable to patients seen exclusively by primary care physicians. Adults with atopic dermatitis had slightly increased risk for death during follow-up. While the risk for death from cardiovascular, urogenital, and infectious diseases was slightly elevated among patients with AD, the absolute risk was very low. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.
Hjortshøj, Cristel M Sørensen; Kempny, Aleksander; Jensen, Annette Schophuus; Sørensen, Keld; Nagy, Edit; Dellborg, Mikael; Johansson, Bengt; Rudiene, Virginija; Hong, Gu; Opotowsky, Alexander R; Budts, Werner; Mulder, Barbara J; Tomkiewicz-Pajak, Lidia; D'Alto, Michele; Prokšelj, Katja; Diller, Gerhard-Paul; Dimopoulos, Konstantinos; Estensen, Mette-Elise; Holmstrøm, Henrik; Turanlahti, Maila; Thilén, Ulf; Gatzoulis, Michael A; Søndergaard, Lars
Eisenmenger syndrome (ES) is associated with considerable morbidity and mortality. Therapeutic strategies have changed during the 2000s in conjunction with an emphasis on specialist follow-up. The aim of this study was to determine the cause-specific mortality in ES and evaluate any relevant changes between 1977 and 2015. This is a retrospective, descriptive multicentre study. A total of 1546 patients (mean age 38.7 ± 15.4 years; 36% male) from 13 countries were included. Cause-specific mortality was examined before and after July 2006, 'early' and 'late', respectively. Over a median follow-up of 6.1 years (interquartile range 2.1-21.5 years) 558 deaths were recorded; cause-specific mortality was identified in 411 (74%) cases. Leading causes of death were heart failure (34%), infection (26%), sudden cardiac death (10%), thromboembolism (8%), haemorrhage (7%), and peri-procedural (7%). Heart failure deaths increased in the 'late' relative to the 'early' era (P = 0.032), whereas death from thromboembolic events and death in relation to cardiac and non-cardiac procedures decreased (P = 0.014, P = 0.014, P = 0.004, respectively). There was an increase in longevity in the 'late' vs. 'early' era (median survival 52.3 vs. 35.2 years, P cause mortality including cardiac remains high. Patients from the 'late' era, however, die later and from chronic rather than acute cardiac causes, primarily heart failure, whereas peri-procedural and deaths due to haemoptysis have become less common. Lifelong vigilance in tertiary centres and further research for ES are clearly needed. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: email@example.com.
Andersen, Per Kragh; Canudas-Romo, Vladimir; Keiding, Niels
Background: A new measure of the number of life years lost due to specific causes of death is introduced. Methods: This measure is based on the cumulative incidence of death, it does not require "independence" of causes, and it satisfies simple balance equations: "total number of life years lost...... = sum of cause-specific life years lost", and "total number of life years lost before age x + temporary life expectancy between birth and age x = x". Results: The measure is contrasted to alternatives suggested in the demographic literature and all methods are illustrated using Danish and Russian...
Khamutian, Razieh; Najafi, Farid; Soltanian, Mohammad; Shokoohizadeh, Mohamad Javad; Poorhaghighat, Saeedeh; Dargahi, Abdollah; Sharafi, Kiomars; Afshari, Alireza
Industrialization and urbanization had a devastating impact on public health and caused an increase in health related morbidity and mortality. In fact, asthma is a chronic condition which is considered as one of the significant challenges of public health. In this study, we investigated the association of air pollution and weather conditions with excess emergency ward admissions of asthmatic patients in Kermanshah hospitals. This was an ecological study. The total number of hospital admissions to emergency wards from all related and major hospitals of Kermanshah was collected from September 2008 through August 2009. In addition, data on air pollution as well as meteorological data were collected from the Environmental Protection Agency and Meteorological Organization of Kermanshah. To determine the association between the number of hospitalization due to asthma with those parameters, Poisson regression was used. The results of Poisson regression revealed a significant association between carbon monoxide, ozone, nitrogen dioxide and temperature with emergency room visits due to asthma in Kermanshah. No associations were found for sulfur dioxide or for particulate matter. This study provides further evidence for the significant effect of monoxide carbon on asthma; and it suggests that temperature may have a role in the exacerbation of asthma. However, due to the multi-factorial nature of asthma, other factors also play a major role in the development and exacerbation of this illness.
Full Text Available Cancer survival estimation is an important part of assessing the overall strength of cancer care in a region. Generally, the death of a patient is taken as the end point in estimation of overall survival. When calculating the overall survival, the cause of death is not taken into account. With increasing demand for better survival of cancer patients it is important for clinicians and researchers to know about survival statistics due to disease of interest, i.e. net survival. It is also important to choose the best method for estimating net survival. Increase in the use of computer programmes has made it possible to carry out statistical analysis without guidance from a bio-statistician. This is of prime importance in third- world countries as there are a few trained bio-statisticians to guide clinicians and researchers. The present communication describes current methods used to estimate net survival such as cause-specific survival and relative survival. The limitation of estimation of cause-specific survival particularly in India and the usefulness of relative survival are discussed. The various sources for estimating cancer survival are also discussed. As survival-estimates are to be projected on to the population at large, it becomes important to measure the variation of the estimates, and thus confidence intervals are used. Rothman′s confidence interval gives the most satisfactory result for survival estimate.
Kim, Eric S; Hagan, Kaitlin A; Grodstein, Francine; DeMeo, Dawn L; De Vivo, Immaculata; Kubzansky, Laura D
Growing evidence has linked positive psychological attributes like optimism to a lower risk of poor health outcomes, especially cardiovascular disease. It has been demonstrated in randomized trials that optimism can be learned. If associations between optimism and broader health outcomes are established, it may lead to novel interventions that improve public health and longevity. In the present study, we evaluated the association between optimism and cause-specific mortality in women after considering the role of potential confounding (sociodemographic characteristics, depression) and intermediary (health behaviors, health conditions) variables. We used prospective data from the Nurses' Health Study (n = 70,021). Dispositional optimism was measured in 2004; all-cause and cause-specific mortality rates were assessed from 2006 to 2012. Using Cox proportional hazard models, we found that a higher degree of optimism was associated with a lower mortality risk. After adjustment for sociodemographic confounders, compared with women in the lowest quartile of optimism, women in the highest quartile had a hazard ratio of 0.71 (95% confidence interval: 0.66, 0.76) for all-cause mortality. Adding health behaviors, health conditions, and depression attenuated but did not eliminate the associations (hazard ratio = 0.91, 95% confidence interval: 0.85, 0.97). Associations were maintained for various causes of death, including cancer, heart disease, stroke, respiratory disease, and infection. Given that optimism was associated with numerous causes of mortality, it may provide a valuable target for new research on strategies to improve health. © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Bion, Julian; Aldridge, Cassie P; Girling, Alan; Rudge, Gavin; Beet, Chris; Evans, Tim; Temple, R Mark; Roseveare, Chris; Clancy, Mike; Boyal, Amunpreet; Tarrant, Carolyn; Sutton, Elizabeth; Sun, Jianxia; Rees, Peter; Mannion, Russell; Chen, Yen-Fu; Watson, Samuel Ian; Lilford, Richard
The mortality associated with weekend admission to hospital (the 'weekend effect') has for many years been attributed to deficiencies in quality of hospital care, often assumed to be due to suboptimal senior medical staffing at weekends. This protocol describes a case note review to determine whether there are differences in care quality for emergency admissions (EAs) to hospital at weekends compared with weekdays, and whether the difference has reduced over time as health policies have changed to promote 7-day services. Cross-sectional two-epoch case record review of 20 acute hospital Trusts in England. Anonymised case records of 4000 EAs to hospital, 2000 at weekends and 2000 on weekdays, covering two epochs (financial years 2012-2013 and 2016-2017). Admissions will be randomly selected across the whole of each epoch from Trust electronic patient records. Following training, structured implicit case reviews will be conducted by consultants or senior registrars (senior residents) in acute medical specialities (60 case records per reviewer), and limited to the first 7 days following hospital admission. The co-primary outcomes are the weekend:weekday admission ratio of errors per case record, and a global assessment of care quality on a Likert scale. Error rates will be analysed using mixed effects logistic regression models, and care quality using ordinal regression methods. Secondary outcomes include error typology, error-related adverse events and any correlation between error rates and staffing. The data will also be used to inform a parallel health economics analysis. The project has received ethics approval from the South West Wales Research Ethics Committee (REC): reference 13/WA/0372. Informed consent is not required for accessing anonymised patient case records from which patient identifiers had been removed. The findings will be disseminated through peer-reviewed publications in high-quality journals and through local High-intensity Specialist-Led Acute
Hodgson, L E; Dimitrov, B D; Roderick, P J; Venn, R; Forni, L G
Hospital-acquired acute kidney injury (HA-AKI) is associated with a high risk of mortality. Prediction models or rules may identify those most at risk of HA-AKI. This study externally validated one of the few clinical prediction rules (CPRs) derived in a general medicine cohort using clinical information and data from an acute hospitals electronic system on admission: the acute kidney injury prediction score (APS). External validation in a single UK non-specialist acute hospital (2013-2015, 12 554 episodes); four cohorts: adult medical and general surgical populations, with and without a known preadmission baseline serum creatinine (SCr). Performance assessed by discrimination using area under the receiver operating characteristic curves (AUCROC) and calibration. HA-AKI incidence within 7 days (kidney disease: improving global outcomes (KDIGO) change in SCr) was 8.1% (n=409) of medical patients with known baseline SCr, 6.6% (n=141) in those without a baseline, 4.9% (n=204) in surgical patients with baseline and 4% (n=49) in those without. Across the four cohorts AUCROC were: medical with known baseline 0.65 (95% CIs 0.62 to 0.67) and no baseline 0.71 (0.67 to 0.75), surgical with baseline 0.66 (0.62 to 0.70) and no baseline 0.68 (0.58 to 0.75). For calibration, in medicine and surgical cohorts with baseline SCr, Hosmer-Lemeshow p values were non-significant, suggesting acceptable calibration. In the medical cohort, at a cut-off of five points on the APS to predict HA-AKI, positive predictive value was 16% (13-18%) and negative predictive value 94% (93-94%). Of medical patients with HA-AKI, those with an APS ≥5 had a significantly increased risk of death (28% vs 18%, OR 1.8 (95% CI 1.1 to 2.9), p=0.015). On external validation the APS on admission shows moderate discrimination and acceptable calibration to predict HA-AKI and may be useful as a severity marker when HA-AKI occurs. Harnessing linked data from primary care may be one way to achieve more accurate
Fan, Lijun; Hou, Xiang-Yu; Zhao, Jingzhou; Sun, Jiandong; Dingle, Kaeleen; Purtill, Rhonda; Tapp, Sam; Lukin, Bill
There has been considerable publicity regarding population ageing and hospital emergency department (ED) overcrowding. Our study aims to investigate impact of one intervention piloted in Queensland Australia, the Hospital in the Nursing Home (HiNH) program, on reducing ED and hospital attendances from residential aged care facilities (RACFs). A quasi-experimental study was conducted at an intervention hospital undertaking the program and a control hospital with normal practice. Routine Queensland health information system data were extracted for analysis. Significant reductions in the number of ED presentations per 1000 RACF beds (rate ratio (95 % CI): 0.78 (0.67-0.92); p = 0.002), number of hospital admissions per 1000 RACF beds (0.62 (0.50-0.76); p Home program could be effective in reducing ED presentations and hospital admissions from RACF residents. Implementation of the program across a variety of settings is preferred to fully assess the ongoing benefits for patients and any possible cost-savings.
Bodilsen, Ann Christine; Hedegaard Klausen, Henrik; Petersen, Janne
of four physical performance measures administered at hospital admission to identify older medical patients who manifest mobility limitations 30 days after discharge. Design: Prospective cohort study of patients (≥65 years) admitted to the emergency department for acute medical illness. During the first...... included. Of those, 128 (40%) patients had mobility limitations at follow-up. Univariate analyzes showed that each of the physical performance measures was strongly associated with mobility limitations at follow-up (handgrip strength(women), OR 0.86 (0.81–0.91), handgrip strength(men), OR 0.90 (0...... medical illness, and the Charlson Comorbidity Index. Based on prespecified cut-offs the prognostic accuracy of the four measures for mobility limitation at follow-up was calculated. The sensitivity and specificity were: handgrip strength(women), 56.8 (45.8–67.3), 75.7 (66.8–83.2), handgrip strength...
Kroczek, Eduard K; Wieners, Gero; Steffen, Ingo; Lindner, Tobias; Streitparth, Florian; Hamm, Bernd; Maurer, Martin H
To evaluate the number, localisation and importance of non-traumatic incidental findings (IFs) in patients with suspected or obvious multiple trauma undergoing whole-body CT (WBCT) in a level-1 trauma centre. Between January 2009 and December 2013, a total of 2440 patients with trauma undergoing WBCT at admission to a level-1 trauma centre of a university hospital were retrospectively analysed, through imaging IFs unrelated to trauma with the radiological reports. All IFs were grouped into four categories according to their clinical relevance. Category 1: urgent treatment or further clarification needed; category 2: further examination and follow-up within 3-6 months required; category 3: findings with no immediate consequences for the treatment of the patient but of potential relevance in the future; category 4: harmless findings. Altogether, 5440 IFs in 2440 patients (1735 male, 705 female; mean age 45.1 years) were documented. In 204 patients (8.4%) urgent category 1 findings were reported, 766 patients (31.4%) had category 2 findings, 1236 patients (50.7%) had category 3 findings and 1173 patients (48.1%) had category 4 findings. Most IFs were detected in the abdomen/pelvis (42.5%). 602 (24.7%) of the patients had no IFs. WBCT scans of unrelated trauma patients demonstrate a high rate of IF. A substantial percentage (8.4%) of patients had urgent category 1IFs and a high percentage (31.4%) had category 2 IFs requiring a follow-up. This high number of patients with polytrauma undergoing WBCT, having IFs of high relevance, poses a major challenge for the level-1 trauma centre in the acute and postacute management of these patients. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Short-Term Associations between Air Pollution Concentrations and Respiratory Health-Comparing Primary Health Care Visits, Hospital Admissions, and Emergency Department Visits in a Multi-Municipality Study.
Taj, Tahir; Malmqvist, Ebba; Stroh, Emilie; Oudin Åström, Daniel; Jakobsson, Kristina; Oudin, Anna
Acute effects of air pollution on respiratory health have traditionally been investigated with data on inpatient admissions, emergency room visits, and mortality. In this study, we aim to describe the total acute effects of air pollution on health care use for respiratory symptoms (ICD10-J00-J99). This will be done by investigating primary health care (PHC) visits, inpatient admissions, and emergency room visits together in five municipalities in southern Sweden, using a case-crossover design. Between 2005 and 2010, there were 81,019 visits to primary health care, 38,217 emergency room visits, and 25,271 inpatient admissions for respiratory symptoms in the study area. There was a 1.85% increase (95% CI: 0.52 to 3.20) in the number of primary health care visits associated with a 10 µg/m³ increase in nitrogen dioxide (NO₂) levels in Malmö, but not in the other municipalities. Air pollution levels were generally not associated with emergency room visits or inpatient admissions, with one exception (in Helsingborg there was a 2.52% increase in emergency room visits for respiratory symptoms associated with a 10 µg/m³ increase in PM 10 ). In conclusion, the results give weak support for short-term effects of air pollution on health care use associated with respiratory health symptoms in the study area.
Challa, Prasanna K; Smith, Karen M; Conti, C Richard
Evaluation of chest pain accounts for millions of costly Emergency Department (ED) visits and hospital admissions annually. Of these, approximately 10-20% are myocardial infarctions (MI). Patients with chest pain whose initial electrocardiogram (ECG) is normal do not require hospital admission for evaluation and management of a possible myocardial infarction. The medical records of a consecutive cohort of 250 patients who presented to the ED with chest pain and were admitted by the ED physician to a cardiology inpatient service of an academic tertiary care medical center were reviewed. Reasons for admission to hospital was to rule out an acute coronary syndrome, specifically, myocardial infarction. The initial ECG of each patient was evaluated for abnormalities and compared with the final diagnosis. Of the 75 patients presenting with normal ECGs (normal, upright T waves and isoelectric ST segments), 1 (1.3%) was subsequently diagnosed with a myocardial infarction by Troponin I elevation alone. Of the 55 patients presenting with abnormal ECGs but no clear evidence of ischemia [i.e., left bundle branch block (LBBB), right bundle branch block (RBBB), left anterior hemiblock (LAH)], 2 (3.6%) were diagnosed with MI. Of the 48 patients presenting with abnormal ECGs questionable for ischemia (nonspecific ST and T wave changes that were not clearly ST segment elevation or depression), 7 (14.6%) were diagnosed with an MI. Of the 72 patients who presented with abnormal ECGs showing ischemia (acute ST segment elevation and/or depression), 39 (54.2%) were shown to have evidence for MI. Patients who presented with normal ECGs (category 1) were extremely low risk for acute myocardial infarction. Patients with abnormal ECGs but no evidence of definite ischemia (category 2) had a relatively low incidence of MI. Patients with abnormal ECGs questionable for ischemia (category 3) had an intermediate risk of acute myocardial infarction. The majority of patients with abnormal ECGs
RN Navigators in the emergency department at Montefiore Medical Center work with social workers to prevent unnecessary admissions. Program targets the homeless and patients with tenuous living situations. CMs work with the emergency department staff to identify patients who don't meet admission criteria but can't be safely discharged. The hospital collaborates with a local housing assistance agency which sends a van to transport appropriate patients to a shelter.
Perez, Laura; Grize, Leticia; Infanger, Denis; Künzli, Nino; Sommer, Hansjörg; Alt, Gian-Marco; Schindler, Christian
In most regions of the world, levels and constituents of the air pollution mixture have substantially changed over the last decades. To evaluate if the effects of PM10 and NO2 on daily emergency hospital admissions and mortality have changed during a ~10 year period in Switzerland; to retrospectively estimate prevention potential of different policy choices. Thirteen Poisson-regression models across Switzerland were developed using daily PM10 and NO2 levels from central monitors and accounting for several temporal and seasonal confounders. Time trends of effects were evaluated with an interaction variable. Distributed lag models with 28 days exposure window were used to retrospectively predict missed prevention potential for each region. Overall, emergency hospitalizations and mortality from any medical cause increased by 0.2% (95% Confidence Interval [95% CI]: 0.01, 0.33) and 0.2% (95% CI: -0.1, 0.6) for a 10 µg/m(3) increment of PM10, and 0.7% (95% CI: 0.1, 1.3) for NO2 and mortality. Over the study period, the association between respiratory emergencies and PM10 changed by a factor of 1.017 (95% CI: 1.001, 1.034) and by a factor of 0.977 [95% CI: 0.956, 0.998]) for respiratory mortality among the elderly for NO2. During the study period, abatement strategies targeting a 20% lower overall mean would have prevented four times more cases than abating days exceeding daily standards. During the last decade, the short term effects of PM10 and NO2 on hospitalizations and mortality in Switzerland have almost not changed. More ambitious strategies of air pollutant reduction in Switzerland would have had non negligible public health benefits. Copyright © 2015 Elsevier Inc. All rights reserved.
This paper reports a discourse analysis of the language doctors used as they talked about and engaged in patient handoffs between the emergency department (ED) and various inpatient services at one highly specialized academic tertiary teaching and referral hospital in the Midwest United States. Although interest in handoff improvement has grown considerably in recent years, progress has been hampered, perhaps in part, because of a widely used but limiting conceptual model of handoff as an information transmission. The purpose of the study reported here is to analyze the way doctors make sense of handoff interactions, including uncovering the interpretive frames they use, in order to provide empirical findings to expand conceptual models of handoff. All data reported were drawn from a two-year ethnographic study (2009-2011) and include semi-structured interviews (n = 48), non-participant observations (349 h), and recorded telephone handoff conversations (n = 48). A total of eighty-six individuals participated, including resident and attending doctors from the ED, internal medicine and surgical services, as well as hospital administrators. Findings are organized around four metaphors doctors used: sales, sports and games, packaging, and teamwork. Each metaphor, in turn, reveals an underlying interpretive frame that appears to be influenced by organizational and social structures and to shape the possibilities for action that doctors perceive. The four underlying interpretive frames are: handoff as persuasion, handoff as competition, handoff as expectation matching, and handoff as collaboration. Taken together, these interpretive frames highlight the complex, socially interactive nature of handoff and provide an empirical basis for grounding and enriching the conceptual model of handoff that guides research and practice improvement efforts. Copyright © 2013 Elsevier Ltd. All rights reserved.
Hategekimana, Celestin; Shoveller, Jeannie; Tuyisenge, Lisine; Kenyon, Cynthia; Cechetto, David F; Lynd, Larry D
The Emergency, Triage, Assessment and Treatment plus Admission care (ETAT+) course, a comprehensive advanced pediatric life support course, was introduced in Rwanda in 2010 to facilitate the achievement of the fourth Millennium Development Goal. The impact of the course on improving healthcare workers (HCWs) knowledge and practical skills related to providing emergency care to severely ill newborns and children in Rwanda has not been studied. To evaluate the impact of the ETAT+ course on HCWs knowledge and practical skills, and to identify factors associated with greater improvement in knowledge and skills. We used a one group, pre-post test study using data collected during ETAT+ course implementation from 2010 to 2013. The paired t-test was used to assess the effect of ETAT+ course on knowledge improvement in participating HCWs. Mixed effects linear and logistic regression models were fitted to explore factors associated with HCWs performance in ETAT+ course knowledge and practical skills assessments, while accounting for clustering of HCWs in hospitals. 374 HCWs were included in the analysis. On average, knowledge scores improved by 22.8/100 (95% confidence interval (CI) 20.5, 25.1). In adjusted models, bilingual (French & English) participants had a greater improvement in knowledge 7.3 (95% CI 4.3, 10.2) and higher odds of passing the practical skills assessment (adjusted odds ratio (aOR) = 2.60; 95% CI 1.25, 5.40) than those who were solely proficient in French. Participants who attended a course outside of their health facility had higher odds of passing the skills assessment (aOR = 2.11; 95% CI 1.01, 4.44) than those who attended one within their health facility. The current study shows a positive impact of ETAT+ course on improving participants' knowledge and skills related to managing emergency pediatric and neonatal care conditions. The findings regarding key factors influencing ETAT+ course outcomes demonstrate the importance of considering key
Hategekimana, Celestin; Shoveller, Jeannie; Tuyisenge, Lisine; Kenyon, Cynthia; Cechetto, David F.; Lynd, Larry D.
Background The Emergency, Triage, Assessment and Treatment plus Admission care (ETAT+) course, a comprehensive advanced pediatric life support course, was introduced in Rwanda in 2010 to facilitate the achievement of the fourth Millennium Development Goal. The impact of the course on improving healthcare workers (HCWs) knowledge and practical skills related to providing emergency care to severely ill newborns and children in Rwanda has not been studied. Objective To evaluate the impact of the ETAT+ course on HCWs knowledge and practical skills, and to identify factors associated with greater improvement in knowledge and skills. Methods We used a one group, pre-post test study using data collected during ETAT+ course implementation from 2010 to 2013. The paired t-test was used to assess the effect of ETAT+ course on knowledge improvement in participating HCWs. Mixed effects linear and logistic regression models were fitted to explore factors associated with HCWs performance in ETAT+ course knowledge and practical skills assessments, while accounting for clustering of HCWs in hospitals. Results 374 HCWs were included in the analysis. On average, knowledge scores improved by 22.8/100 (95% confidence interval (CI) 20.5, 25.1). In adjusted models, bilingual (French & English) participants had a greater improvement in knowledge 7.3 (95% CI 4.3, 10.2) and higher odds of passing the practical skills assessment (adjusted odds ratio (aOR) = 2.60; 95% CI 1.25, 5.40) than those who were solely proficient in French. Participants who attended a course outside of their health facility had higher odds of passing the skills assessment (aOR = 2.11; 95% CI 1.01, 4.44) than those who attended one within their health facility. Conclusions The current study shows a positive impact of ETAT+ course on improving participants’ knowledge and skills related to managing emergency pediatric and neonatal care conditions. The findings regarding key factors influencing ETAT+ course outcomes
Full Text Available The Emergency, Triage, Assessment and Treatment plus Admission care (ETAT+ course, a comprehensive advanced pediatric life support course, was introduced in Rwanda in 2010 to facilitate the achievement of the fourth Millennium Development Goal. The impact of the course on improving healthcare workers (HCWs knowledge and practical skills related to providing emergency care to severely ill newborns and children in Rwanda has not been studied.To evaluate the impact of the ETAT+ course on HCWs knowledge and practical skills, and to identify factors associated with greater improvement in knowledge and skills.We used a one group, pre-post test study using data collected during ETAT+ course implementation from 2010 to 2013. The paired t-test was used to assess the effect of ETAT+ course on knowledge improvement in participating HCWs. Mixed effects linear and logistic regression models were fitted to explore factors associated with HCWs performance in ETAT+ course knowledge and practical skills assessments, while accounting for clustering of HCWs in hospitals.374 HCWs were included in the analysis. On average, knowledge scores improved by 22.8/100 (95% confidence interval (CI 20.5, 25.1. In adjusted models, bilingual (French & English participants had a greater improvement in knowledge 7.3 (95% CI 4.3, 10.2 and higher odds of passing the practical skills assessment (adjusted odds ratio (aOR = 2.60; 95% CI 1.25, 5.40 than those who were solely proficient in French. Participants who attended a course outside of their health facility had higher odds of passing the skills assessment (aOR = 2.11; 95% CI 1.01, 4.44 than those who attended one within their health facility.The current study shows a positive impact of ETAT+ course on improving participants' knowledge and skills related to managing emergency pediatric and neonatal care conditions. The findings regarding key factors influencing ETAT+ course outcomes demonstrate the importance of considering key
The digestive system and genitourinary systems were the most commonly affected systems. Emergency admission accounted for 18.1% of all surgical admissions while elective admissions accounted for the rest. Conclusion: More detailed research on the pattern of admissions is important in planning and should be carried ...
Tyrer, F.; McGrother, C.
Background: The study of premature deaths in people with intellectual disability (ID) has become the focus of recent policy initiatives in England. This is the first UK population-based study to explore cause-specific mortality in adults with ID compared with the general population. Methods: Cause-specific standardised mortality ratios (SMRs) and…
Department of Homeland Security — Nonimmigrants are foreign nationals granted temporary admission into the United States. The major purposes for which nonimmigrant admission may be authorized include...
Morisot, Adeline; Bessaoud, Faïza; Landais, Paul; Rébillard, Xavier; Trétarre, Brigitte; Daurès, Jean-Pierre
Estimations of survival rates are diverse and the choice of the appropriate method depends on the context. Given the increasing interest in multiple imputation methods, we explored the interest of a multiple imputation approach in the estimation of cause-specific survival, when a subset of causes of death was observed. By using European Randomized Study of Screening for Prostate Cancer (ERSPC), 20 multiply imputed datasets were created and analyzed with a Multivariate Imputation by Chained Equation (MICE) algorithm. Then, cause-specific survival was estimated on each dataset with two methods: Kaplan-Meier and competing risks. The two pooled cause-specific survival and confidence intervals were obtained using Rubin's rules after complementary log-log transformation. Net survival was estimated using Pohar-Perme's estimator and was compared to pooled cause-specific survival. Finally, a sensitivity analysis was performed to test the robustness of our constructed multiple imputation model. Cause-specific survival performed better than net survival, since this latter exceeded 100 % for almost the first 2 years of follow-up and after 9 years whereas the cause-specific survival decreased slowly and than stabilized at around 94 % at 9 years. Sensibility study results were satisfactory. On our basis of prostate cancer data, the results obtained by cause-specific survival after multiple imputation appeared to be better and more realistic than those obtained using net survival.
Peng Chiong Tan
Conclusion: In women who have had prior vaginal birth attempting a trial of labor after cesarean, a vaginal delivery before cesarean delivery is an independent risk factor for repeat cesarean. Women with two or more prior vaginal births have a similar risk for repeat cesarean and neonatal admission to women with only one prior vaginal birth.
Barfod, Charlotte; Laurtizen, Marlene Mp; Danker, Jakob K
ABSTRACT: BACKGROUND: Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting...... outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerod Acute Process Triage (HAPT) system and the outcome measures; Admission to Intensive Care Unit (ICU) and in-hospital mortality, and to identify the vital signs......, scored and categorized at admission, that are most strongly associated with the outcome measures. METHODS: The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT) and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category...
Julio Yoshio Takada
Full Text Available FUNDAMENTO: Há controvérsias sobre a hora da admissão e os desfechos hospitalares da síndrome coronária aguda (SCA. A admissão em horários não regulares seria associada ao pior prognóstico dos pacientes. OBJETIVO: Analisar a influência da hora da admissão na internação prolongada e na mortalidade de pacientes com SCA, segundo os períodos diurno (das 7h às 19h e noturno (das 19h às 7h. MÉTODOS: Foram avaliados, prospectivamente, 1.104 pacientes consecutivos com SCA. O óbito intra-hospitalar e a internação igual ou superior a cinco dias foram os desfechos analisados. RESULTADOS: A admissão no período diurno foi maior em comparação ao noturno (63% vs. 37%; p < 0,001. A angina instável foi mais prevalente no período diurno (43% vs. 32%; p < 0,001 e o infarto sem supradesnivelamento do segmento ST (IAMssST no noturno (33% vs. 43%; p = 0,001. Não se observaram diferenças na mortalidade e no tempo de internação nos períodos estudados. Os fatores de predição de internação igual ou superior a cinco dias foram: idade [OR 1,042 (IC 95% 1,025 - 1,058, p < 0,001]; fração de ejeção (FE [OR 0,977 (IC 95% 0,966 - 0,988, p < 0,001]; IAMssST [OR 1,699 (IC 95% 1,221 - 2,366, p = 0,001]; e tabagismo [OR 1,723 (IC 95% 1,113 - 2,668, p = 0,014]. Para o óbito intra-hospitalar, foram: idade [OR 1,090 (IC 95% 1,047 - 1,134, p < 0,001]; FE [OR 0,936 (IC 95% 0,909 - 0,964, p < 0,001]; e tratamento cirúrgico [OR 3,781 (IC 95% 1,374 - 10,409, p = 0,01]. CONCLUSÃO: A internação prolongada e óbito intra-hospitalar em pacientes com SCA independem do horário de admissão.
Jørgensen, Jeanette Therming; Karlsen, Sashia; Stayner, Leslie T.
or 1999 from the Danish nurse cohort where they reported information on shift work (night, evening, rotating, or day), to the Danish Register of Causes of Death to identify deaths up to 2013. We used Cox regression models with age as the underlying scale to examine the associations between night, evening......Objectives: Evidence of an effect of shift work on all-cause and cause-specific mortality is inconsistent. This study aims to examine whether shift work is associated with increased all-cause and cause-specific mortality. Methods: We linked 28 731 female nurses (age ≥44 years), recruited in 1993......, and rotating shift work (compared to day shift work) and all-cause and cause-specific mortality in models adjusted for potentially confounding variables. Results: Of 18 015 nurses included in this study, 1616 died during the study time period from the following causes: cardiovascular disease (N=217), cancer...
Conclusion: Air pollution in Tehran increases the load of emergency visits to hospitals and increases the risk of respiratory and heart diseases. Therefore, measures to reduce and control air pollution and to prepare, equip, and mobilize hospitals, particularly emergency wards, are among important priorities that should be pursued seriously by the authorities.
Bos, Vivian; Kunst, Anton E.; Keij-Deerenberg, Ingeborg M.; Garssen, Joop; Mackenbach, Johan P.
BACKGROUND: By describing ethnic differences in age- and cause-specific mortality in The Netherlands we aim to identify factors that determine whether ethnic minority groups have higher or lower mortality than the native population of the host country. METHODS: We used data for 1995-2000 from the
Bijwaard, G.E.; Myrskylä, M.; Tynelius, P.; Rasmussen, F.
Education is negatively associated with mortality for most major causes of death. The literature ignores that cause-specific hazard rates are interdependent and that education and mortality both depend on cognitive ability. We analyze the education-mortality gradient at ages 18-63 using Swedish
Erlangsen, Annette; Andersen, Per Kragh; Toender, Anita
BACKGROUND: People with mental disorders have higher mortality rates than the general population and more detailed estimates of mortality differences are needed to address this public health issue. We aimed to assess whether differences in cause-specific mortality between people with and without ...
Rod, Naja Hulvej; Kumari, Meena; Lange, Theis
Both sleep duration and sleep quality are related to future health, but their combined effects on mortality are unsettled. We aimed to examine the individual and joint effects of sleep duration and sleep disturbances on cause-specific mortality in a large prospective cohort study....
Background The extent to which diabetes mellitus or hyperglycemia is related to risk of death from cancer or other nonvascular conditions is uncertain. Methods We calculated hazard ratios for cause-specific death, according to baseline diabetes status or fasting glucose level, from
Lambert, Paul C; Wilkes, Sally R; Crowther, Michael J
Competing risks arise with time-to-event data when individuals are at risk of more than one type of event and the occurrence of one event precludes the occurrence of all other events. A useful measure with competing risks is the cause-specific cumulative incidence function (CIF), which gives the probability of experiencing a particular event as a function of follow-up time, accounting for the fact that some individuals may have a competing event. When modelling the cause-specific CIF, the most common model is a semi-parametric proportional subhazards model. In this paper, we propose the use of flexible parametric survival models to directly model the cause-specific CIF where the effect of follow-up time is modelled using restricted cubic splines. The models provide smooth estimates of the cause-specific CIF with the important advantage that the approach is easily extended to model time-dependent effects. The models can be fitted using standard survival analysis tools by a combination of data expansion and introducing time-dependent weights. Various link functions are available that allow modelling on different scales and have proportional subhazards, proportional odds and relative absolute risks as particular cases. We conduct a simulation study to evaluate how well the spline functions approximate subhazard functions with complex shapes. The methods are illustrated using data from the European Blood and Marrow Transplantation Registry showing excellent agreement between parametric estimates of the cause-specific CIF and those obtained from a semi-parametric model. We also fit models relaxing the proportional subhazards assumption using alternative link functions and/or including time-dependent effects. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
Morisot, Adeline; Bessaoud, Fa?za; Landais, Paul; R?billard, Xavier; Tr?tarre, Brigitte; Daur?s, Jean-Pierre
Background Estimations of survival rates are diverse and the choice of the appropriate method depends on the context. Given the increasing interest in multiple imputation methods, we explored the interest of a multiple imputation approach in the estimation of cause-specific survival, when a subset of causes of death was observed. Methods By using European Randomized Study of Screening for Prostate Cancer (ERSPC), 20 multiply imputed datasets were created and analyzed with a Multivariate Imput...
Full Text Available The relevance of critical illness coverage and life insurance in cause-specific mortality conditions is increasing in many industrialized countries. Specific conditions on the illness and on death event, providing cheapest premiums for the insureds and lower obligations for the insurers, constitute interesting products in an insurance market looking to offer appealing products. On the other hand, the systematic improvement in longevity gives rise to a market with agents getting increasingly older, and the insurer pays attention to this trend. There are financial contracts joined with insurance coverage, and this particularly happens in the case of the so-called insured loan. Insured loans are financial contracts often proposed together with a term life insurance in order to cover the lender and the heirs against the borrower’s death event within the loan duration. This paper explores new insurance products that, linked to an insured loan, are founded on specific illness hypotheses and/or cause-specific mortality. The aim is to value how much the insurance costs lighten with respect to the traditional term insurance. The authors project cause-specific mortality rates and specific diagnosis rates, in this last case overcoming the discontinuities in the data. The new contractual schemes are priced. Numerical applications also show, with several graphs, the rates projection procedure and plenty of tables report the premiums in the new proposed contractual forms. The complete amortization schedule closes the work.
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Breitner, Susanne; Wolf, Kathrin; Peters, Annette; Schneider, Alexandra
This time series study aimed to examine the association between daily air temperature and cause-specific cardiovascular mortality in Bavaria, Southern Germany. We obtained data from the cities Munich, Nuremberg and Augsburg and two adjacent administrative districts (Augsburg and Aichach-Friedberg), for the period 1990-2006. Data included daily cause-specific cardiovascular death counts, mean daily meteorological variables and air pollution concentrations. In the first stage, data were analysed for Munich, Nuremberg and the Augsburg region separately using Poisson regression models combined with distributed lag non-linear models adjusting for long-term trend, calendar effects and meteorological factors. In a second stage, we combined city-specific exposure-response relationships through a multivariate meta-analysis framework. An increase in the 2-day average temperature from the 90th (20.0°C) to the 99th centiles (24.8°C) resulted in an increase of cardiovascular mortality by 10% (95% CI 5% to 15%) in the pooled analysis, while for a decrease from the 10th (-1.0°C) to the 1st centiles (-7.5°C) in the 15-day average temperature cardiovascular mortality increased by 8% (95% CI 2% to 14%). Strongest consistent risk estimates were seen for high 2-day average temperatures and mortality due to other heart diseases (including arrhythmias and heart failure) and cerebrovascular diseases, especially in the elderly. Results indicate that, in addition to low temperatures, high temperatures increase cause-specific cardiovascular mortality in temperature climates. These findings may guide planning public health interventions to control and prevent the health effects of exposure to air temperature, especially for individuals at risk for mortality due to heart failure, arrhythmias or cerebrovascular diseases. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Riad N. Younes
Full Text Available Hypertonic solutions have been studied extensively in the treatment of hypovolemic shock, both in experimental and clinical models. Safety, efficacy, and long-term effects on animals and patients have been evaluated. The present article reviews indications, safety, mortality rates, and outcome in patients with hemorrhagic hypovolemic shock who were treated after admission with a hypertonic/hyperoncotic solution under strict observation in the emergency room.As soluções hipertônicas têm sido estudadas no tratamento de choque hipovolêmico, tanto em protocolos experimentais quanto clínicos. A eficácia, a segurança e os efeitos a longo prazo em animais e pacientes foram avaliados. O presente estudo apresenta uma revisão da literatura sobre as indicações, as taxas de morbidade e de mortalidade e a evolução de pacientes com choque hipovolêmico, admitidos e tratados com soluções hipertônicas/hiperoncóticas, admitidos e tratados sob observação contínua na sala de emergência do pronto socorro.
Background Competing risks are a common occurrence in survival analysis. They arise when a patient is at risk of more than one mutually exclusive event, such as death from different causes, and the occurrence of one of these may prevent any other event from ever happening. Methods There are two main approaches to modelling competing risks: the first is to model the cause-specific hazards and transform these to the cumulative incidence function; the second is to model directly on a transformation of the cumulative incidence function. We focus on the first approach in this paper. This paper advocates the use of the flexible parametric survival model in this competing risk framework. Results An illustrative example on the survival of breast cancer patients has shown that the flexible parametric proportional hazards model has almost perfect agreement with the Cox proportional hazards model. However, the large epidemiological data set used here shows clear evidence of non-proportional hazards. The flexible parametric model is able to adequately account for these through the incorporation of time-dependent effects. Conclusion A key advantage of using this approach is that smooth estimates of both the cause-specific hazard rates and the cumulative incidence functions can be obtained. It is also relatively easy to incorporate time-dependent effects which are commonly seen in epidemiological studies. PMID:23384310
Miller, B.G.; MacCalman, L. [Institute of Occupational Medicine, Edinburgh (United Kingdom)
In the 1950s the Pneumoconiosis Field Research (PFR) programme was set up to study the health of British coal workers. Studies included regular health surveys, an intensive characterisation of workers' individual exposures, and entry to a cohort followed up to the present for cause-specific mortality. This study reports on analyses of cause-specific mortality in a cohort of almost 18 000 men from 10 British collieries. External analyses used standardised mortality ratios (SMRs), comparing observed mortality with reference rates from the regions in which the collieries were situated. Causes investigated include lung and stomach cancers, chronic obstructive pulmonary disease and cardiovascular endpoints. Internal analyses used Cox regression models with time-dependent exposures adjusting for the confounding effects of age, smoking, cohort entry date and regional differences in population mortality rates. Several causes showed evidence of a healthy worker effect early in the follow-up, with a deficit in the SMR diminishing over time. For most of the causes there was a significant excess in the latter part of follow-up. Internal analyses found evidence of an association between increased risks of lung cancer and increased quartz exposure, particularly at a lag of 15 years. Risks of mortality from non-malignant respiratory disease showed increases with increased exposure to respirable dust. This paper adds to the evidence on the long-term effects of exposure to coalmine dust on mortality from respiratory diseases.
Brian G Miller; Laura MacCalman [Institute of Occupational Medicine, Edinburgh (United Kingdom)
In the 1950s the Pneumoconiosis Field Research (PFR) programme was set up to study the health of British coal workers. Studies included regular health surveys, an intensive characterisation of workers' individual exposures, and entry to a cohort followed up to the present for cause-specific mortality. This study reports on analyses of cause-specific mortality in a cohort of almost 18?000 men from 10 British collieries. External analyses used standardised mortality ratios (SMRs), comparing observed mortality with reference rates from the regions in which the collieries were situated. Causes investigated include lung and stomach cancers, chronic obstructive pulmonary disease and cardiovascular endpoints. Internal analyses used Cox regression models with time-dependent exposures adjusting for the confounding effects of age, smoking, cohort entry date and regional differences in population mortality rates. Several causes showed evidence of a healthy worker effect early in the follow-up, with a deficit in the SMR diminishing over time. For most of the causes there was a significant excess in the latter part of follow-up. Internal analyses found evidence of an association between increased risks of lung cancer and increased quartz exposure, particularly at a lag of 15 years. Risks of mortality from non-malignant respiratory disease showed increases with increased exposure to respirable dust. This paper adds to the evidence on the long-term effects of exposure to coalmine dust on mortality from respiratory diseases.
Mogensen, UB; Olsen, TS; Andersen, KK
We investigated cause-specific mortality in relation to age, sex, stroke severity, and cardiovascular risk factor profile in the Copenhagen Stroke Study cohort with 10 years of follow-up. In a Copenhagen community, all patients admitted to the hospital with stroke during 1992-1993 (n = 988) were...... registered on admission. Evaluation included stroke severity, computed tomography scan, and a cardiovascular risk profile. Cause of death within 10 years according to death certificate information was classified as stroke, heart/arterial disease, or nonvascular disease. Competing-risks analyses were...... after 10 years (18%). Stroke was the dominant cause of death during first year, with an absolute risk of 20.2% versus 5.2% for heart/arterial disease and 6.5% for nonvascular disease. The subsequent absolute risk of death per year was 2.8% for stroke, 4.5% for heart/arterial disease, and 5...
Full Text Available To describe the cause-specific morbidity and mortality, and referral patterns of all neonates admitted to a tertiary referral hospital in the northern provinces of Vietnam.A prospective hospital based observational study.The Neonatal Department, National Hospital of Pediatrics, Hanoi, Vietnam.All admissions to the Neonatal Department over a 12 month period.Cause-specific morbidity and mortality; deaths.There were 5064 admissions with the commonest discharge diagnoses being infection (32% and prematurity (29%. The case fatality ratio (CFR was 13.9% (n = 703. Infection (38%, cardio/respiratory disorders (27%, congenital abnormalities (20% and neurological conditions (10% were the main causes of death. Of all the deaths, 38% had an admission weight ≥2500g. Higher CFR were associated with lower admission weights. Very few deaths (3% occurred in the first 24 hours of life. Most referrals and deaths came from Hanoi and neighbouring provincial hospitals, with few from the most distant provinces. Two distant referral provinces had the highest CFR.The CFR was high and few deaths occurred in neonates <24 hours old. The high rates of infection call for an improvement in infection control practices and peripartum antibiotic use at provincial and tertiary level. Understanding provincial hospital capacity and referral pathways is crucial to improving the outcomes at tertiary centres. A quality of care audit tool would enable more targeted interventions and monitoring of health outcomes.
Rafnsson, V; Olafsson, E; Hauser, W A; Gudmundsson, G
To determine the cause-specific mortality relative to that expected in a population-based incidence cohort of people with unprovoked seizures. The cohort comprises 224 inhabitants of Iceland first diagnosed as suffering from unprovoked seizures during a 5-year period from 1960 to 1964. The expected number of deaths was calculated by multiplying person-years of observation within 5-year age categories for each year from diagnosis through 1995 by cause-specific and sex-specific national death rates for those aged 20 years and above. The standardized mortality ratio (SMR) and 95% confidence intervals (95% CI) were calculated. All-cause mortality was increased among men (SMR 2.25, 95% CI 1.56-3.14) but not women (SMR 0.79, 95% CI 0.38-1.46). Among men, there were 8 deaths from accidents, poisoning and violence observed versus 2.82 expected (SMR 2.84, 95% CI 1.22-5.59) and 4 deaths from suicide versus 0.69 expected (SMR 5.80, 95% CI 1.56-14.84). All-cause mortality for men was still elevated after restriction of analysis to those with seizures of unknown etiology (SMR 1.73, 95% CI 1.05-2.67) with the excess deaths attributable to suicide (SMR 5.26, 95% CI 1.06-15.38). Both males and females with remote symptomatic unprovoked seizures had an increase in all-cause mortality due to excess mortality from all cancers, cerebrovascular disease and accidents. When compared with the age-, time-period- and gender-specific mortality in the general population, there is excess mortality in men but not women. The increased mortality for men is partly attributable to excess mortality from accidents and suicides. Copyright 2001 S. Karger AG, Basel
Michet, Clement J; Schleck, Cathy D; Larson, Dirk R; Maradit Kremers, Hilal; Berry, Daniel J; Lewallen, David G
While studies have demonstrated that mortality after total hip (THA) and total knee (TKA) arthroplasty is better than the general population, the causes of death are not well established. We evaluated cause-specific mortality after THA and TKA. The study included population-based cohorts of patients who underwent THA (N = 2019) and TKA (N = 2259) between 1969 and 2008. Causes of death were classified using the International Classification of Diseases 9th and 10th editions. Cause-specific standardized mortality ratios (SMR) and 95% confidence intervals (CI) were calculated by comparing observed and expected mortality. Expected mortality was derived from mortality rates in the United States white population of similar calendar year, age, and sex characteristics. All-cause mortality was lower than expected following both THA and TKA. However, there was excess mortality due to mental diseases such as dementia following both THA (SMR 1.40, 95% CI 1.08, 1.80) and TKA (SMR 1.49, 95% CI 1.19, 1.85). There was also excess mortality from inflammatory musculoskeletal diseases in THA (SMR 3.50, 95% CI 2.11, 5.46) and TKA (SMR 4.85, 95% CI 3.29, 6.88). When the cohorts were restricted to patients with osteoarthritis as the surgical indication, the excess risk of death from mental diseases still persisted in THA (SMR 1.36, 95% CI 1.02, 1.78) and TKA (SMR 1.52, 95% CI 1.20, 1.91). THA and TKA patients experience a higher risk of death from mental and inflammatory musculoskeletal diseases. These findings warrant further research to identify drivers of mortality and prevention strategies in arthroplasty patients. Copyright © 2016 Elsevier Inc. All rights reserved.
Park, Song-Yi; Freedman, Neal D; Haiman, Christopher A; Le Marchand, Loïc; Wilkens, Lynne R; Setiawan, Veronica Wendy
Coffee consumption has been associated with reduced risk for death in prospective cohort studies; however, data in nonwhites are sparse. To examine the association of coffee consumption with risk for total and cause-specific death. The MEC (Multiethnic Cohort), a prospective population-based cohort study established between 1993 and 1996. Hawaii and Los Angeles, California. 185 855 African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites aged 45 to 75 years at recruitment. Outcomes were total and cause-specific mortality between 1993 and 2012. Coffee intake was assessed at baseline by means of a validated food-frequency questionnaire. 58 397 participants died during 3 195 484 person-years of follow-up (average follow-up, 16.2 years). Compared with drinking no coffee, coffee consumption was associated with lower total mortality after adjustment for smoking and other potential confounders (1 cup per day: hazard ratio [HR], 0.88 [95% CI, 0.85 to 0.91]; 2 to 3 cups per day: HR, 0.82 [CI, 0.79 to 0.86]; ≥4 cups per day: HR, 0.82 [CI, 0.78 to 0.87]; P for trend coffee. Significant inverse associations were observed in 4 ethnic groups; the association in Native Hawaiians did not reach statistical significance. Inverse associations were also seen in never-smokers, younger participants (coffee was associated with lower risk for death in African Americans, Japanese Americans, Latinos, and whites. National Cancer Institute.
Godefay, Hagos; Abrha, Atakelti; Kinsman, John; Myléus, Anna; Byass, Peter
The lack of adequate documentation of deaths, and particularly their cause, is often noted in African and Asian settings, but practical solutions for addressing the problem are not always clear. Verbal autopsy methods (interviewing witnesses after a death) have developed rapidly, but there remains a lack of clarity as to how these methods can be effectively applied to large unregistered populations. This paper sets out practical details for undertaking a representative survey of cause-specific mortality in a population of several million, taking Tigray Region in Ethiopia as a prototype. Sampling was designed around an expected level of maternal mortality ratio of 400 per 100,000 live births, which needed measuring within a 95% confidence interval of approximately ±100. Taking a stratified cluster sample within the region at the district level for logistic reasons, and allowing for a design effect of 2, this required a population of around 900,000 people, equating to six typical districts. Since the region is administered in six geographic zones, one district per zone was randomly selected. The survey was implemented as a two-stage process: first, to trace deaths that occurred in the sampled districts within the preceding year, and second to follow them up with verbal autopsy interviews. The field work for both stages was undertaken by health extension workers, working in their normally assigned areas. Most of the work was associated with tracing the deaths, rather than undertaking the verbal autopsy interviews. This approach to measuring cause-specific mortality in an unregistered Ethiopian population proved to be feasible and effective. Although it falls short of the ideal situation of continuous civil registration and vital statistics, a survey-based strategy of this kind may prove to be a useful intermediate step on the road towards full civil registration and vital statistics implementation.
Kõks, Gea; Fischer, Krista; Kõks, Sulev
Tobacco smoking is known to be the single largest cause of premature death worldwide. The aim of present study was to analyse the effect of smoking on general and cause-specific mortality in the Estonian population. The data from 51,756 adults in the Estonian Genome Center of the University of Tartu was used. Information on dates and causes of death was retrieved from the National Causes of Death Registry. Smoking status, general survival, general mortality and cause-specific mortality were analysed using Kaplan-Meier estimator and Cox proportional hazards models. The study found that smoking reduces median survival in men by 11.4 years and in women by 5.8 years. Tobacco smoking produces a very specific pattern in the cause of deaths, significantly increasing the risks for different cancers and cardiovascular diseases as causes of death for men and women. This study also identified that external causes, such as alcohol intoxication and intentional self-harm, are more prevalent causes of death among smokers than non-smokers. Additionally, smoking cessation was found to reverse the increased risks for premature mortality. Tobacco smoking remains the major cause for losses of life inducing cancers and cardiovascular diseases. In addition to the common diseases, external causes also reduce substantially the years of life. External causes of death indicate that smoking has a long-term influence on the behaviour of smokers, provoking self-destructive behaviour. Our study supports the idea, that tobacco smoking generates complex harm to our health increasing mortality from both somatic and mental disorders.
Full Text Available Background: The lack of adequate documentation of deaths, and particularly their cause, is often noted in African and Asian settings, but practical solutions for addressing the problem are not always clear. Verbal autopsy methods (interviewing witnesses after a death have developed rapidly, but there remains a lack of clarity as to how these methods can be effectively applied to large unregistered populations. This paper sets out practical details for undertaking a representative survey of cause-specific mortality in a population of several million, taking Tigray Region in Ethiopia as a prototype. Sampling: Sampling was designed around an expected level of maternal mortality ratio of 400 per 100,000 live births, which needed measuring within a 95% confidence interval of approximately ±100. Taking a stratified cluster sample within the region at the district level for logistic reasons, and allowing for a design effect of 2, this required a population of around 900,000 people, equating to six typical districts. Since the region is administered in six geographic zones, one district per zone was randomly selected. Implementation: The survey was implemented as a two-stage process: first, to trace deaths that occurred in the sampled districts within the preceding year, and second to follow them up with verbal autopsy interviews. The field work for both stages was undertaken by health extension workers, working in their normally assigned areas. Most of the work was associated with tracing the deaths, rather than undertaking the verbal autopsy interviews. Discussion: This approach to measuring cause-specific mortality in an unregistered Ethiopian population proved to be feasible and effective. Although it falls short of the ideal situation of continuous civil registration and vital statistics, a survey-based strategy of this kind may prove to be a useful intermediate step on the road towards full civil registration and vital statistics implementation.
Marí-Dell'Olmo, Marc; Gotsens, Mercè; Palència, Laia; Burström, Bo; Corman, Diana; Costa, Giuseppe; Deboosere, Patrick; Díez, Èlia; Domínguez-Berjón, Felicitas; Dzúrová, Dagmar; Gandarillas, Ana; Hoffmann, Rasmus; Kovács, Katalin; Martikainen, Pekka; Demaria, Moreno; Pikhart, Hynek; Rodríguez-Sanz, Maica; Saez, Marc; Santana, Paula; Schwierz, Cornelia; Tarkiainen, Lasse; Borrell, Carme
Socioeconomic inequalities are increasingly recognised as an important public health issue, although their role in the leading causes of mortality in urban areas in Europe has not been fully evaluated. In this study, we used data from the INEQ-CITIES study to analyse inequalities in cause-specific mortality in 15 European cities at the beginning of the 21st century. A cross-sectional ecological study was carried out to analyse 9 of the leading specific causes of death in small areas from 15 European cities. Using a hierarchical Bayesian spatial model, we estimated smoothed Standardized Mortality Ratios, relative risks and 95% credible intervals for cause-specific mortality in relation to a socioeconomic deprivation index, separately for men and women. We detected spatial socioeconomic inequalities for most causes of mortality studied, although these inequalities differed markedly between cities, being more pronounced in Northern and Central-Eastern Europe. In the majority of cities, most of these causes of death were positively associated with deprivation among men, with the exception of prostatic cancer. Among women, diabetes, ischaemic heart disease, chronic liver diseases and respiratory diseases were also positively associated with deprivation in most cities. Lung cancer mortality was positively associated with deprivation in Northern European cities and in Kosice, but this association was non-existent or even negative in Southern European cities. Finally, breast cancer risk was inversely associated with deprivation in three Southern European cities. The results confirm the existence of socioeconomic inequalities in many of the main causes of mortality, and reveal variations in their magnitude between different European cities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Moon, Paul J
Hospice admission assessment is a pivotal encounter for patient/family and hospice representative. For patient/family, the admission is the threshold by which a particular level of care can commence and, symbolically, a certain marker in health status trajectory is reached. For hospice representative, the admission episode is an occasion to inaugurate an ambience that can serve to frame future hospice care experiences for the patient/family. Through a narrative lens, hospice admission assessment can be seen as experiential time and space, where patient's and family's stories are mindfully and deliberately witnessed and explored. Through the practice of narrative mining, the hospice representative can better understand others' offered stories of reality, which will better inform the plan of palliation and hospice care.
Department of Homeland Security — Nonimmigrants are foreign nationals granted temporary admission into the United States. The major purposes for which nonimmigrant admission may be authorized include...
Department of Homeland Security — Nonimmigrants are foreign nationals granted temporary admission into the United States. The major purposes for which nonimmigrant admission may be authorized include...
Medici, Clara Reece; Vestergaard, Claus Høstrup; Hadzi-Pavlovic, Dusan
BACKGROUND: Bipolar disorder is characterized by a seasonal pattern with emerging evidence that weather conditions may trigger symptoms. Thus, our aims were to investigate if year-to-year variations in admissions with mania correlated with year-to-year variations in key meteorological variables, ...
Tjepkema, Michael; Wilkins, Russell; Long, Andrea
People with lower levels of education tend to have higher rates of disease and death, compared with people who have higher levels of education. However, because death registrations in Canada do not contain information on the education of the deceased, unlinked vital statistics cannot be used to examine mortality differentials by education. This study examines cause-specific mortality rates by education in a broadly representative sample of Canadians aged 25 or older. The data are from the 1991 to 2006 Canadian census mortality follow-up study, which included about 2.7 million people and 426,979 deaths. Age-standardized mortality rates (ASMRs) were calculated by education for different causes of death. Rate ratios, rate differences and excess mortality were also calculated. All-cause ASMRs were highest among people with less than secondary graduation and lowest for university degree-holders. If all cohort members had the mortality rates of those with a university degree, the overall ASMRs would have been 27% lower for men and 22% lower for women. The causes contributing most to that "excess" mortality were ischemic heart disease, lung cancer, chronic obstructive pulmonary disease, stroke, diabetes, injuries (men), and respiratory infections (women). Causes associated with smoking and alcohol abuse had the steepest gradients. A mortality gradient by education was evident for many causes of death.
Muntaner, Carles; Lynch, John W; Hillemeier, Marianne; Lee, Ju Hee; David, Richard; Benach, Joan; Borrell, Carme
This study tests two propositions from Navarro's critique of the social capital literature: that social capital's importance has been exaggerated and that class-related political factors, absent from social epidemiology and public health, might be key determinants of population health. The authors estimate cross-sectional associations between economic inequality, working-class power, and social capital and life expectancy, self-rated health, low birth weight, and age- and cause-specific mortality in 16 wealthy countries. Of all the health outcomes, the five variables related to birth and infant survival and nonintentional injuries had the most consistent association with economic inequality and working-class power (in particular with strength of the welfare state) and, less so, with social capital indicators. Rates of low birth weight and infant deaths from all causes were lower in countries with more "left" (e.g., socialist, social democratic, labor) votes, more left members of parliament, more years of social democratic government, more women in government, and various indicators of strength of the welfare state, as well as low economic inequality, as measured in a variety of ways. Similar associations were observed for injury mortality, underscoring the crucial role of unions and labor parties in promoting workplace safety. Overall, social capital shows weaker associations with population health indicators than do economic inequality and working-class power. The popularity of social capital and exclusion of class-related political and welfare state indicators does not seem to be justified on empirical grounds.
Wu, Chen-Yi; Hu, Hsiao-Yun; Huang, Nicole; Chou, Yi-Chang; Li, Chung-Pin; Chou, Yiing-Jenq
To investigate the association between serum albumin levels and cause-specific mortality among community-dwelling older adults. This cohort study was based on data obtained from the government-sponsored Annual Geriatric Health Examination Program for the older adults in Taipei City between 2006 and 2010. The study sample consisted of 77,531 community-dwelling Taipei citizens (≥65 years old). Mortality was determined by matching the participants' medical records with national death files. Serum albumin levels were categorized into dwelling older adults had a mean albumin level of 4.3 g/dL, which significantly reduced by age. Compared to albumin levels ≥4.4 g/dL, mildly low albumin levels (4.2-4.3 g/dL) were associated with an increased mortality risk (hazard ratio [HR]: 1.16, 95% confidence interval [CI]: 1.05-1.28 for all-cause mortality), and albumin levels dwelling older adults, and mortality risk increased as the albumin level decreased. Copyright © 2017. Published by Elsevier Inc.
Islami, Farhad; Pourshams, Akram; Nasseri-Moghaddam, Siavosh; Khademi, Hooman; Poutschi, Hossein; Khoshnia, Masoud; Norouzi, Alireza; Amiriani, Taghi; Sohrabpour, Amir Ali; Aliasgari, Ali; Jafari, Elham; Semnani, Shahryar; Abnet, Christian C.; Pharaoh, Paul D.; Brennan, Paul; Kamangar, Farin; Dawsey, Sanford M.; Boffetta, Paolo; Malekzadeh, Reza
BACKGROUND Only a few studies in Western countries have investigated the association between gastroesophageal reflux disease (GERD) and mortality at the general population level and they have shown mixed results. This study investigated the association between GERD symptoms and overall and cause-specific mortality in a large prospective population-based study in Golestan Province, Iran. METHODS Baseline data on frequency, onset time, and patient-perceived severity of GERD symptoms were available for 50001 participants in the Golestan Cohort Study (GCS). We identified 3107 deaths (including 1146 circulatory and 470 cancer-related) with an average follow-up of 6.4 years and calculated hazard ratios (HR) and 95% confidence intervals (CI) adjusted for multiple potential confounders. RESULTS Severe daily symptoms (defined as symptoms interfering with daily work or causing nighttime awakenings on a daily bases, reported by 4.3% of participants) were associated with cancer mortality (HR 1.48, 95% CI: 1.04-2.05). This increase was too small to noticeably affect overall mortality. Mortality was not associated with onset time or frequency of GERD and was not increased with mild to moderate symptoms. CONCLUSION We have observed an association with GERD and increased cancer mortality in a small group of individuals that had severe symptoms. Most patients with mild to moderate GERD can be re-assured that their symptoms are not associated with increased mortality. PMID:24872865
Background: Road traffic accident remains a leading cause of trauma and admissions to the accidents and emergency units of most hospitals. The aim of this study was to determine the pattern and epidemiological characteristics of trauma admissions to the Obafemi Awolowo University Teaching Hospital. Methods: This ...
Walsh, Bronagh; Lattimer, Valerie; Wintrup, Julie; Brailsford, Sally
There is debate worldwide about the best way to manage increased healthcare demand within ageing populations, particularly rising rates of unplanned and avoidable hospital admissions. To understand health and social care professionals' perspectives on barriers to admission avoidance throughout the admissions journey, in particular: the causes of avoidable admissions in older people; drivers of admission and barriers to use of admission avoidance strategies; and improvements to reduce unnecessary admissions. A qualitative framework analysis of interview data from a System dynamics (SD) modelling study. Semi-structured interviews were conducted with twenty health and social care professionals with experience of older people's admissions. The interviews were used to build understanding of factors facilitating or hindering admission avoidance across the admissions system. Data were analysed using framework analysis. Three overarching themes emerged: understanding the needs of the patient group; understanding the whole system; and systemwide access to expertise in care of older people. There were diverse views on the underlying reasons for avoidable admissions and recognition of the need for whole-system approaches to service redesign. Participants recommended system redesign that recognises the specific needs of older people, but there was no consensus on underlying patient needs or specific service developments. Access to expertise in management of older and frailer patients was seen as a barrier to admission avoidance throughout the system. Providing access to expertise and leadership in care of frail older people across the admissions system presents a challenge for service managers and nurse educators but is seen as a prerequisite for effective admission avoidance. System redesign to meet the needs of frail older people requires agreement on causes of avoidable admission and underlying patient needs. © 2014 John Wiley & Sons Ltd.
Olsen, Anne-Marie Schjerning; Fosbøl, Emil L; Lindhardsen, Jesper
Non steroidal anti-inflammatory drugs (NSAIDs) increase mortality and morbidity after myocardial infarction (MI). We examined cause-specific mortality and morbidity associated with NSAIDs in a nationwide cohort of MI patients.......Non steroidal anti-inflammatory drugs (NSAIDs) increase mortality and morbidity after myocardial infarction (MI). We examined cause-specific mortality and morbidity associated with NSAIDs in a nationwide cohort of MI patients....
Silventoinen, Karri; Laatikainen, Tiina; Jousilahti, Pekka; Salomaa, Veikko; Kaprio, Jaakko
Objective: To assess long-term, cause-specific mortality rates and rate ratios of the patients alive at 1 year after subarachnoid hemorrhage (SAH). Methods: The population-based, prospective, cohort study with a nested case-control design consisted of 64,349 persons (aged 25–74 years at enrollment) who participated in the National FINRISK Study between 1972 and 2007. Four hundred thirty-seven SAH cases, 233 one-year SAH survivors, and their matched intrinsic controls were identified and followed up until the end of 2009 through the nationwide Finnish Causes of Death Register. All-cause mortality rates and rate ratios of the 1-year SAH survivors and controls were the main outcome measures. Results: Eighty-eight (37.8%) of 233 one-year SAH survivors died during the total follow-up time of 2,487 person-years (median 8.6 years, range 0.1–35.8 years). The 1-year SAH survivors had a hazard ratio of 1.96 (95% confidence interval 1.57–2.47) for death compared with the matched general population with 10 controls for each SAH survivor. One-year SAH survivors had up to 31 additional deaths per 1,000 person-years compared with controls with minimal cerebrovascular risk factors. The higher long-term risk of death among SAH survivors was attributed solely to cerebrovascular diseases, and most important modifiable risk factors for death were smoking, high systolic blood pressure (≥159 mm Hg), and high cholesterol levels (≥7.07 mmol/L). Conclusion: One-year SAH survivors have excess mortality, which is attributed to an exceptional risk of deadly cerebrovascular events. Aggressive post-SAH cerebrovascular risk factor intervention strategies are highly warranted. PMID:23303843
Ding, Ming; Satija, Ambika; Bhupathiraju, Shilpa N; Hu, Yang; Sun, Qi; Han, Jiali; Lopez-Garcia, Esther; Willett, Walter; van Dam, Rob M; Hu, Frank B
The association between consumption of caffeinated and decaffeinated coffee and risk of mortality remains inconclusive. We examined the associations of consumption of total, caffeinated, and decaffeinated coffee with risk of subsequent total and cause-specific mortality among 74,890 women in the Nurses' Health Study (NHS), 93,054 women in the Nurses' Health Study II, and 40,557 men in the Health Professionals Follow-up Study. Coffee consumption was assessed at baseline using a semiquantitative food frequency questionnaire. During 4,690,072 person-years of follow-up, 19,524 women and 12,432 men died. Consumption of total, caffeinated, and decaffeinated coffee were nonlinearly associated with mortality. Compared with nondrinkers, coffee consumption of 1 to 5 cups per day was associated with lower risk of mortality, whereas coffee consumption of more than 5 cups per day was not associated with risk of mortality. However, when restricting to never smokers compared with nondrinkers, the hazard ratios (and 95% confidence intervals) of mortality were 0.94 (0.89-0.99) for 1.0 or less cup per day, 0.92 (0.87-0.97) for 1.1 to 3.0 cups per day, 0.85 (0.79-0.92) for 3.1 to 5.0 cup per day, and 0.88 (0.78-0.99) for more than 5.0 cup per day (P value for nonlinearity = 0.32; P value for trend trend coffee (P value for trend = 0.022). Significant inverse associations were observed between coffee consumption and deaths attributed to cardiovascular disease, neurologic diseases, and suicide. No significant association between coffee consumption and total cancer mortality was found. Higher consumption of total coffee, caffeinated coffee, and decaffeinated coffee was associated with lower risk of total mortality. © 2015 American Heart Association, Inc.
Ding, Ming; Satija, Ambika; Bhupathiraju, Shilpa N; Hu, Yang; Sun, Qi; Han, Jiali; Lopez-Garcia, Esther; Willett, Walter; van Dam, Rob M.; Hu, Frank B.
Background The association between consumption of caffeinated and decaffeinated coffee and risk of mortality remains inconclusive. Methods and Results We examined the associations of consumption of total, caffeinated, and decaffeinated coffee with risk of subsequent total and cause-specific mortality among 74,890 women in the Nurses’ Health Study (NHS), 93,054 women in the NHS 2, and 40,557 men in the Health Professionals Follow-up Study. Coffee consumption was assessed at baseline using a semi-quantitative food frequency questionnaire. During 4,690,072 person-years of follow-up, 19,524 women and 12,432 men died. Consumption of total, caffeinated, and decaffeinated coffee were non-linearly associated with mortality. Compared to non-drinkers, coffee consumption one to five cups/d was associated with lower risk of mortality, while coffee consumption more than five cups/d was not associated with risk of mortality. However, when restricting to never smokers, compared to non-drinkers, the HRs of mortality were 0.94 (0.89 to 0.99) for ≤ 1 cup/d, 0.92 (0.87 to 0.97) for 1.1-3 cups/d, 0.85 (0.79 to 0.92) for 3.1-5 cups/d, and 0.88 (0.78 to 0.99) for > 5 cups/d (p for non-linearity = 0.32; p for trend coffee (p for trend = 0.022). Significant inverse associations were observed between coffee consumption and deaths due to cardiovascular disease, neurological diseases, and suicide. No significant association between coffee consumption and total cancer mortality was found. Conclusions Higher consumption of total coffee, caffeinated coffee, and decaffeinated coffee was associated with lower risk of total mortality. PMID:26572796
Discusses different emphases placed by institutions of higher education on a range of admissions criteria including academic performance, evidence of graduation, letters of recommendation, personal essays, and interviews. Concludes that standardized tests are not the pervasive barrier to higher education in the United States that many test critics…
Full Text Available The structure of causes of death in Canada has been changing since the onset of the “cardiovascular revolution.” While mortality due to cardiovascular diseases has been declining, mortality due to other causes of death, such as cancers and Alzheimer’s disease has been increasing. Our research investigates how these changes have re-modeled life expectancy at age 65 and age 85, and what specific causes of death are involved. We distinguish between premature and senescent deaths in Canada, using a cause-specific age structure. Our results suggest that although a decline in premature deaths has contributed to increasing life expectancy in recent years, most of the gains in life expectancy at age 65 and 85 have resulted from a decline in senescent deaths. We also find a decline in mortality due to the main causes of death, leading to a greater diversification of causes. Depuis le début de la révolution cardiovasculaire, le Canada a connu d’importants changements dans la distribution des décès selon la cause. La mortalité par maladies cardiovasculaires a connu une importante diminution alors que les taux de mortalité pour les cancers et pour la maladie d’Alzheimer ont augmenté. Cet article examine comment ces changements ont influencé les tendances de l’espérance de vie à 65 et à 85 ans et quelles causes de décès spécifiques furent impliquées. Une distinction entre les décès prématurés et les décès liés à un processus de sénescence est réalisée, se basant sur deux indicateurs de variations par âge des causes de décès. Nos résultats suggèrent que la majorité des gains en espérance de vie à 65 et 85 ans proviennent d’une plus faible mortalité par cause de décès sénescente. De plus, une diminution des principales causes de décès chez les personnes âgées de 65 ans et plus laisse place à une plus grande diversification de causes aux grands âges.
Sotos-Prieto, Mercedes; Bhupathiraju, Shilpa N.; Mattei, Josiemer; Fung, Teresa T.; Li, Yanping; Pan, An; Willett, Walter C.; Rimm, Eric B.; Hu, Frank B.
BACKGROUND Few studies have evaluated the relationship between changes in diet quality over time and the risk of death. METHODS We used Cox proportional-hazards models to calculate adjusted hazard ratios for total and cause-specific mortality among 47,994 women in the Nurses’ Health Study and 25,745 men in the Health Professionals Follow-up Study from 1998 through 2010. Changes in diet quality over the preceding 12 years (1986–1998) were assessed with the use of the Alternate Healthy Eating Index–2010 score, the Alternate Mediterranean Diet score, and the Dietary Approaches to Stop Hypertension (DASH) diet score. RESULTS The pooled hazard ratios for all-cause mortality among participants who had the greatest improvement in diet quality (13 to 33% improvement), as compared with those who had a relatively stable diet quality (0 to 3% improvement), in the 12-year period were the following: 0.91 (95% confidence interval [CI], 0.85 to 0.97) according to changes in the Alternate Healthy Eating Index score, 0.84 (95 CI%, 0.78 to 0.91) according to changes in the Alternate Mediterranean Diet score, and 0.89 (95% CI, 0.84 to 0.95) according to changes in the DASH score. A 20-percentile increase in diet scores (indicating an improved quality of diet) was significantly associated with a reduction in total mortality of 8 to 17% with the use of the three diet indexes and a 7 to 15% reduction in the risk of death from cardiovascular disease with the use of the Alternate Healthy Eating Index and Alternate Mediterranean Diet. Among participants who maintained a high-quality diet over a 12-year period, the risk of death from any cause was significantly lower — by 14% (95% CI, 8 to 19) when assessed with the Alternate Healthy Eating Index score, 11% (95% CI, 5 to 18) when assessed with the Alternate Mediterranean Diet score, and 9% (95% CI, 2 to 15) when assessed with the DASH score — than the risk among participants with consistently low diet scores over time. CONCLUSIONS
Sotos-Prieto, Mercedes; Bhupathiraju, Shilpa N; Mattei, Josiemer; Fung, Teresa T; Li, Yanping; Pan, An; Willett, Walter C; Rimm, Eric B; Hu, Frank B
Few studies have evaluated the relationship between changes in diet quality over time and the risk of death. We used Cox proportional-hazards models to calculate adjusted hazard ratios for total and cause-specific mortality among 47,994 women in the Nurses' Health Study and 25,745 men in the Health Professionals Follow-up Study from 1998 through 2010. Changes in diet quality over the preceding 12 years (1986-1998) were assessed with the use of the Alternate Healthy Eating Index-2010 score, the Alternate Mediterranean Diet score, and the Dietary Approaches to Stop Hypertension (DASH) diet score. The pooled hazard ratios for all-cause mortality among participants who had the greatest improvement in diet quality (13 to 33% improvement), as compared with those who had a relatively stable diet quality (0 to 3% improvement), in the 12-year period were the following: 0.91 (95% confidence interval [CI], 0.85 to 0.97) according to changes in the Alternate Healthy Eating Index score, 0.84 (95 CI%, 0.78 to 0.91) according to changes in the Alternate Mediterranean Diet score, and 0.89 (95% CI, 0.84 to 0.95) according to changes in the DASH score. A 20-percentile increase in diet scores (indicating an improved quality of diet) was significantly associated with a reduction in total mortality of 8 to 17% with the use of the three diet indexes and a 7 to 15% reduction in the risk of death from cardiovascular disease with the use of the Alternate Healthy Eating Index and Alternate Mediterranean Diet. Among participants who maintained a high-quality diet over a 12-year period, the risk of death from any cause was significantly lower - by 14% (95% CI, 8 to 19) when assessed with the Alternate Healthy Eating Index score, 11% (95% CI, 5 to 18) when assessed with the Alternate Mediterranean Diet score, and 9% (95% CI, 2 to 15) when assessed with the DASH score - than the risk among participants with consistently low diet scores over time. Improved diet quality over 12 years was
Rubano, Jerry A; Vosswinkel, James A; McCormack, Jane E; Huang, Emily C; Shapiro, Marc J; Jawa, Randeep S
The prevalence and outcomes of trauma patients requiring an unplanned return to the intensive care unit (ICU) and those initially admitted to a step-down unit or floor and subsequently upgraded to the ICU, collectively termed unplanned ICU (UP-ICU) admission, are largely unknown. A retrospective review of the trauma registry of a suburban regional trauma center was conducted for adult patients who were admitted between 2007 and 2013, focusing on patients requiring ICU admission. Prehospital or emergency department intubations and patients undergoing surgery immediately after emergency room evaluation were excluded. Of 5411 admissions, there were 212 UP-ICU admissions, 541 planned ICU (PL-ICU) admissions, and 4658 that were never admitted to the ICU (NO-ICU). Of the 212 UP-ICU admits, 19.8% were unplanned readmissions to the ICU. Injury Severity Score was significantly different between PL-ICU (16), UP-ICU (13), and NO-ICU (9) admits. UP-ICU patients had significantly more often major (Abbreviated Injury Score ≥ 3) head/neck injury (46.7%) and abdominal injury (9.0%) than the NO-ICU group (22.5%, 3.4%), but significantly less often head/neck (59.5%) and abdominal injuries (17.9%) than PL-ICU patients. Major chest injury in the UP-ICU group (27.8%) occurred at a statistically comparable rate to PL-ICU group (31.6%) but more often than the NO-ICU group (14.7%). UP-ICU patients also significantly more often underwent major neurosurgical (10.4% vs 0.7%), thoracic (0.9% vs 0.1%), and abdominal surgery (8.5% vs 0.4%) than NO-ICU patients. Meanwhile, the PL-ICU group had statistically comparable rates of neurosurgical (6.8%) and thoracic surgical (0.9%) procedures but lower major abdominal surgery rate (2.0%) than the UP-ICU group. UP-ICU admission occurred at a median of 2 days following admission. UP-ICU median hospital LOS (15 days), need for mechanical ventilation (50.9%), and in-hospital mortality (18.4%) were significantly higher than those in the PL-ICU (9 days
... I Waiting So Long? Admission to the Hospital Heroes on Medicine's Front Line Observation Emergency Care Fact ... The dispatcher may need more information. Teach your children how to place an emergency call, in case ...
Full Text Available Since 2014, there have been admission tests in mathematics for applicants to the Estonian University of Life Sciences for Geodesy, Land Management and Real Estate Planning; Civil Engineering; Hydraulic Engineering and Water Pollution Control; Engineering and Technetronics curricula. According to admission criteria, the test must be taken by students who have not passed the specific mathematics course state exam or when the score was less than 20 points. The admission test may also be taken by those who wish to improve their state exam score. In 2016, there were 126 such applicants of whom 63 took the test. In 2015, the numbers were 129 and 89 and in 2014 150 and 47 accordingly. The test was scored on scale of 100. The arithmetic average of the score was 30.6 points in 2016, 29.03 in 2015 and 18.84 in 2014. The test was considered to be passed with 1 point in 2014 and 20 points in 2015 and 2016. We analyzed test results and gave examples of problems which were solved exceptionally well or not at all.
Barfod, Charlotte; Lauritzen, Marlene Mp; Danker, Jakob K
(range 1-123). The proportion of patients admitted to Intensive Care Unit was 1.6% (95% CI 1.2-2.0), 1.8% (95% CI 1.5-2.2) died within 7 days, and 4.2% (95% CI 3.7-4.7) died within 28 days after admission. CONCLUSIONS: Despite challenges of data registration, we succeeded in creating a database...... outcome. A likely explanation is the difficulty in retrieving all relevant information from one database. The objective of this article was 1) to describe the formation and design of the 'Acute Admission Database', and 2) to characterize the cohort included. METHODS: All adult patients triaged...
Bijwaard, G.E.; Myrskylä, M.; Tynelius, P.; Rasmussen, F.
A negative educational gradient has been found for many causes of death. This association may be partly explained by confounding factors that affect both educational attainment and mortality. We correct the cause-specific educational gradient for observed individual background and unobserved family
Jepsen, Britta; Lomborg, Kirsten; Engberg, Marianne
Background: In many countries, medical authorities are responsible for involuntary admissions of mentally ill patients. Nonetheless, very little is known about GPs' experiences with involuntary admission. Aim: The aim of the present study was to explore GP's experiences from participating in invo...... by the psychiatric system. Conclusion: The unpleasant experiences and induced feelings resulting from involuntary admissions reflect an undesirable and stressful working environment.......Background: In many countries, medical authorities are responsible for involuntary admissions of mentally ill patients. Nonetheless, very little is known about GPs' experiences with involuntary admission. Aim: The aim of the present study was to explore GP's experiences from participating...... in involuntary admissions. Setting: General practice, Aarhus, Denmark. Method: One focus group interview and six individual interviews were conducted with 13 Danish GPs, who had recently sectioned one of their own patients. Results: GPs experienced stress and found the admission procedure time consuming...
Full Text Available In our paper there is an emphasis on simulations of admission control methods in MATLAB environment. The main task of admission control method is to make a decision if the connection requiring network access should be accepted to the network or the access should be rejected. If the connection is accepted to the network, the admission control has to ensure that Quality of Service of this connection will be satisfied, as well as Quality of Service of all other existing connections. We have observed several Measurement based admission control algorithms and the result is the identification of the suitable algorithm which can estimate the required bandwidth.
that documents the relevance of theory and illustrates how to apply optimal admission procedures. Indirect gains from optimal admission procedures include the potential for increasing entire cohorts of students' probability of graduating with a higher education degree, thereby increasing the skill level...
Ban, Jie; Xu, Dandan; He, Mike Z; Sun, Qinghua; Chen, Chen; Wang, Wentao; Zhu, Pengfei; Li, Tiantian
Although existing studies have linked high temperature to mortality in a small number of regions, less evidence is available on the variation in the associations between high temperature exposure and cause-specific mortality of multiple regions in China. Our study focused on the use of time series analysis to quantify the association between high temperature and different cause-specific mortalities for susceptible populations for 43 counties in China. Two-stage analyses adopting a distributed lag non-linear model (DLNM) and a meta-analysis allowed us to obtain county-specific estimates and national-scale pooled estimates of the nonlinear temperature-mortality relationship. We also considered different populations stratified by age and sex, causes of death, absolute and relative temperature patterns, and potential confounding from air pollutants. All of the observed cause-specific mortalities are significantly associated with higher temperature. The estimated effects of high temperature on mortality varied by spatial distribution and temperature patterns. Compared with the 90th percentile temperature, the overall relative risk (RR) at the 99th percentile temperature for non-accidental mortality is 1.105 (95%CI: 1.089, 1.122), for circulatory disease is 1.107 (95%CI: 1.081, 1.133), for respiratory disease is 1.095 (95%CI: 1.050, 1.142), for coronary heart disease is 1.073 (95%CI: 1.047, 1.099), for acute myocardial infarction is 1.072 (95%CI: 1.042, 1.104), and for stroke is 1.095 (95%CI: 1.052, 1.138). Based on our findings, we believe that heat-related health effect in China is a significant issue that requires more attention and allocation of existing resources. Copyright © 2017 Elsevier Ltd. All rights reserved.
Walsh, Daniel P.; Norton, Andrew S.; Storm, Daniel J.; Van Deelen, Timothy R.; Heisy, Dennis M.
Implicit and explicit use of expert knowledge to inform ecological analyses is becoming increasingly common because it often represents the sole source of information in many circumstances. Thus, there is a need to develop statistical methods that explicitly incorporate expert knowledge, and can successfully leverage this information while properly accounting for associated uncertainty during analysis. Studies of cause-specific mortality provide an example of implicit use of expert knowledge when causes-of-death are uncertain and assigned based on the observer's knowledge of the most likely cause. To explicitly incorporate this use of expert knowledge and the associated uncertainty, we developed a statistical model for estimating cause-specific mortality using a data augmentation approach within a Bayesian hierarchical framework. Specifically, for each mortality event, we elicited the observer's belief of cause-of-death by having them specify the probability that the death was due to each potential cause. These probabilities were then used as prior predictive values within our framework. This hierarchical framework permitted a simple and rigorous estimation method that was easily modified to include covariate effects and regularizing terms. Although applied to survival analysis, this method can be extended to any event-time analysis with multiple event types, for which there is uncertainty regarding the true outcome. We conducted simulations to determine how our framework compared to traditional approaches that use expert knowledge implicitly and assume that cause-of-death is specified accurately. Simulation results supported the inclusion of observer uncertainty in cause-of-death assignment in modeling of cause-specific mortality to improve model performance and inference. Finally, we applied the statistical model we developed and a traditional method to cause-specific survival data for white-tailed deer, and compared results. We demonstrate that model selection
NN, NN; Whitlock, Gary; Lewington, Sarah
BACKGROUND: The main associations of body-mass index (BMI) with overall and cause-specific mortality can best be assessed by long-term prospective follow-up of large numbers of people. The Prospective Studies Collaboration aimed to investigate these associations by sharing data from many studies....... METHODS: Collaborative analyses were undertaken of baseline BMI versus mortality in 57 prospective studies with 894 576 participants, mostly in western Europe and North America (61% [n=541 452] male, mean recruitment age 46 [SD 11] years, median recruitment year 1979 [IQR 1975-85], mean BMI 25 [SD 4] kg...
Nyaguara O. Amek
Full Text Available Background: Assessing the progress in achieving the United Nation's Millennium Development Goals in terms of population health requires consistent and reliable information on cause-specific mortality, which is often rare in resource-constrained countries. Health and demographic surveillance systems (HDSS have largely used medical personnel to review and assign likely causes of death based on the information gathered from standardized verbal autopsy (VA forms. However, this approach is expensive and time consuming, and it may lead to biased results based on the knowledge and experience of individual clinicians. We assessed the cause-specific mortality for children under 5 years old (under-5 deaths in Siaya County, obtained from a computer-based probabilistic model (InterVA-4. Design: Successfully completed VA interviews for under-5 deaths conducted between January 2003 and December 2010 in the Kenya Medical Research Institute/US Centers for Disease Control and Prevention HDSS were extracted from the VA database and processed using the InterVA-4 (version 4.02 model for interpretation. Cause-specific mortality fractions were then generated from the causes of death produced by the model. Results: A total of 84.33% (6,621 childhood deaths had completed VA data during the study period. Children aged 1–4 years constituted 48.53% of all cases, and 42.50% were from infants. A single cause of death was assigned to 89.18% (5,940 of cases, 8.35% (556 of cases were assigned two causes, and 2.10% (140 were assigned ‘indeterminate’ as cause of death by the InterVA-4 model. Overall, malaria (28.20% was the leading cause of death, followed by acute respiratory infection including pneumonia (25.10%, in under-5 children over the study period. But in the first 5 years of the study period, acute respiratory infection including pneumonia was the main cause of death, followed by malaria. Similar trends were also reported in infants (29 days–11 months and
Thorsteinsson, Kristinn; Andreasen, Jan Jesper; Torp-Pedersen, Christian
O5 Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery: A nationwide cohort study Kristinn Thorsteinsson, Jan Jesper Andreasen, Christian Torp Pedersen, Kirsten Fonager, Rikke Nørmark Mortensen, Kristian Kragholm, Gunnar Gislason, Lars Køber....... Aalborg, Denmark Background: Data on nursing home admission in patients >80 years of age after isolated coronary artery bypass grafting (CABG) are scarce. Aim: The purpose of this study was to evaluate longevity and subsequent admission to nursing home stratified by age in a nationwide CABG cohort....... Methods: All patients who underwent isolated CABG in 1996-2012 in Denmark were identified through nationwide administrative registers and included. The cumulative incidence of admission to a nursing home after CABG was estimated. A cause specific Cox-regression model was constructed to identify predictors...
Sankar, M J; Natarajan, C K; Das, R R; Agarwal, R; Chandrasekaran, A; Paul, V K
About 99% of neonatal deaths occur in low- and middle-income countries. There is a paucity of information on the exact timing of neonatal deaths in these settings. The objective of this review was to determine the timing of overall and cause-specific neonatal deaths in developing country settings. We searched MEDLINE via PubMed, Cochrane CENTRAL, WHOLIS and CABI using sensitive search strategies. Searches were limited to studies involving humans published in the last 10 years. A total of 22 studies were included in the review. Pooled results indicate that about 62% of the total neonatal deaths occurred during the first 3 days of life; the first day alone accounted for two-thirds. Almost all asphyxia-related and the majority of prematurity- and malformation-related deaths occurred in the first week of life (98%, 83% and 78%, respectively). Only one-half of sepsis-related deaths occurred in the first week while one-quarter occurred in each of the second and third to fourth weeks of life. The distribution of both overall and cause-specific mortality did not differ greatly between Asia and Africa. The first 3 days after birth account for about 30% of under-five child deaths. The first week of life accounts for most of asphyxia-, prematurity- and malformation-related mortality and one-half of sepsis-related deaths. PMID:27109087
Whalen, Kristine A; Judd, Suzanne; McCullough, Marjorie L; Flanders, W Dana; Hartman, Terryl J; Bostick, Roberd M
Background: Poor diet quality is associated with a higher risk of many chronic diseases that are among the leading causes of death in the United States. It has been hypothesized that evolutionary discordance may account for some of the higher incidence and mortality from these diseases. Objective: We investigated associations of 2 diet pattern scores, the Paleolithic and the Mediterranean, with all-cause and cause-specific mortality in the REGARDS (REasons for Geographic and Racial Differences in Stroke) study, a longitudinal cohort of black and white men and women ≥45 y of age. Methods: Participants completed questionnaires, including a Block food-frequency questionnaire (FFQ), at baseline and were contacted every 6 mo to determine their health status. Of the analytic cohort ( n = 21,423), a total of 2513 participants died during a median follow-up of 6.25 y. We created diet scores from FFQ responses and assessed their associations with mortality using multivariable Cox proportional hazards regression models adjusting for major risk factors. Results: For those in the highest relative to the lowest quintiles of the Paleolithic and Mediterranean diet scores, the multivariable adjusted HRs for all-cause mortality were, respectively, 0.77 (95% CI: 0.67, 0.89; P- trend diets closer to Paleolithic or Mediterranean diet patterns may be inversely associated with all-cause and cause-specific mortality. © 2017 American Society for Nutrition.
The aim of this book is to present the fundamental theoretical results concerning inference rules in deductive formal systems. Primary attention is focused on: admissible or permissible inference rules the derivability of the admissible inference rules the structural completeness of logics the bases for admissible and valid inference rules. There is particular emphasis on propositional non-standard logics (primary, superintuitionistic and modal logics) but general logical consequence relations and classical first-order theories are also considered. The book is basically self-contained and
P. Kim Streatfield
Full Text Available Background: Childhood mortality, particularly in the first 5 years of life, is a major global concern and the target of Millennium Development Goal 4. Although the majority of childhood deaths occur in Africa and Asia, these are also the regions where such deaths are least likely to be registered. The INDEPTH Network works to alleviate this problem by collating detailed individual data from defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective: To present a description of cause-specific mortality rates and fractions over the first 15 years of life as documented by INDEPTH Network sites in sub-Saharan Africa and south-east Asia. Design: All childhood deaths at INDEPTH sites are routinely registered and followed up with verbal autopsy (VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provided person-time denominators for mortality rates. Cause-specific mortality rates and cause-specific mortality fractions are presented according to WHO 2012 VA cause groups for neonatal, infant, 1–4 year and 5–14 year age groups. Results: A total of 28,751 childhood deaths were documented during 4,387,824 person-years over 18 sites. Infant mortality ranged from 11 to 78 per 1,000 live births, with under-5 mortality from 15 to 152 per 1,000 live births. Sites in Vietnam and Kenya accounted for the lowest and highest mortality rates reported. Conclusions: Many children continue to die from relatively preventable causes, particularly in areas with high rates of malaria and HIV/AIDS. Neonatal mortality persists at relatively high, and perhaps sometimes under-documented, rates
Chen, Tsun-Hsuan; Li, Xiao; Zhao, Jing; Zhang, Kai
Cold weather was estimated to account for more than half of weather-related deaths in the U.S. during 2006-2010. Studies have shown that cold-related excessive mortality is especially relevant with decreasing latitude or in regions with mild winter. However, only limited studies have been conducted in the southern U.S. The purpose of our study is to examine impacts of cold weather on mortality in 12 major Texas Metropolitan Areas (MSAs) for the 22-year period, 1990-2011. Our study used a two-stage approach to examine the cold-mortality association. We first applied distributed lag non-linear models (DLNM) to 12 major MSAs to estimate cold effects for each area. A random effects meta-analysis was then used to estimate pooled effects. Age-stratified and cause-specific mortalities were modeled separately for each MSA. Most of the MSAs were associated with an increased risk in mortality ranging from 0.1% to 5.0% with a 1 °C decrease in temperature below the cold thresholds. Higher increased mortality risks were generally observed in MSAs with higher average daily mean temperatures and lower latitudes. Pooled effect estimate was 1.58% (95% Confidence Interval (CI) [0.81, 2.37]) increase in all-cause mortality risk with a 1 °C decrease in temperature. Cold wave effects in Texas were also examined, and several MSAs along the Texas Gulf Coast showed statistically significant cold wave-mortality associations. Effects of cold on all-cause mortality were highest among people over 75 years old (1.86%, 95% CI [1.09, 2.63]). Pooled estimates for cause-specific mortality were strongest in myocardial infarction (4.30%, 95% CI [1.18, 7.51]), followed by respiratory diseases (3.17%, 95% CI [0.26, 6.17]) and ischemic heart diseases (2.54%, 95% CI [1.08, 4.02]). In conclusion, cold weather generally increases mortality risk significantly in Texas, and the cold effects vary with MSAs, age groups, and cause-specific deaths. Copyright © 2017 Elsevier Ltd. All rights reserved.
Hansen, Ann-Brit Eg; Lohse, Nicolai; Gerstoft, Jan
BACKGROUND: Co-infection with hepatitis C in HIV-infected individuals is associated with 3- to 4-fold higher mortality among these patients' siblings, compared with siblings of mono-infected HIV-patients or population controls. This indicates that risk factors shared by family members partially...... account for the excess mortality of HIV/HCV-co-infected patients. We aimed to explore the causes of death contributing to the excess sibling mortality. METHODOLOGY AND PRINCIPAL FINDINGS: We retrieved causes of death from the Danish National Registry of Deaths and estimated cause-specific excess mortality...... rates (EMR) for siblings of HIV/HCV-co-infected individuals (n = 436) and siblings of HIV mono-infected individuals (n = 1837) compared with siblings of population controls (n = 281,221). Siblings of HIV/HCV-co-infected individuals had an all-cause EMR of 3.03 (95% CI, 1.56-4.50) per 1,000 person...
Hansen, Ann-Brit Eg; Lohse, Nicolai; Gerstoft, Jan
BACKGROUND: Co-infection with hepatitis C in HIV-infected individuals is associated with 3- to 4-fold higher mortality among these patients' siblings, compared with siblings of mono-infected HIV-patients or population controls. This indicates that risk factors shared by family members partially...... account for the excess mortality of HIV/HCV-co-infected patients. We aimed to explore the causes of death contributing to the excess sibling mortality. METHODOLOGY AND PRINCIPAL FINDINGS: We retrieved causes of death from the Danish National Registry of Deaths and estimated cause-specific excess mortality...... as underlying cause of death. Siblings of HIV-mono-infected individuals had an all-cause EMR of 0.60 (0.16-1.05) compared with siblings of controls. This modest excess mortality...
Lee, Ye Rin; Kim, Young Ae; Park, So Youn; Oh, Chang Mo; Kim, Young Eun; Oh, In Hwan
Years of life lost (YLLs) are estimated based on mortality and cause of death (CoD); therefore, it is necessary to accurately calculate CoD to estimate the burden of disease. The garbage code algorithm was developed by the Global Burden of Disease (GBD) Study to redistribute inaccurate CoD and enhance the validity of CoD estimation. This study aimed to estimate cause-specific mortality rates and YLLs in Korea by applying a modified garbage code algorithm. CoD data for 2010-2012 were used to calculate the number of deaths. The garbage code algorithm was then applied to calculate target cause (i.e., valid CoD) and adjusted CoD using the garbage code redistribution. The results showed that garbage code deaths accounted for approximately 25% of all CoD during 2010-2012. In 2012, lung cancer contributed the most to cause-specific death according to the Statistics Korea. However, when CoD was adjusted using the garbage code redistribution, ischemic heart disease was the most common CoD. Furthermore, before garbage code redistribution, self-harm contributed the most YLLs followed by lung cancer and liver cancer; however, after application of the garbage code redistribution, though self-harm was the most common leading cause of YLL, it is followed by ischemic heart disease and lung cancer. Our results showed that garbage code deaths accounted for a substantial amount of mortality and YLLs. The results may enhance our knowledge of burden of disease and help prioritize intervention settings by changing the relative importance of burden of disease.
Anne-Marie Schjerning Olsen
Full Text Available BACKGROUND: Non steroidal anti-inflammatory drugs (NSAIDs increase mortality and morbidity after myocardial infarction (MI. We examined cause-specific mortality and morbidity associated with NSAIDs in a nationwide cohort of MI patients. METHODS AND RESULTS: By individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark, patients aged >30 years admitted with first-time MI during 1997-2009 and their subsequent NSAID use were identified. The risk of three cardiovascular specific endpoints: cardiovascular death, the composite of coronary death and nonfatal MI, and the composite of fatal and nonfatal stroke, associated with NSAID use was analyzed by Cox proportional hazard analyses. Of 97,698 patients included 44.0% received NSAIDs during follow-up. Overall use of NSAIDs was associated with an increased risk of cardiovascular death (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.36-1.49. In particular use of the nonselective NSAID diclofenac and the selective cyclooxygenase-2 inhibitor rofecoxib was associated with increased risk of cardiovascular death (HR 1.96 [1.79-2.15] and HR1.66 [1.44-1.91], respectively with a dose dependent increase in risk. Use of ibuprofen was associated with increased risk of cardiovascular death (HR 1.34[1.26-1.44], whereas naproxen was associated with the lowest risk of (e.g., HR 1.27[1.01-1.59]. CONCLUSION: Use of individual NSAIDs is associated with different cause-specific cardiovascular risk and in particular rofecoxib and diclofenac were associated with increased cardiovascular morbidity and mortality. These results support caution with use of all NSAIDs in patients with prior MI.
The mean duration of admission was 3.1 (3) days. 157 patients (89.2%) were discharged to the wards while 19 patients (10.8%) died in the ICU. Significant predictors of mortality were oliguria and use of Vaso-active support. Conclusion: Ninety percent (90%) of ICU deaths in general surgery occur in risk emergency surgical ...
Indications for admission were uncontrolled diabetes mellitus (39.2%), diabetic foot syndrome (38.6%), hyperglycaemic emergencies(15.7%), and hypoglycaemia (6.5%). In-hospital diabetic mortality was 15% with patients admitted for diabetic foot ulcer accounting for 52.2% of deaths and 80% of those who left against ...
The indications for admission were chronic diabetic complications involving different body systems (of which renal system involvement was the commonest), poorly controlled diabetes, acute emergencies and foot ulcers. Outcome was good in the majority while a case fatality rate of 23.7% was recorded. Conclusion: Chronic ...
... OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 618.300 Admission. (a) General. No person shall, on the basis of sex, be denied admission, or be subjected to discrimination in admission, by any...
Full Text Available Abstract Background The process of data collection and the methods used to assign the cause of death vary significantly among different verbal autopsy protocols, but there are few data to describe the consequences of the choices made. The aim of this study was to objectively define the impact of the format of data presented to physician reviewers on the cause-specific mortality fractions defined by a verbal autopsy-based mortality-surveillance system. Methods Verbal autopsies were done by primary health care workers for all deaths between October 2006 and September 2007 in a community in rural Andhra Pradesh, India (total population about 180,162. Each questionnaire had a structured section, composed of a series of check boxes, and a free-text section, in which a narrative description of the events leading to death was recorded. For each death, a physician coder was presented first with one section and then the other in random order with a 20- to 40-day interval between. A cause of death was recorded for each data format at the level of ICD 10 chapter headings or else the death was documented as unclassified. After another 20- to 40-day interval, both the structured and free-text sections of the questionnaire were presented together and an index cause of death was assigned. Results In all, 1,407 verbal autopsies were available for analysis, representing 94% of all deaths recorded in the population that year. An index cause of death was assigned using the combined data for 1,190 with the other 217 remaining unclassified. The observed cause-specific mortality fractions were the same regardless of whether the structured, free-text or combined data sources were used. At the individual level, the assignments made using the structured format matched the index in 1,012 (72% of cases with a kappa statistic of 0.66. For the free-text format, the corresponding figures were 989 (70% and 0.64. Conclusions The format of the verbal autopsy data used to assign
M. A. Beydoun
Full Text Available Abstract Background Studies uncovering factors beyond socio-economic status (SES that would explain racial and ethnic disparities in mortality are scarce. Methods Using prospective cohort data from the Third National Health and Nutrition Examination Survey (NHANES III, we examined all-cause and cause-specific mortality disparities by race, mediation through key factors and moderation by age (20–49 vs. 50+, sex and poverty status. Cox proportional hazards, discrete-time hazards and competing risk regression models were conducted (N = 16,573 participants, n = 4207 deaths, Median time = 170 months (1–217 months. Results Age, sex and poverty income ratio-adjusted hazard rates were higher among Non-Hispanic Blacks (NHBs vs. Non-Hispanic Whites (NHW. Within the above-poverty young men stratum where this association was the strongest, the socio-demographic-adjusted HR = 2.59, p < 0.001 was only partially attenuated by SES and other factors (full model HR = 2.08, p = 0.003. Income, education, diet quality, allostatic load and self-rated health, were among key mediators explaining NHB vs. NHW disparity in mortality. The Hispanic paradox was observed consistently among women above poverty (young and old. NHBs had higher CVD-related mortality risk compared to NHW which was explained by factors beyond SES. Those factors did not explain excess risk among NHB for neoplasm-related death (fully adjusted HR = 1.41, 95 % CI: 1.02–2.75, p = 0.044. Moreover, those factors explained the lower risk of neoplasm-related death among MA compared to NHW, while CVD-related mortality risk became lower among MA compared to NHW upon multivariate adjustment. Conclusions In sum, racial/ethnic disparities in all-cause and cause-specific mortality (particularly cardiovascular and neoplasms were partly explained by socio-demographic, SES, health-related and dietary factors, and differentially by age, sex and poverty strata.
Patel, Shaili K; Kacheriwala, Samir M; Duttaroy, Dipesh D
The objective of this study was to conduct an audit of Surgical Intensive Care Unit (SICU) for identifying the admission risk factors and evaluating the outcomes of postoperative surgical patients. This was a prospective, observational study. This study was conducted at SICU of a 1500-bedded tertiary care university hospital in Western India. Two hundred and forty patients admitted to the SICU postoperatively over a period of 15 months. Planned and unplanned postoperative SICU admission rate was 4.45% and 0.09% of the 5284 patients operated. Indications for planned admissions included preoperative medical illnesses, anticipated blood loss, and anticipated mechanical ventilation while unpredicted intraoperative hypotension was the principal cause of unplanned admittance. Univariate analysis for two groups of the American Society of Anesthesiologists (ASA) physical status indicated that advanced age, high American College of Cardiology/American Heart Association (ACC/AHA) surgical risk, emergency surgery, planned admissions, and mortality were related to high ASA class. Analysis for ACC/AHA surgical risk showed association of high ACC/AHA surgical risk with advanced age, male gender, high ASA physical status, emergency surgery, planned admissions, and mortality. High mortality was observed in patients with SICU stay of >7 days (75.86%) and readmitted cases (72.73%). The need for postoperative critical care is significantly higher in males, elderly, patients with poor preoperative risk stratification scores, preexisting medical illness, major intraoperative hemorrhage, hypotension requiring inotropic support, perioperative respiratory problems and patients undergoing abdominal, trauma, and emergent surgeries. A larger study inclusive of other surgical subspecialties would aid in optimal decision-making for admissions to the SICU.
Nielsen, Naja Rod; Kristensen, Tage S; Schnohr, Peter
The authors assessed the effect of psychological stress on total and cause-specific mortality among men and women. In 1981-1983, the 12,128 Danish participants in the Copenhagen City Heart Study were asked two questions on stress intensity and frequency and were followed in a nationwide registry...... until 2004, with stress and mortality (p = 0.02). After adjustments, men with high stress versus low stress had higher all-cause mortality (hazard ratio (HR) = 1.32, 95% confidence interval (CI): 1.15, 1.52). This finding...... was most pronounced for deaths due to respiratory diseases (high vs. low stress: HR = 1.79, 95% CI: 1.10, 2.91), external causes (HR = 3.07, 95% CI: 1.65, 5.71), and suicide (HR = 5.91, 95% CI: 2.47, 14.16). High stress was related to a 2.59 (95% CI: 1.20, 5.61) higher risk of ischemic heart disease...
Trickey, Adam; May, Margaret T; Vehreschild, Jorg-Janne
OBJECTIVES: To estimate mortality rates and prognostic factors in HIV-positive patients who started combination antiretroviral therapy between 1996-1999 and survived for more than ten years. METHODS: We used data from 18 European and North American HIV cohort studies contributing to the Antiretro......OBJECTIVES: To estimate mortality rates and prognostic factors in HIV-positive patients who started combination antiretroviral therapy between 1996-1999 and survived for more than ten years. METHODS: We used data from 18 European and North American HIV cohort studies contributing...... to the Antiretroviral Therapy Cohort Collaboration. We followed up patients from ten years after start of combination antiretroviral therapy. We estimated overall and cause-specific mortality rate ratios for age, sex, transmission through injection drug use, AIDS, CD4 count and HIV-1 RNA. RESULTS: During 50,593 person...... mortality in models adjusted for patient characteristics ten years after start of antiretroviral therapy. The most frequent causes of death (among 340 classified) were non-AIDS cancer, AIDS, cardiovascular, and liver-related disease. Older age was strongly associated with cardiovascular mortality, injecting...
Loftfield, Erikka; Freedman, Neal D; Graubard, Barry I; Guertin, Kristin A; Black, Amanda; Huang, Wen-Yi; Shebl, Fatma M; Mayne, Susan T; Sinha, Rashmi
Concerns about high caffeine intake and coffee as a vehicle for added fat and sugar have raised questions about the net impact of coffee on health. Although inverse associations have been observed for overall mortality, data for cause-specific mortality are sparse. Additionally, few studies have considered exclusively decaffeinated coffee intake or use of coffee additives. Coffee intake was assessed at baseline by self-report in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Hazard ratios were estimated using Cox proportional hazards models. Among 90,317 US adults without cancer at study baseline (1998-2001) or history of cardiovascular disease at study enrollment (1993-2001), 8,718 deaths occurred during 805,644 person-years of follow-up from 1998 through 2009. Following adjustment for smoking and other potential confounders, coffee drinkers, as compared with nondrinkers, had lower hazard ratios for overall mortality (coffee and coffee additives. Inverse associations were observed for deaths from heart disease, chronic respiratory diseases, diabetes, pneumonia and influenza, and intentional self-harm, but not cancer. Coffee may reduce mortality risk by favorably affecting inflammation, lung function, insulin sensitivity, and depression. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
Loftfield, Erikka; Freedman, Neal D.; Graubard, Barry I.; Guertin, Kristin A.; Black, Amanda; Huang, Wen-Yi; Shebl, Fatma M.; Mayne, Susan T.; Sinha, Rashmi
Abstract Concerns about high caffeine intake and coffee as a vehicle for added fat and sugar have raised questions about the net impact of coffee on health. Although inverse associations have been observed for overall mortality, data for cause-specific mortality are sparse. Additionally, few studies have considered exclusively decaffeinated coffee intake or use of coffee additives. Coffee intake was assessed at baseline by self-report in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Hazard ratios were estimated using Cox proportional hazards models. Among 90,317 US adults without cancer at study baseline (1998–2001) or history of cardiovascular disease at study enrollment (1993–2001), 8,718 deaths occurred during 805,644 person-years of follow-up from 1998 through 2009. Following adjustment for smoking and other potential confounders, coffee drinkers, as compared with nondrinkers, had lower hazard ratios for overall mortality (coffee and coffee additives. Inverse associations were observed for deaths from heart disease, chronic respiratory diseases, diabetes, pneumonia and influenza, and intentional self-harm, but not cancer. Coffee may reduce mortality risk by favorably affecting inflammation, lung function, insulin sensitivity, and depression. PMID:26614599
Hansen, Ann-Brit Eg; Lohse, Nicolai; Gerstoft, Jan
BACKGROUND: Co-infection with hepatitis C in HIV-infected individuals is associated with 3- to 4-fold higher mortality among these patients' siblings, compared with siblings of mono-infected HIV-patients or population controls. This indicates that risk factors shared by family members partially...... account for the excess mortality of HIV/HCV-co-infected patients. We aimed to explore the causes of death contributing to the excess sibling mortality. METHODOLOGY AND PRINCIPAL FINDINGS: We retrieved causes of death from the Danish National Registry of Deaths and estimated cause-specific excess mortality...... as underlying cause of death. Siblings of HIV-mono-infected individuals had an all-cause EMR of 0.60 (0.16-1.05) compared with siblings of controls. This modest excess mortality was due to deaths from an unknown cause [EMR = 0.28 (0.07-0.48)], deaths from substance abuse [EMR = 0.19 (-0.04-0.43)], and unnatural...
Wohl, David A.; Schoenbach, Victor J.
Purpose We compared mortality rates among state prisoners and other state residents to identify prisoners’ healthcare needs Methods We linked North Carolina prison records with state death records for 1995-2005 to estimate all-cause and cause-specific death rates among Black and White male prisoners aged 20-79 years, and used standardized mortality ratios (SMRs) to compare these observed deaths with the expected number based on death rates among state residents Results The all-cause SMR of Black prisoners was 0.52 (95%CI: 0.48 0.57), with fewer deaths than expected from accidents, homicides, cardiovascular disease and cancer. The all-cause SMR of White prisoners was 1.12 (95%CI: 1.01, 1.25) with fewer deaths than expected for accidents, but more deaths than expected from viral hepatitis, liver disease, cancer, chronic lower respiratory disease, and HIV. Conclusions Mortality of Black prisoners was lower than that of Black state residents for both traumatic and chronic causes of death. Mortality of White prisoners was lower than that of White state residents for accidents, but higher for several chronic causes of death. Future studies should investigate the effect of prisoners’ pre-incarceration and in-prison morbidity, the prison environment, and prison healthcare on prisoners’ patterns of mortality. PMID:21737304
Abdullah, Asnawi; Wolfe, Rory; Stoelwinder, Johannes U
) of the Framingham Cohort Study were followed up every 2 years from 1948 for up to 48 years. The association between obesity duration and all-cause and cause-specific mortality was analysed using time-dependent Cox models adjusted for body mass index. The role of biological intermediates and chronic diseases...... was also explored. RESULTS: The adjusted hazard ratio (HR) for mortality increased as the number of years lived with obesity increased. For those who were obese for 1-4.9, 5-14.9, 15-24.9 and =25 years of the study follow-up period, adjusted HRs for all-cause mortality were 1.51 [95% confidence interval...... (CI) 1.27-1.79], 1.94 (95% CI 1.71-2.20), 2.25 (95% CI 1.89-2.67) and 2.52 (95% CI 2.08-3.06), respectively, compared with those who were never obese. A dose-response relation between years of duration of obesity was also clear for all-cause, cardiovascular, cancer and other-cause mortality. For every...
Rieke, Katherine; Smolsky, Ann; Bock, Erin; Erkes, Laura Peet; Porterfield, Erin; Watanabe-Galloway, Shinobu
Individuals experiencing chronic homelessness may utilize hospital services more frequently than the general population. Understanding the benefits of providing permanent supportive housing to these individuals can lead to improved services for this population. This study examined the effect of supportive housing placement on hospital admissions of adults who were homeless. Admissions were examined for a period of one-year pre- and postsupportive housing placement for 23 adults. Results showed a reduction in the number of emergency department admissions and an increase in outpatient admissions during the year following housing placement, indicating that supportive housing may encourage more appropriate use of health care services.
Defines sex discrimination in higher education in the following areas: admissions and Title IX provisions, types of discrimination in admissions, additional factors that affect admissions policies, affirmative recruiting and preference admissions, and how to end discrimination in admissions. (PG)
Feb 1, 2013 ... interdisciplinary topics to serve as a platform for attractive career opportunities in academia and industry. Applications are invited for admission to the four-year B S programme at the Institute. Eligibility, selection criteria and other details are available at our website http://www.iisc.ernet.in/ug. ELIGIBILITY.
This paper constructs higher education admission rules that maximise graduation rates and thus increase the skill level of the work force. An application shows that students with a low level in mathematics in secondary school ought to find it easier to be admitted to an economics programme than t...
Jurajda, Štěpán; Münich, Daniel
Roč. 29, č. 6 (2010), s. 1100-1109 ISSN 0272-7757 R&D Projects: GA MŠk LC542 Institutional research plan: CEZ:MSM0021620846 Keywords : admissions to school * alphabetical order * order effects Subject RIV: AH - Economics Impact factor: 1.066, year: 2010
Newcomb, Theodore M.
Institutions of higher education will have to change themselves radically if they are seriously interested in instituting open admissions policies, and one of the biggest obstacles to creating a learning environment conducive to a new kind of student will be overcoming institutional pride in its own elitism. Students have traditionally entered the…
Willingham, Warren W.; Breland, Hunter M.
The extent to which personal and academic factors are important in college admission decisions was studied in 1978, based on data on 25,000 applicants to 9 colleges (Colgate University, Williams College, Ohio Wesleyan University, Kenyon College, Kalamazoo College, Occidental College, Hartwick College, University of Richmond, and Bucknell…
Admission haematological abnormalities and postoperative outcomes in neonates with acute surgical conditions in Alexandria, Egypt. HL Wella, SMM Farahat. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals ...
Bijwaard, Govert E; Myrskylä, Mikko; Tynelius, Per; Rasmussen, Finn
A negative educational gradient has been found for many causes of death. This association may be partly explained by confounding factors that affect both educational attainment and mortality. We correct the cause-specific educational gradient for observed individual background and unobserved family factors using an innovative method based on months lost due to a specific cause of death re-weighted by the probability of attaining a higher educational level. We use data on men with brothers from the Swedish Military Conscription Registry (1951-1983), linked to administrative registers. This dataset of some 700,000 men allows us to distinguish between five education levels and many causes of death. The empirical results reveal that raising the educational level from primary to tertiary would result in an additional 20 months of survival between ages 18 and 63. This improvement in mortality is mainly attributable to fewer deaths from external causes. The highly educated gain more than nine months due to the reduction in deaths from external causes, but gain only two months due to the reduction in cancer mortality and four months due to the reduction in cardiovascular mortality. Ignoring confounding would lead to an underestimation of the gains by educational attainment, especially for the less educated. Our results imply that if the education distribution of 50,000 Swedish men from the 1951 cohort were replaced with that of the corresponding 1983 cohort, 22% of the person-years that were lost to death between ages 18 and 63 would have been saved for this cohort. Copyright © 2017 Elsevier Ltd. All rights reserved.
Watt Graham CM
Full Text Available Abstract Background Smoking and consuming alcohol are both related to increased mortality risk. Their combined effects on cause-specific mortality were investigated in a prospective cohort study. Methods Participants were 5771 men aged 35-64, recruited during 1970-73 from various workplaces in Scotland. Data were obtained from a questionnaire and a screening examination. Causes of death were all cause, coronary heart disease (CHD, stroke, alcohol-related, respiratory and smoking-related cancer. Participants were divided into nine groups according to their smoking status (never, ex or current and reported weekly drinking (none, 1-14 units and 15 or more. Cox proportional hazards models were used to obtain relative rates of mortality, adjusted for age and other risk factors. Results In 30 years of follow-up, 3083 men (53.4% died. Compared with never smokers who did not drink, men who both smoked and drank 15+ units/week had the highest all-cause mortality (relative rate = 2.71 (95% confidence interval 2.31-3.19. Relative rates for CHD mortality were high for current smokers, with a possible protective effect of some alcohol consumption in never smokers. Stroke mortality increased with both smoking and alcohol consumption. Smoking affected respiratory mortality with little effect of alcohol. Adjusting for a wide range of confounders attenuated the relative rates but the effects of alcohol and smoking still remained. Premature mortality was particularly high in smokers who drank 15 or more units, with a quarter of the men not surviving to age 65. 30% of men with manual occupations both smoked and drank 15+ units/week compared with only 13% with non-manual ones. Conclusions Smoking and drinking 15+ units/week was the riskiest behaviour for all causes of death.
May, Margaret T.; Vehreschild, Janne; Obel, Niels; Gill, Michael John; Crane, Heidi; Boesecke, Christoph; Samji, Hasina; Grabar, Sophie; Cazanave, Charles; Cavassini, Matthias; Shepherd, Leah; d’Arminio Monforte, Antonella; Smit, Colette; Saag, Michael; Lampe, Fiona; Hernando, Vicky; Montero, Marta; Zangerle, Robert; Justice, Amy C.; Sterling, Timothy; Miro, Jose; Ingle, Suzanne; Sterne, Jonathan A. C.
Objectives To estimate mortality rates and prognostic factors in HIV-positive patients who started combination antiretroviral therapy between 1996–1999 and survived for more than ten years. Methods We used data from 18 European and North American HIV cohort studies contributing to the Antiretroviral Therapy Cohort Collaboration. We followed up patients from ten years after start of combination antiretroviral therapy. We estimated overall and cause-specific mortality rate ratios for age, sex, transmission through injection drug use, AIDS, CD4 count and HIV-1 RNA. Results During 50,593 person years 656/13,011 (5%) patients died. Older age, male sex, injecting drug use transmission, AIDS, and low CD4 count and detectable viral replication ten years after starting combination antiretroviral therapy were associated with higher subsequent mortality. CD4 count at ART start did not predict mortality in models adjusted for patient characteristics ten years after start of antiretroviral therapy. The most frequent causes of death (among 340 classified) were non-AIDS cancer, AIDS, cardiovascular, and liver-related disease. Older age was strongly associated with cardiovascular mortality, injecting drug use transmission with non-AIDS infection and liver-related mortality, and low CD4 and detectable viral replication ten years after starting antiretroviral therapy with AIDS mortality. Five-year mortality risk was AIDS, and transmission via injecting drug use continue to predict higher all-cause and AIDS-related mortality in patients treated with combination antiretroviral therapy for over a decade. Deaths from AIDS and non-AIDS infection are less frequent than deaths from other non-AIDS causes. PMID:27525413
Castro, Elena; Goh, Chee; Leongamornlert, Daniel; Saunders, Ed; Tymrakiewicz, Malgorzata; Dadaev, Tokhir; Govindasami, Koveela; Guy, Michelle; Ellis, Steve; Frost, Debra; Bancroft, Elizabeth; Cole, Trevor; Tischkowitz, Marc; Kennedy, M John; Eason, Jacqueline; Brewer, Carole; Evans, D Gareth; Davidson, Rosemarie; Eccles, Diana; Porteous, Mary E; Douglas, Fiona; Adlard, Julian; Donaldson, Alan; Antoniou, Antonis C; Kote-Jarai, Zsofia; Easton, Douglas F; Olmos, David; Eeles, Rosalind
Germline BRCA mutations are associated with worse prostate cancer (PCa) outcomes; however, the most appropriate management for mutation carriers has not yet been investigated. To evaluate the response of BRCA carriers to conventional treatments for localised PCa by analysing metastasis-free survival (MFS) and cause-specific survival (CSS) following radical prostatectomy (RP) or external-beam radiation therapy (RT). Tumour features and outcomes of 1302 patients with local/locally advanced PCa (including 67 BRCA mutation carriers) were analysed. RP was undergone by 535 patients (35 BRCA); 767 received RT (32 BRCA). Median follow-up was 64 mo. Median survival and 3-, 5-, and 10-yr survival rates were estimated using the Kaplan-Meier method. Generated survival curves were compared using the log-rank test. Cox regression analyses were used to assess the prognostic value of BRCA mutations. A total of 67 BRCA carriers and 1235 noncarriers were included. At 3, 5, and 10 yr after treatment, 97%, 94%, and 84% of noncarriers and 90%, 72%, and 50% of carriers were free from metastasis (pBRCA mutations as an independent prognostic factor for MFS (hazard ratio [HR]: 2.36; 95% confidence interval [CI], 1.38-4.03; p=0.002) and CSS (HR: 2.17; 95% CI, 1.16-4.07; p=0.016). BRCA carriers had worse outcomes than noncarriers when conventionally treated for local/locally advanced PCa. Prostate cancer patients with germline BRCA mutations had worse outcomes than noncarriers when conventionally treated with surgery or radiation therapy. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Vahtera, Jussi; Laine, Sari; Virtanen, Marianna; Oksanen, Tuula; Koskinen, Aki; Pentti, Jaana; Kivimaki, Mika
Objective To examine the association between worktime control and subsequent retirement on health ground (disability pension) among employees. Methods A prospective cohort study of 30 700 public sector employees (78% women) aged 18 to 64 at baseline. Two scores of worktime control, self-assessed and co-worker assessed, were obtained from responses to the baseline survey in 2000-2001 (score range 1 to 5). Information on cause-specific disability pension during follow-up was collected from national registers. Results During a mean follow-up of 4.4 years, 1178 employees were granted disability pension (incidence per 1000 person-years 9.2 in women and 8.7 in men). The most common causes of a disability pension were musculoskeletal disorders (43% of all pensions), mental disorders (25%), tumours (8%), and diseases of the circulatory system (6%) and the nervous system (6%). A 1 unit increase in self-assessed and co-worker assessed worktime control score was associated with a 41-48% lowering of the risk of disabling musculoskeletal disorders in men and 33-35% lowering in women. This association was robust to adjustment for all 17 baseline covariates (in men and women combined, adjusted hazard ratio 0.76, 95% CI 0.67-0.87 and 0.64, 95% CI 0.51-0.79 per 1 unit increase in self-assessed and co-worker assessed worktime control, respectively).Self-assessed worktime control was also associated with the risk of disability retirement due to mental disorders in women, but this association was not replicated using co-workers’ assessment. Disability pensions from other disease categories were not related to control over working times. Conclusions In this cohort of public sector employees, high worktime control among employees was associated with reduced risk of early retirement caused by musculoskeletal disorders independent of baseline characteristics. PMID:19914911
Nordahl, Helene; Lange, Theis; Osler, Merete; Diderichsen, Finn; Andersen, Ingelise; Prescott, Eva; Tjønneland, Anne; Frederiksen, Birgitte Lidegaard; Rod, Naja Hulvej
Differential exposures to behavioral risk factors have been shown to play an important mediating role on the education-mortality relation. However, little is known about the extent to which educational attainment interacts with health behavior, possibly through differential vulnerability. In a cohort study of 76,294 participants 30 to 70 years of age, we estimated educational differences in cause-specific mortality from 1980 through 2009 and the mediating role of behavioral risk factors (smoking, alcohol intake, physical activity, and body mass index). With the use of marginal structural models and three-way effect decomposition, we simultaneously regarded the behavioral risk factors as intermediates and clarified the role of their interaction with educational exposure. Rate differences in mortality comparing participants with low to high education were 1,277 (95% confidence interval = 1,062 to 1,492) per 100,000 person-years for men and 746 (598 to 894) per 100,000 person-years for women. Smoking was the strongest mediator for cardiovascular disease, cancer, and respiratory disease mortality when conditioning on sex, age, and cohort. The proportion mediated through smoking was most pronounced in cancer mortality as a combination of the pure indirect effect, owing to differential exposure (men, 42% [25% to 75%]; women, 36% [17% to 74%]) and the mediated interactive effect, owing to differential vulnerability (men, 18% [2% to 35%], women, 26% [8% to 50%]). The mediating effects through body mass index, alcohol intake, or physical activity were partial and varied for the causes of deaths. Differential exposure and vulnerability should be addressed simultaneously, as these mechanisms are not mutually exclusive and may operate at the same time.
Haukka, Jari; Niskanen, Leo; Auvinen, Anssi
Both diabetes mellitus (DM) and cancer are common diseases and they frequently occur in the same patients. We investigated the all-cause and cause-specific mortality dynamics in relation to baseline DM, statin use and metformin use. The study population consisted of 39,900 incident cancer cases from Finland, 19,822 patients were free of DM at the start of follow-up and 20,078 had DM. Mortality from all causes, and cancer, cardiovascular (CVD) and other causes was analysed using Poisson regression model with the following variables: sex, age, DM, statin and metformin usage in baseline, cancer type and stage and calendar period. Statin usage was associated with a reduced cancer-specific mortality with incidence rate ratio (IRR) 0.72 (95% confidence interval 0.69-0.74), IRR for CVD mortality was 0.95 (0.88-1.02) and for other causes 0.64 (0.56-0.74). In a sub-population of DM patients, IRR for metformin in all-cause mortality was 0.74 (0.71-0.78), in cancer mortality 0.75 (0.72-0.79), in CVD mortality 0.75 (0.68-0.83) and other causes 0.68 (0.60-0.78). In conclusion, our register-based study of survival after cancer diagnosis showed that patients with diabetes had substantially poorer outcome in all measures. An association between baseline statin usage and lower all-cause, cancer and cardiovascular mortality was modified by cancer type. The effect of statin use was largest for breast and colorectal cancer. Metformin usage in a subpopulation of oral antidiabetic users was in general associated with lower mortality, but this association was modified by cancer type. The association was strongest for liver, colorectal and breast cancer. © 2017 UICC.
Arto Y Strandberg
Full Text Available Insulin therapy in type 2 diabetes may increase mortality and cancer incidence, but the impact of different types of basal insulins on these endpoints is unclear. Compared to the traditional NPH insulin, the newer, longer-acting insulin analogues detemir and glargine have shown benefits in randomized controlled trials. Whether these advantages translate into lower mortality among users in real life is unknown.To estimate the differences in all-cause and cause-specific mortality rates between new users of basal insulins in a population-based study in Finland.23 751 individuals aged ≥40 with type 2 diabetes, who initiated basal insulin therapy in 2006-2009 were identified from national registers, with comprehensive data for mortality, causes of death, and background variables. Propensity score matching was performed on characteristics. Follow-up time was up to 4 years (median 1.7 years.2078 deaths incurred. With NPH as reference, the adjusted HRs for all-cause mortality were 0.39 (95% CI, 0.30-0.50 for detemir, and 0.55 (95% CI, 0.44-0.69 for glargine. As compared to glargine, the HR was 0.71 (95% CI, 0.54-0.93 among detemir users. Compared to NPH, the mortality risk for both cardiovascular causes as well as cancer were also significantly lower for glargine, and especially for detemir in adjusted analysis. Furthermore, the results were robust in various sensitivity analyses.In real clinical practice, mortality was substantially higher among users of NPH insulin as compared to insulins detemir or glargine. Considering the large number of patients who require insulin therapy, this difference in risk may have major clinical and public health implications. Due to limitations of the observational study design, further investigation using an interventional study design is warranted.
Strandberg, Arto Y; Hoti, Fabian J; Strandberg, Timo E; Christopher, Solomon; Haukka, Jari; Korhonen, Pasi
Insulin therapy in type 2 diabetes may increase mortality and cancer incidence, but the impact of different types of basal insulins on these endpoints is unclear. Compared to the traditional NPH insulin, the newer, longer-acting insulin analogues detemir and glargine have shown benefits in randomized controlled trials. Whether these advantages translate into lower mortality among users in real life is unknown. To estimate the differences in all-cause and cause-specific mortality rates between new users of basal insulins in a population-based study in Finland. 23 751 individuals aged ≥40 with type 2 diabetes, who initiated basal insulin therapy in 2006-2009 were identified from national registers, with comprehensive data for mortality, causes of death, and background variables. Propensity score matching was performed on characteristics. Follow-up time was up to 4 years (median 1.7 years). 2078 deaths incurred. With NPH as reference, the adjusted HRs for all-cause mortality were 0.39 (95% CI, 0.30-0.50) for detemir, and 0.55 (95% CI, 0.44-0.69) for glargine. As compared to glargine, the HR was 0.71 (95% CI, 0.54-0.93) among detemir users. Compared to NPH, the mortality risk for both cardiovascular causes as well as cancer were also significantly lower for glargine, and especially for detemir in adjusted analysis. Furthermore, the results were robust in various sensitivity analyses. In real clinical practice, mortality was substantially higher among users of NPH insulin as compared to insulins detemir or glargine. Considering the large number of patients who require insulin therapy, this difference in risk may have major clinical and public health implications. Due to limitations of the observational study design, further investigation using an interventional study design is warranted.
Full Text Available Abstract Background Previous research has shown large and increasing relative differences in mortality by marital status in several countries, but few studies have considered trends in cause-specific mortality by marital status among elderly people. Methods The author uses discrete-time hazard regression and register data covering the entire Norwegian population to analyze how associations between marital status and several causes of death have changed for men and women of age 75-89 from 1971-2007. Educational level, region of residence and centrality are included as control variables. There are 804 243 deaths during the 11 102 306 person-years of follow-up. Results Relative to married persons, those who are never married, divorced or widowed have significantly higher mortality for most causes of death. The odds of death are highest for divorcees, followed by never married and widowed. Moreover, the excess mortality among the non-married is higher for men than for women, at least in the beginning of the time period. Relative differences in mortality by marital status have increased from 1971-2007. In particular, the excess mortality of the never married women and, to a lesser extent, men has been rising. The widening of the marital status differentials is most pronounced for mortality resulting from circulatory diseases, respiratory diseases (women, other diseases and external deaths (women. Differences in cancer mortality by marital status have been stable over time. Conclusions Those who are married may have lower mortality because of protective effects of marriage or selection of healthy individuals into marriage, and the importance of such mechanisms may have changed over time. However, with the available data it is not possible to identify the mechanisms responsible for the increasing relative differences in mortality by marital status in Norway.
Full Text Available Abstract Background Socioeconomic inequalities in mortality have increased in recent years in many countries. We examined age-, sex-, and cause-specific mortality rates for social groups in and regions of Scotland to understand the patterning of inequalities and the causes contributing to these inequalities. Methods We used death records for 1980–82, 1991–92 and 2000–02 together with mid-year population estimates for 1981, 1991 and 2001 covering the whole of Scotland to calculate directly standardised mortality rates. Deaths and populations were coded to small areas (postcode sectors and data zones, and deprivation was assessed using area based measures (Carstairs scores and the Scottish Index of Multiple Deprivation. We measured inequalities using rate ratios and the Slope Index of Inequality (SII. Results Substantial overall decreases in mortality rates disguised increases for men aged 15–44 and little change for women at the same ages. The pattern at these ages was mostly attributable to increases in suicides and deaths related to the use of alcohol and drugs. Under 65 a 49% fall in the mortality of men in the least deprived areas contrasted with a fall of just 2% in the most deprived. There were substantial increases in the social gradients for most causes of death. Excess male mortality in the Clydeside region was largely confined to more deprived areas, whilst for women in the region mortality was in line with the Scottish experience. Relative inequalities for men and women were greatest between the ages of 30 and 49. Conclusion General reductions in mortality in the major causes of death (ischaemic heart disease, malignant neoplasms are encouraging; however, such reductions were socially patterned. Relative inequalities in mortality have increased and are greatest among younger adults where deaths related to unfavourable lifestyles call for direct social policies to address poverty.
Schmidt, Thomas; Bech, Camilla Louise Nørgaard; Brabrand, Mikkel
Understanding the use of patient monitoring systems in emergency and acute facilities may help to identify reasons for failure to identify risk patients in these settings. Hence, we investigate factors related to the utilization of automated monitoring for patients admitted to an acute admission...... one measurement were analyzed using quantile regression by looking at the impact of distance from nursing office, number of concurrent patients, wing type (medical/surgical), age, sex, comorbidities, and severity conditioned on how much patients were monitored during their admissions. We registered 11......,848 admissions, of which we were able to link patient monitor readings to 3149 (26.6 %) with 50 % being monitored nursing office had little influence on patients monitored
N. I. Gaponova
Full Text Available Aim. To assess the changes in the costs of treatment of patients with hypertensive crisis (HC in pre-admission care in Moscow from 2005 to 2010. Material and methods. Comparative analysis of the treatment costs was performed depending on outcomes in patients with HC at Moscow Emergency Medical Care Station named after A.S. Puchkov. HC arresting excluding the need of admission was taken into account in addition to antihypertensive effect and safety in evaluation of pre-admission care efficacy. Results. Introduction in practice of modern algorithms of emergency pre-admission care, supply of ambulance crews with modern antihypertensive drugs reduced the rate of admission from 71% in 2005 to 44% in 2010 among patients with HC. Total savings amounted to 403,691,808 rubles. Conclusion. Introduction of modern technologies in the emergency pre-admission care for patients with HC is economically reasonable.
N. I. Gaponova
Full Text Available Aim. To assess the changes in the costs of treatment of patients with hypertensive crisis (HC in pre-admission care in Moscow from 2005 to 2010. Material and methods. Comparative analysis of the treatment costs was performed depending on outcomes in patients with HC at Moscow Emergency Medical Care Station named after A.S. Puchkov. HC arresting excluding the need of admission was taken into account in addition to antihypertensive effect and safety in evaluation of pre-admission care efficacy. Results. Introduction in practice of modern algorithms of emergency pre-admission care, supply of ambulance crews with modern antihypertensive drugs reduced the rate of admission from 71% in 2005 to 44% in 2010 among patients with HC. Total savings amounted to 403,691,808 rubles. Conclusion. Introduction of modern technologies in the emergency pre-admission care for patients with HC is economically reasonable.
Brabrand, Mikkel; Folkestad, Lars; Hallas, Peter
INTRODUCTION: Many emergency departments use validated triage tools. It is currently undocumented if such a practice is common in Danish medical admission units (MAU). The current study was conducted in order to clarify this. MATERIAL AND METHODS: Questionnaire survey with data collected from....... At 87% of the MAUs, a doctor was contacted by the admitting physician, while the contact was the responsibility of a nurse in 13% of MAUs. None of the contacted MAUs used a validated triage tool and 95% answered that they triaged on the basis of individual clinical assessment of patients. However, 22......% answered that selected groups of patients were routinely assessed by a senior physician. CONCLUSION: None of the Danish MAUs uses a validated triage tool to prioritize acutely admitted medical patients. Udgivelsesdato: 2010-May-31...
André I. Wierdsma
Full Text Available Background: Over recent years, the number of compulsory admissions in many countries has increased, probably as a result of the shift from inpatient to outpatient mental health care. This might be mitigated by formal or collaborative relationships between services. Methods: In a retrospective record linkage study, we compared two neighboring districts, varying in level of service integration. Two periods were combined: 1991–1993 and 2001–2003. We included patients aged 18–60, who had a first emergency compulsory admission (n=830. Their psychiatric history was assessed, and service-use after admission was monitored over a 12-month follow-up. Results: Over a 10-year period, compulsory admission rates increased by 47%. Difference in relative increase between the integrated and non-integrated services was 14%. Patient characteristics showed different profiles in the two districts. Length of stay was >10 days shorter in the integrated district, where the proportion of involuntary readmissions decreased more, and where aftercare was swift and provided to about 10% more patients than in the non-integrated district. Conclusions: Services outcomes showed better results where mental healthcare was more integrated. However, limited effects were found and other factors than integration of services may be more important in preventing compulsory admissions.
Chaloupka, Milani; Work, Thierry M.; Balazs, George H.; Murakawa, Shawn K. K.; Morris, Robert
We investigated cause-specific temporal and spatial trends in sea turtle strandings in the Hawaiian Archipelago. Five species of sea turtle were recorded in 3,861 strandings over a 22-year period (1982–2003). Green turtles comprised 97% of these strandings with size and gender composition reflecting the demographic structure of the resident green turtle population and relative green turtle abundance in Hawaiian waters. The cause of strandings was determined by necropsy based on a complete gross external and internal examination. Totally 75% of the 3,732 green turtle strandings were from Oahu where strandings occur year-round. The most common known cause of the green turtle strandings was the tumour-forming disease, fibropapillomatosis (28%) followed by hook-and-line fishing gear-induced trauma (7%), gillnet fishing gear-induced trauma (5%), boat strike (2.5%), and shark attack (2.7%). Miscellaneous causes comprised 5.4% of strandings whereas 49% of green turtle strandings could not be attributed to any known cause. Green turtle strandings attributable to boat strike were more likely from Kauai and Oahu while fibropapilloma strandings were more likely from Oahu and Maui. Hook-and-line gear strandings were more likely from Oahu due to higher per capita inshore fishing effort. The specific mortality rate (conditional probability) for fibropapillomatosis was 88%, 69% for gillnet gear and 52% for hook-and-line gear. The probability of a dead green turtle stranding increased from 1982 but levelled off by the mid-1990s. The declining mortality risk was because the prevalence and severity of fibropapillomatosis has decreased recently and so has the mortality risk attributable to gillnet gear. Despite exposure to disease and inshore fishing gears, the Hawaiian green turtle stock continues to recover following protection since the late 1970s. Nevertheless, measures to reduce incidental capture of sea turtles in coastal Hawaiian fisheries would be prudent, especially since
Cross, Paul C.; Maichak, Eric J.; Rogerson, Jared D.; Irvine, Kathryn M.; Jones, Jennifer D; Heisey, Dennis M.; Edwards, William H.; Scurlock, Brandon M.
Understanding the seasonal timing of disease transmission can lead to more effective control strategies, but the seasonality of transmission is often unknown for pathogens transmitted directly. We inserted vaginal implant transmitters (VITs) in 575 elk (Cervus elaphus canadensis) from 2006 to 2014 to assess when reproductive failures (i.e., abortions or still births) occur, which is the primary transmission route of Brucella abortus, the causative agent of brucellosis in the Greater Yellowstone Ecosystem. Using a survival analysis framework, we developed a Bayesian hierarchical model that simultaneously estimated the total baseline hazard of a reproductive event as well as its 2 mutually exclusive parts (abortions or live births). Approximately, 16% (95% CI = 0.10, 0.23) of the pregnant seropositive elk had reproductive failures, whereas 2% (95% CI = 0.01, 0.04) of the seronegative elk had probable abortions. Reproductive failures could have occurred as early as 13 February and as late as 10 July, peaking from March through May. Model results suggest that less than 5% of likely abortions occurred after 6 June each year and abortions were approximately 5 times more likely in March, April, or May compared to February or June. In western Wyoming, supplemental feeding of elk begins in December and ends during the peak of elk abortions and brucellosis transmission (i.e., Mar and Apr). Years with more snow may enhance elk-to-elk transmission on supplemental feeding areas because elk are artificially aggregated for the majority of the transmission season. Elk-to-cattle transmission will depend on the transmission period relative to the end of the supplemental feeding season, elk seroprevalence, population size, and the amount of commingling. Our statistical approach allowed us to estimate the probability density function of different event types over time, which may be applicable to other cause-specific survival analyses. It is often challenging to assess the
Tsujimoto, Tetsuro; Kajio, Hiroshi; Sugiyama, Takehiro
To assess whether caffeine intake is associated with all-cause and cause-specific mortality. We conducted a prospective cohort study using data from the National Health and Nutrition Examination Survey 1999-2010. Cox proportional hazards models were used to compare the multivariate-adjusted hazard ratios (HRs) of participants with a caffeine intake of 10 to 99, 100 to 199, and 200 mg/d or more with those of participants with a caffeine intake of less than 10 mg/d. In total, 17,594 participants were included, and the mean ± SD and median (interquartile range) follow-up was 6.5±2.8 years and 6.4 (3.6-9.5) years, respectively; 17,568 participants (99.8%) completed the follow-up, and 1310 died. Compared with those who had a caffeine intake of less than 10 mg/d, HRs and 95% CIs for all-cause mortality were significantly lower in participants with a caffeine intake of 10 to 99 mg/d (HR, 0.81; 95% CI, 0.66-1.00; P=.05), 100 to 199 mg/d (HR, 0.63; 95% CI, 0.51-0.78; Pcaffeine intake of 100 to 199 mg/d (HR, 0.46; 95% CI, 0.22-0.93). There was no association between caffeine intake and cardiovascular mortality, whereas the HRs for noncardiovascular mortality were significantly lower in those with a caffeine intake of 10 to 99 mg/d (HR, 0.74; 95% CI, 0.57-0.95; P=.01), 100 to 199 mg/d (HR, 0.60; 95% CI, 0.46-0.77; Pcaffeine intake was associated with a decreased risk of all-cause mortality, regardless of the presence or absence of coffee consumption. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
Ann-Brit Eg Hansen
Full Text Available BACKGROUND: Co-infection with hepatitis C in HIV-infected individuals is associated with 3- to 4-fold higher mortality among these patients' siblings, compared with siblings of mono-infected HIV-patients or population controls. This indicates that risk factors shared by family members partially account for the excess mortality of HIV/HCV-co-infected patients. We aimed to explore the causes of death contributing to the excess sibling mortality. METHODOLOGY AND PRINCIPAL FINDINGS: We retrieved causes of death from the Danish National Registry of Deaths and estimated cause-specific excess mortality rates (EMR for siblings of HIV/HCV-co-infected individuals (n = 436 and siblings of HIV mono-infected individuals (n = 1837 compared with siblings of population controls (n = 281,221. Siblings of HIV/HCV-co-infected individuals had an all-cause EMR of 3.03 (95% CI, 1.56-4.50 per 1,000 person-years, compared with siblings of matched population controls. Substance abuse-related deaths contributed most to the elevated mortality among siblings [EMR = 2.25 (1.09-3.40] followed by unnatural deaths [EMR = 0.67 (-0.05-1.39]. No siblings of HIV/HCV co-infected patients had a liver-related diagnosis as underlying cause of death. Siblings of HIV-mono-infected individuals had an all-cause EMR of 0.60 (0.16-1.05 compared with siblings of controls. This modest excess mortality was due to deaths from an unknown cause [EMR = 0.28 (0.07-0.48], deaths from substance abuse [EMR = 0.19 (-0.04-0.43], and unnatural deaths [EMR = 0.18 (-0.06-0.42]. CONCLUSIONS: HCV co-infection among HIV-infected patients was a strong marker for family-related mortality due to substance abuse and other unnatural causes. To reduce morbidity and mortality in HIV/HCV-co-infected patients, the advances in antiviral treatment of HCV should be accompanied by continued focus on interventions targeted at substance abuse-related risk factors.
Full Text Available Background: The USA is one of only a few advanced economies globally that does not guarantee its workers paid sick leave. While there are plausible reasons why paid sick leave may be linked to mortality, little is known empirically about this association. Methods: In a pooled USA nationally-representative longitudinal sample of 57,323 working adults aged 18–85 years from the National Health Interview Surveys 2000–2002, paid sick leave was examined as a predictor of all-cause and cause-specific mortality. Multivariate Cox proportional hazards models were used to estimate the impact of paid sick leave on mortality. Results: Having paid sick leave through one’s job was associated with 10% (hazards ratio, HR = 0.90; 95% CI = 0.81–0.996; p = 0.04, 14% (HR = 0.86; 95% CI = 0.74–0.99; p = 0.04, and 22% (HR = 0.78; 95% CI = 0.65–0.94; p = 0.01 significantly lower hazards of all-cause mortality after mean follow-up times of 11.1, 6.5, and 4.5 years, respectively. This study further identified associations of paid sick leave with 24% (HR = 0.76; 95% CI = 0.59–0.98; p = 0.03, and 35% (HR = 0.65; 95% CI = 0.44–0.95; p = 0.03 lower hazards of dying from heart diseases and unintentional injuries, respectively. Conclusions: To the author’s knowledge, this study provides the first empirical evidence on the linkages between paid sick leave and mortality and supports protective effects, particularly against heart diseases and unintentional injuries. The most salient association corresponded to a lag period of just less than five years. Social policies that mandate paid sick leave may help to reduce health inequities and alleviate the population burden of mortality among working adults in the USA.
Linet, Martha S; Yin, Song-Nian; Gilbert, Ethel S; Dores, Graça M; Hayes, Richard B; Vermeulen, Roel; Tian, Hao-Yuan; Lan, Qing; Portengen, Lutzen; Ji, Bu-Tian; Li, Gui-Lan; Rothman, Nathaniel
Benzene exposure has been causally linked with acute myeloid leukemia (AML), but inconsistently associated with other hematopoietic, lymphoproliferative and related disorders (HLD) or solid tumors in humans. Many neoplasms have been described in experimental animals exposed to benzene. We used Poisson regression to estimate adjusted relative risks (RR) and the likelihood ratio statistic to derive confidence intervals for cause-specific mortality and HLD incidence in 73,789 benzene-exposed compared with 34,504 unexposed workers in a retrospective cohort study in 12 cities in China. Follow-up and outcome assessment was based on factory, medical and other records. Benzene-exposed workers experienced increased risks for all-cause mortality (RR = 1.1, 95% CI = 1.1, 1.2) due to excesses of all neoplasms (RR = 1.3, 95% CI = 1.2, 1.4), respiratory diseases (RR = 1.7, 95% CI = 1.2, 2.3) and diseases of blood forming organs (RR = ∞, 95% CI = 3.4, ∞). Lung cancer mortality was significantly elevated (RR = 1.5, 95% CI = 1.2, 1.9) with similar RRs for males and females, based on three-fold more cases than in our previous follow-up. Significantly elevated incidence of all myeloid disorders reflected excesses of myelodysplastic syndrome/acute myeloid leukemia (RR = 2.7, 95% CI = 1.2, 6.6) and chronic myeloid leukemia (RR = 2.5, 95% CI = 0.8, 11), and increases of all lymphoid disorders included excesses of non-Hodgkin lymphoma (RR = 3.9, 95%CI = 1.5, 13) and all lymphoid leukemia (RR = 5.4, 95%CI = 1.0, 99). The 28-year follow-up of Chinese benzene-exposed workers demonstrated increased risks of a broad range of myeloid and lymphoid neoplasms, lung cancer, and respiratory diseases and suggested possible associations with other malignant and non-malignant disorders. © 2015 UICC.
Beale, Andrew V.
The development of college admissions requirements during the seventeenth and eighteenth centuries was basically the story of the admission policies and practices at Harvard College. Candidates for admission were examined on their ability to read and translate Latin and Greek, and a careful check was made of their character and background. With…
... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Admission. 113.300 Section 113.300 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NONDISCRIMINATION IN FINANCIAL ASSISTANCE... Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 113.300 Admission. (a) General. No...
In this thesis, we investigate the admissible rules of intermediate logics. On the one hand, one can characterize the admissibility of rules in certain logic, and on the other hand, one can characterize logics through their admissible rules. We take both approaches, and reach new results in both
in the social gradient in the primary admission system, admitting students on the basis of their high school grade point average, and in the secondary admission system, admitting university students based on more qualitative assessments. I find that the secondary higher education admission system does...
Cummins, Niamh Maria
BACKGROUND: Accurate patient diagnosis in the prehospital environment is essential to initiate suitable care pathways. The advanced paramedic (AP) is a relatively recent role in Ireland, and refers to a prehospital practitioner with advanced life-support skills and training. OBJECTIVES: The objectives of this study were to compare the diagnostic decisions of APs with emergency medicine (EM) physicians, and to investigate if APs, as currently trained, can predict the requirement for hospital admission. METHODS: A prospective study was initiated, whereby each emergency ambulance call received via the statutory 999 system was recorded by the attending AP. The AP was asked to provide a clinical diagnosis for each patient, and to predict if hospital admission was required. The data was then cross-referenced with the working diagnosis of the receiving emergency physician and the hospital admission records. RESULTS: A total of 17 APs participated in the study, and 1369 emergency calls were recorded over a 6-month period. Cases where a general practitioner attended the scene were excluded from the concordance analysis. Concordance with the receiving emergency physician represents 70% (525\\/748) for all cases of AP diagnosis, and is mirrored with 70% (604\\/859) correct hospital admission predictions. CONCLUSIONS: AP diagnosis and admission prediction for emergency calls is similar to other emergency medical services systems despite the relative recency of the AP programme in Ireland. Recognition of non-concordance case types may identify priorities for AP education, and drive future AP practice in areas such as \\'treat and refer\\'.
Sixty-seven general paediatric surgical patients were admitted with a male to female ratio of 1.4:1. There were 32 (47.8%) infants, 6(9%) pre-school children and 29(43.3%) older children. There were 57(85.1%) emergency procedures. Of the 40 patients who had documented indications for admission, 25(62.5%) had ...
Bourke, David; Finucane, Gregory; Dysart, Jo; Roxburgh, Richard
We aimed to determine if the appointment of a Huntington's disease (HD) nurse specialist has influenced inpatient admission rates and admission quality at Auckland Hospital. We collated HD inpatient admission data for the 32 months before and after her appointment and compared the quality of cognition, mood, speech/swallowing and safety assessments between admissions where the nurse was and was not involved. After the appointment of the HD nurse there was a 51% reduction in average monthly HD admission rates (p = 0.0009). HD admissions specifically related to HD decreased by 54% (p = 0.005). There was also an improvement in the quality of admissions.
Full Text Available Although increasing numbers of very elderly patients are requiring intensive care, few large sample studies have investigated ICU admission of very elderly patients. Data on pre triage by physicians from other specialities is limited. This observational cohort study aims at examining inter-hospital variability of ICU admission rates and its association with patients' outcomes. All patients over 80 years possibly qualifying for ICU admission who presented to the emergency departments (ED of 15 hospitals in the Paris (France area during a one-year period were prospectively included in the study. Main outcome measures were ICU eligibility, as assessed by the ED and ICU physicians; in-hospital mortality; and vital and functional status 6 months after the ED visit. 2646 patients (median age 86; interquartile range 83-91 were included in the study. 94% of participants completed follow-up (n = 2495. 12.4% (n = 329 of participants were deemed eligible for ICU admission by ED physicians and intensivists. The overall in-hospital and 6-month mortality rates were respectively 27.2% (n = 717 and 50.7% (n = 1264. At six months, 57.5% (n = 1433 of patients had died or had a functional deterioration. Rates of patients deemed eligible for ICU admission ranged from 5.6% to 38.8% across the participating centers, and this variability persisted after adjustment for patients' characteristics. Despite this variability, we found no association between level of ICU eligibility and either in-hospital death or six-month death or functional deterioration. In France, the likelihood that a very elderly person will be admitted to an ICU varies widely from one hospital to another. Influence of intensive care admission on patients' outcome remains unclear.ClinicalTrials.gov NCT00912600.
Full Text Available Background: The admission test (AT has been carried out for many years, but there are still debates about the prognostic value of the test. Therefore, we aimed to examine the value of the AT in predicting the adverse outcome in neonates. Methods: In this cross-sectional study, 425 pregnant women with normal vaginal delivery were studied between2009 and 2014at Vali-e-Asr Hospital. Based on the results, the women were divided into 2groups of normal and abnormal ATs. All the patients were followed up until the birth of their baby, when the status of mother and neonate was determined. The main outcomes of the study were cesarean rate, neonatal intensive care unit (NICU admission, fetus demise, neonatal acidosis, and Apgar score. The independent t-test, chi-square test, Fisher exact test, and logistic regression were used for statistical analysis. The data were analyzed using SPSS (version 17. Results: Of 425 pregnant women studied, 142 (33.4% had abnormal ATs with a mean age of 29 (±4.5 years. Multivariate analysis showed that an abnormal AT was able to predict the incidence of cesarean section, intrauterine growth restriction, turned cord, and Apgar<7, but it could not predict neonatal death and hypoxia. Conclusion: The AT was shown to be a useful screening test with risk factors such as oligohydramnios, bloody amniotic fluid, meconium amniotic fluid, intrauterine growth restriction, and turned cord. Additionally, the test was also able to predict NICU admission and the need for cesarean section, but it could not predict the occurrence of neonatal death.
Schreyer, Kraftin E; Martin, Richard
With increasing attention to the actual cost of delivering care, return-on-investment calculations take on new significance. Boarded patients in the emergency department (ED) are harmful to clinical care and have significant financial opportunity costs. We hypothesize that investment in an admissions holding unit for admitted ED patients not only captures opportunity cost but also significantly lowers direct cost of care. This was a three-phase study at a busy urban teaching center with significant walkout rate. We first determined the true cost of maintaining a staffed ED bed for one patient-hour and compared it to alternative settings. The opportunity cost for patients leaving without being seen was then conservatively estimated. Lastly, a convenience sample of admitted patients boarding in the ED was observed continuously from one hour after decision-to-admit until physical departure from the ED to capture a record of every interaction with a nurse or physician. Personnel costs per patient bed-hour were $58.20 for the ED, $24.80 for an inpatient floor, $19.20 for the inpatient observation unit, and $10.40 for an admissions holding area. An eight-bed holding unit operating at practical capacity would free 57.4 hours of bed space in the ED and allow treatment of 20 additional patients. This could yield increased revenues of $27,796 per day and capture opportunity cost of $6.09 million over 219 days, in return for extra staffing costs of $218,650. Analysis of resources used for boarded patients was determined by continuous observation of a convenience sample of ED-boarded patients, which found near-zero interactions with both nursing and physicians during the boarding interval. Resource expense per ED bed-hour is more than twice that in non-critical care inpatient units. Despite the high cost of available resources, boarded non-critical patients receive virtually no nursing or physician attention. An admissions holding unit is remarkably effective in avoiding the
Full Text Available This paper reports a review of studies on admission criteria for MBA programs. The method consisted in a literary review based on a systematic search in international databases (Emerald, ABI/INFORM Global, ProQuest Education Journals, ProQuest European Business, ProQuest Science Journal, ProQuest Research Library, ProQuest Psychology Journals, ProQuest Social Science Journals and Business Source Complete of studies published from January 1990 to December 2013, which explore the academic performance of students or graduates of MBA programs. A quantitative review was performed. Results show that most researchers studied relations between GMAT (Graduate Management Admission Test and UGPA (Undergraduate Grade Point Average as predictors of GGPA (Graduate Grade Point Average. On the other hand, work experience and personal traits (such as personality, motivation, learning strategies, self-efficacy beliefs and achievement expectations and their relation with GGPA had been less studied, and results are not consistent enough to consider them valid predictors of student performance at this time.
van Monsjou, H.S.; Schaapveld, M.; Hamming-Vrieze, O.; de Boer, J.P.; van den Brekel, M.W.M.; Balm, A.J.M.
Purpose: To assess cause-specific mortality in a large population-based cohort of 14,393 patients treated for squamous cell carcinoma of the oral cavity (OC) or oropharynx (OP) in The Netherlands between 1989 and 2006. Patients and methods: Causes of death were obtained for 94.7% of 9620 patients
van Monsjou, H. S.; Schaapveld, M.; Hamming-Vrieze, O.; de Boer, J. P.; van den Brekel, M. W. M.; Balm, A. J. M.
To assess cause-specific mortality in a large population-based cohort of 14,393 patients treated for squamous cell carcinoma of the oral cavity (OC) or oropharynx (OP) in The Netherlands between 1989 and 2006. Causes of death were obtained for 94.7% of 9620 patients who had died up to January 1,
Bruns, A. H. W.; Oosterheert, J. J.; Cucciolillo, M. C.; el Moussaoui, R.; Groenwold, R. H. H.; Prins, J. M.; Hoepelman, A. I. M.
Insights into long-term mortality, especially into the cause of death after initial recovery from an episode of community-acquired pneumonia (CAP), may help in determining optimal preventive measures in such patients. Prospective observational cohort studies were conducted to compare cause-specific
Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188
Hurt, Lisa; ten Asbroek, Augustinus; Amenga-Etego, Seeba; Zandoh, Charles; Danso, Samuel; Edmond, Karen; Hurt, Chris; Tawiah, Charlotte; Hill, Zelee; Fenty, Justin; Owusu-Agyei, Seth; Campbell, Oona M.; Kirkwood, Betty R.
To determine the effect of weekly low-dose vitamin A supplementation on cause-specific mortality in women of reproductive age in Ghana. A cluster-randomized, triple-blind, placebo-controlled trial was conducted in seven districts of the Brong Ahafo region of Ghana. Women aged 15-45 years who were
Muazzam, Sana; Nasrullah, Muazzam
Gross Domestic Product (GDP) and unemployment has a strong documented impact on injury mortality. The aim of our study is to investigate the relationship of GDP per capita and unemployment with gender- and cause-specific injury mortalities in the member nations of Organization for Economic Cooperation and Development (OECD). Country-based data on injury mortality per 100,000 population, including males and females aged 1-74, for the 4 year period 1996-1999, were gathered from the World Health Organization's Statistical Information System. We selected fourteen cause-specific injury mortalities. Data on GDP, unemployment rate and population growth were taken from World Development Indicators. GDP and unemployment rate per 100 separately were regressed on total and cause-specific injury mortality rate per 100,000 for males and females. Overall in the OECD countries, GDP per capita increased 12.5% during 1996-1999 (P = 0.03) where as unemployment rate decreased by 12.3% (P = 0.05). Among males, most cause-specific injury mortality rates decreased with increasing GDP except motor vehicle traffic crashes (MTC) that increased with increasing GDP (coefficient = 0.75; P falls (coefficient = 0.36; P = 0.01) were found significantly associated with increasing unemployment rate. GDP is more related to cause-specific injury mortality than unemployment. Injury mortality does not relate similarly to each diagnosis-specific cause among males and females. Further research on causation with more predictors is needed.
INTRODUCTION: Cost effectiveness of healthcare has become an important component in its delivery. Current practices need to be assessed and measured for variations that may lead to financial savings. Speciality specific admission is known not only to lead improved clinical outcomes but also to lead important cost reductions. METHODS: All patients admitted to an Irish teaching hospital via the emergency department over a 2-year period with a gastroenterology (GI) related illness were included in this analysis.GI illness was classified using the Disease related grouping (DRG) system. Mean length of stay (LOS) and patient level costing (PLC) were calculated. Differences between DRGs with respect to speciality (i.e. specialist vs. non-specialist) were calculated for the five commonest DRGs. RESULTS: Significant variations in LOS and PLC were demonstrated in the DRGs. Mean LOS varied with increasing complexity, from 3.2 days for non-complex GI haemorrhage to 14.4 days for complex alcohol related cirrhosis as expected. A substantial difference in LOS within DRG groups was demonstrated by large standard deviations in the mean (up to 8.1 days in some groups) and was independent of complexity of cases. PLC also varied widely in both complex and non-complex cases with standard deviations of up to
Karazsia, Bryan T; Stavnezer, Amy Jo; Reeves, Jonathan W
Discussions of and recommendations for the training of clinical neuropsychologists exist at the doctoral, internship, and post-doctoral level. With few exceptions, the literature on undergraduate preparations in clinical neuropsychology is sparse and lacks empirical evidence. In the present study, graduate-level faculty and current trainees completed surveys about graduate school preparations. Faculty expectations of minimum and ideal undergraduate training were highest for research methods, statistics, and assessment. Preferences for "goodness of fit" also emerged as important admissions factors. These results offer evidence for desirable undergraduate preparations for advanced study in clinical neuropsychology. Although undergraduate training in psychology is intentionally broad, results from this study suggest that students who desire advanced study in clinical neuropsychology need to tailor their experiences to be competitive in the application process. The findings have implications for prospective graduate students, faculty who train and mentor undergraduates, and faculty who serve on admissions committees.
The highest mortality within the first 24 hours of admission was recorded among patients with malaria (89.0%) followed by protein energy malnutrition. CONCLUSION: Majority of deaths among emergency paediatric admission occur within the first 24 hours of admission and are associated with clinical conditions such as ...
Bunkenborg, G.; Lund, C.; Petersen, John Asger
The aim of medical emergency teams (MET) is to identify and treat deteriorating patients on general wards, and to avoid cardiac arrest, unplanned intensive care unit admission and death. The effectiveness of METs has yet to be proven, as the only two randomised, controlled trials on the subject...
Çevik, Yunsur; Doğan, Nurettin Özgür; Daş, Murat; Ahmedali, Asliddin; Kul, Seval; Bayram, Hasan
Although several factors such as cigarette smoking, blood pressure, diabetes, obesity, hypercholesterolemia, physical inactivity and dietary factors have been well documented to increase the risk for stroke, there are conflicting data about the role of meteorological variables in the etiology of stroke. We conducted a retrospective study to investigate the association between weather patterns, including daily temperature, humidity, wind speed, and air pressure, and stroke admissions to the Emergency Department of Atatürk Training and Research Hospital in Ankara, Turkey, between January 2009 and April 2010. Generalized additive models with logistic link function were used to investigate the relationship between predictors and days with and without stroke admission at lags 0-4. A total of 373 stroke patients were admitted to the emergency department (ED) between January 2009 and April 2010. Of patients, 297 had ischemic stroke (IS), 34 hemorrhagic stroke (HS), and 42 subarachnoidal hemorrhage (SAH). Although we did not find any association between overall admissions due to stroke and meteorological parameters, univariable analysis indicated that there were significantly more SAH cases on days with lower daily mean temperatures of 8.79 ± 8.75 °C as compared to relatively mild days with higher temperatures (mean temperature = 11.89 ± 7.94 °C, p = 0.021). The multivariable analysis demonstrated that admissions due to SAH increased on days with lower daily mean temperatures for the same day (lag 0; odds ratio (OR) [95 % confidence interval (95 % CI)] = 0.93 [0.89-0.98], p = 0.004) and lag 1 (OR [95 % CI] =0.76 [0.67-0.86], p = 0.001). Furthermore, the wind speed at both lag 1 (OR [95 % CI] = 1.63 [1.27-2.09], p = 0.001) and lag 3 (OR [95 % CI] = 1.43 [1.12-1.81], p = 0.004) increased admissions due to HS, respectively. In conclusion, our study demonstrated that there was an association between ED admissions due to SAH and HS and weather conditions suggesting that
Background To evaluate the role of admission cardiotocography in intrapartum patients in detecting fetal hypoxia already present and to correlate the results of admission cardiotocography with perinatal outcome. Materials and Methods: It was a cross‑sectional study conducted in the Labor and Maternity ward during the ...
A Biographical Questionnaire (BQ) has been used in the Faculty of Humanities at the University of the Witwatersrand since the mid-80s, to identify potential to succeed at university among applicants who have not met the requirements for automatic admission. As the key instrument in a special admissions process, the
Cortes, Carla M.
A profile-oriented retention strategy embraces the admission process as a powerful lever in improving retention and completion rates and recognizes that the student profile can be shaped by changes in admission policies or priorities--even within the current market position of the institution. In addition, the student body can be oriented toward…
Background and objectives. The purpose of this report is to describe the changing trends in adolescent treatment admissions for methamphetamine in Cape Town, and to discuss possible implications. Method. Data were collected on admissions for drug abuse treatment through a regular monitoring system involving drug ...
Feb 2, 2015 ... advertisement that will appear in Employment News dated 14th February 2015 and also our website: www.iisc.ernet.in/admissions. Online submission of application be made by accessing the IISc website www.iisc.ernet.in/admissions for all the programmes. IMPORTANT DATES. Website opening and ...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex... of sex, be denied admission, or be subjected to discrimination in admission, by any recipient to...
... Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex... basis of sex, be denied admission, or be subjected to discrimination in admission, by any recipient to...
Cherngchawano, Wirun; Jaturapitakkul, Natjiree
University Admission Tests in Thailand are important documents which reflect Thailand's education system. To study at a higher education level, all students generally need to take the University Admission Tests designed by the National Institute of Educational Testing Service (NIETS). For the English test, vocabulary and reading comprehension is…
Thorpe, K E
This article examines factors accounting for higher costs in urban hospitals as well as their relative contribution to those costs. The costs of urban hospitals are influenced by case mix, wages, competition, the ratio of forecasted to actual admissions, teaching, and the percentage of patients admitted through the emergency room. The bulk of the higher costs in urban hospitals are linked to graduate medical education. Treatment of poor patients and the admission of patients through the emerg...
Kirkbride, Geri; Floyd, Valerie; Tate, Cheryl; Wendler, M Cecilia
To evaluate nurses' satisfaction with, and perceptions of, a practice innovation introducing a Mobile Admission Nurse service. Staff nurses identified that the admission process, while crucial to initiating safe and appropriate acute care, can be disruptive and interfere with care in progress. A pilot project implementing the role of a Mobile Admission Nurse was introduced to address this need. A self-developed web-based survey was administered to a convenience sample of 104 RNs who had used the services during the pilot project. Staff nurses (n = 78) reported a chaotic, demanding work environment within which the admission process disrupts the flow of care. The Mobile Admission Nurse helped them in 'weathering the storm', which was the overarching theme that emerged during data analysis. Having an admission nurse complete the admission process steadied workflow processes for nurses. Improved patient safety and increased staff and family satisfaction were also reported. The strongly positive feedback led to expansion of the service. Proactively redesigning work processes, using a structured theoretical model such as the (Plan-Do-Study-Act) PDSA approach, may improve outcomes in a chaotic practice environment. © 2011 Blackwell Publishing Ltd.
Millett, Christopher; Lee, John Tayu; Laverty, Anthony A; Glantz, Stanton A; Majeed, Azeem
To assess whether the implementation of English smoke-free legislation in July 2007 was associated with a reduction in hospital admissions for childhood asthma. Interrupted time series study using Hospital Episodes Statistics data from April 2002 to November 2010. Sample consisted of all children (aged ≤14 years) having an emergency hospital admission with a principle diagnosis of asthma. Before the implementation of the legislation, the admission rate for childhood asthma was increasing by 2.2% per year (adjusted rate ratio 1.02; 95% confidence interval [CI]: 1.02-1.03). After implementation of the legislation, there was a significant immediate change in the admission rate of -8.9% (adjusted rate ratio 0.91; 95% CI: 0.89-0.93) and change in time trend of -3.4% per year (adjusted rate ratio 0.97; 95% CI: 0.96-0.98). This change was equivalent to 6802 fewer hospital admissions in the first 3 years after implementation. There were similar reductions in asthma admission rates among children from different age, gender, and socioeconomic status groups and among those residing in urban and rural locations. These findings confirm those from a small number of previous studies suggesting that the well-documented population health benefits of comprehensive smoke-free legislation appear to extend to reducing hospital admissions for childhood asthma.
Tahirbegolli, Bernard; Çavdar, Sabanur; Çetinkaya Sümer, Esin; Akdeniz, Sıdıka I; Vehid, Suphi
To examine the most frequent admitted polyclinics, diagnoses, and the costs of Syrian refugee patient in a Turkish university hospital in the metropolitan city of Istanbul, Western part of Turkey. Research methodology consist of analyzing outpatient admissions to the Hospital Polyclinics of Faculty of Medicine, Istanbul University, Cerrahpasa, Istanbul, Turkey from January-June 2014. We carried out diagnosis groups as classified in the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification, and analyzed the hospital cost of first admission through records based in the hospital information system. Median age of 251 Syrian refugee patients is 19 years, inter quartile rate 7-34 years. Patients aged 65 and older compared with those until 18 years and 19 to 64 years aged groups have made statistically significant (p less than 0.001) less hospital admissions. The Most frequented clinic was the emergency clinic. On June there have been significantly (p less than 0.001) more admissions compared with other months. The most common diagnoses were diseases of the respiratory system. The costs of per admission was estimated nearly 48 US Dollar/per patient and the total amount of hospital admissions was 12,031.93 US Dollar. On the specified dates, the clinics were mostly frequented from Syrian refugees until 18 years group. The most common presenting symptoms are respiratory diseases and most frequented clinic is emergency.
If higher order wave equations are reduced to first order by supplementary conditions, then quadratic Hamiltonians of the most general type will emerge. Even then, for several reasons elaborated below, canonical quantization can still not be applied consistently. The benefit of clinging to a Lagrangian description of non-localized phenomena is then questionable. Non canonical quantization procedures should be considered. Some initial attempts at Lie-admissible quantization are examined critically here, and it is concluded that further recourse to experiment seems to be necessary
Guzmán Laura, K P; Periañez Vasco, A; Falcón Neyra, M D; Croche Santander, B
Varicella (chickenpox) can cause serious complications and admission to hospital. Several countries included the varicella vaccine in their immunization schedules. A descriptive and retrospective study of hospitalizations due to varicella and its complications was conducted in a referral center from 2005 to 2011. A total of 1192 children with varicella were seen in the emergency room, of which 99 (8.5%) required admission. The annual incidence of admissions due to varicella and varicella complications was, 19.4 and 15.3 cases per 100,000 children under 14 years, respectively. Complications were more common in children under 5 years (79.5%), and with no underlying disease (78.2%). Infection of skin and soft tissue was the most common complication (62%). The mean hospital stay was 4.5 days (SD 4). Varicella causes high morbidity, and is more frequent in absolute terms in healthy children under 5 years of age. Therefore, routine vaccination recommended by the Immunization Advisory Committee should be mandatory. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.
Full Text Available BACKGROUND: Despite the magnitude and increase of sickness absence due to mental diagnoses, little is known regarding long-term health outcomes. The aim of this nationwide population-based, prospective cohort study was to investigate the association between sickness absence due to specific mental diagnoses and the risk of all-cause and cause-specific mortality. METHODS: A cohort of all 4 857 943 individuals living in Sweden on 31.12.2004 (aged 16-64 years, not sickness absent, or on retirement or disability pension, was followed from 01.01.2005 through 31.12.2008 for all-cause and cause-specific mortality (suicide, cancer, circulatory disease through linkage of individual register data. Individuals with at least one new sick-leave spell with a mental diagnosis in 2005 were compared to individuals with no sickness absence. Hazard ratios (HR and 95% confidence intervals (CI were estimated by Cox regression, adjusting for age, sex, education, country of birth, family situation, area of residence, and pre-existing morbidity (diagnosis-specific hospital inpatient (2000-2005 and outpatient (2001-2005 care. RESULTS: In the multivariate analyses, mental sickness absence in 2005 was associated with an increased risk for all-cause mortality: HR: 1.65, 95% CI: 1.47-1.86 in women and in men: 1.73, 1.57-1.91; for suicide, cancer (both smoking and non-smoking related as well as mortality due to circulatory disease only in men. Estimates for cause-specific mortality ranged from 1.48 to 3.37. Associations with all-cause mortality were found for all mental sickness absence diagnostic groups studied. CONCLUSIONS: Knowledge about the prognosis of patients sickness absent with specific mental diagnoses is of crucial clinical importance in health care. Sickness absence due to specific mental diagnoses may here be used as a risk indictor for subsequent mortality.
Fretts, Amanda M; Mozaffarian, Dariush; Siscovick, David S; King, Irena B; McKnight, Barbara; Psaty, Bruce M; Rimm, Eric B; Sitlani, Colleen; Sacks, Frank M; Song, Xiaoling; Sotoodehnia, Nona; Spiegelman, Donna; Lemaitre, Rozenn N
Not much is known about the relations of circulating saturated fatty acids (SFAs), which are influenced by both metabolic and dietary determinants, with total and cause-specific mortality. We examined the associations of plasma phospholipid SFAs with total and cause-specific mortality among 3941 older adults from the Cardiovascular Health Study, a population-based prospective study of adults aged ≥65 y who were followed from 1992 through 2011. The relations of total and cause-specific mortality with plasma phospholipid palmitic acid (16:0), stearic acid (18:0), arachidic acid (20:0), behenic acid (22:0), and lignoceric acid (24:0) were assessed using Cox proportional hazards models. During 45,450 person-years of follow-up, 3134 deaths occurred. Higher concentrations of the plasma phospholipid SFAs 18:0, 22:0, and 24:0 were associated with a lower risk of total mortality [multivariable-adjusted HRs (95% CIs)] for the top compared with the bottom quintile: 0.85 (0.75, 0.95) for 18:0; 0.85 (0.75, 0.95) for 22:0; and 0.80 (0.71, 0.90) for 24:0. In contrast, plasma 16:0 concentrations in the highest quintile were associated with a higher risk of total mortality compared with concentrations in the lowest quintile [1.25 (1.11, 1.41)]. We also found no association of plasma phospholipid 20:0 with total mortality. These findings suggest that the associations of plasma phospholipid SFAs with the risk of death differ according to SFA chain length and support future studies to better characterize the determinants of circulating SFAs and to explore the mechanisms underlying these relations. © 2016 American Society for Nutrition.
Laukkala, T; Parkkola, K; Henriksson, M; Pirkola, S; Kaikkonen, N; Pukkala, E; Jousilahti, P
To estimate total and cause-specific mortality after international peacekeeping deployments among the Finnish military peacekeeping personnel in comparison to the general population of similar age and sex. A register-based study of a cohort of military peacekeeping personnel in 1990-2010 followed for mortality until the end of 2013. Causes of death were obtained from the national Causes of Death Register. The standardised mortality ratio (SMR) for total and cause-specific mortality was calculated as the ratio of observed and expected number of deaths. Finland (peacekeeping operations in different countries in Africa, Asia and in an area of former Yugoslavia in Europe). 14 584 men and 418 women who had participated in international military peacekeeping operations ending between 1990 and 2010. Participation in military peacekeeping operations. Total and cause-specific mortality. 209 men and 3 women died after their peacekeeping service. The SMR for all-cause mortality was 0.55 (95% CI 0.48 to 0.62). For the male peacekeeping personnel, the SMR for all diseases was 0.44 (95% CI 0.35 to 0.53) and for accidental and violent deaths 0.69 (95% CI 0.57 to 0.82). The SMR for suicides was 0.71 (95% CI 0.53 to 0.92). Even though military peacekeeping personnel are working in unique and often stressful conditions, their mortality after their service is lower compared with the general population. Military peacekeeping personnel appear to be a selected population group with low general mortality and no excess risk of any cause of death after peacekeeping service. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Laukkala, T; Parkkola, K; Henriksson, M; Pirkola, S; Kaikkonen, N; Pukkala, E; Jousilahti, P
Objectives To estimate total and cause-specific mortality after international peacekeeping deployments among the Finnish military peacekeeping personnel in comparison to the general population of similar age and sex. Design A register-based study of a cohort of military peacekeeping personnel in 1990–2010 followed for mortality until the end of 2013. Causes of death were obtained from the national Causes of Death Register. The standardised mortality ratio (SMR) for total and cause-specific mortality was calculated as the ratio of observed and expected number of deaths. Setting Finland (peacekeeping operations in different countries in Africa, Asia and in an area of former Yugoslavia in Europe). Participants 14 584 men and 418 women who had participated in international military peacekeeping operations ending between 1990 and 2010. Interventions Participation in military peacekeeping operations. Main outcome Total and cause-specific mortality. Results 209 men and 3 women died after their peacekeeping service. The SMR for all-cause mortality was 0.55 (95% CI 0.48 to 0.62). For the male peacekeeping personnel, the SMR for all diseases was 0.44 (95% CI 0.35 to 0.53) and for accidental and violent deaths 0.69 (95% CI 0.57 to 0.82). The SMR for suicides was 0.71 (95% CI 0.53 to 0.92). Conclusions Even though military peacekeeping personnel are working in unique and often stressful conditions, their mortality after their service is lower compared with the general population. Military peacekeeping personnel appear to be a selected population group with low general mortality and no excess risk of any cause of death after peacekeeping service. PMID:27799241
Full Text Available In this paper we present admission control methods for IMS network. The task of RACS block is to accept or reject new connection into the network. The main goal of the admission control method is to ensure the Quality of Service not only for new connection but also for already accepted connections. We discuss and compare three admission control algorithms in the paper from the qualitative parameters point of view.
Brabrand, Mikkel; Hallas, Jesper; Knudsen, Torben
BACKGROUND: There exist several risk stratification systems for predicting mortality of emergency patients. However, some are complex in clinical use and others have been developed using suboptimal methodology. The objective was to evaluate the capability of the staff at a medical admission unit...... (MAU) to use clinical intuition to predict in-hospital mortality of acutely admitted patients. METHODS: This is an observational prospective cohort study of adult patients (15 years or older) admitted to a MAU at a regional teaching hospital. The nursing staff and physicians predicted in...... admitted. The nursing staff assessed 2,404 admissions and predicted mortality in 1,820 (63.9%). AUROC was 0.823 (95% CI: 0.762-0.884) and calibration poor. Physicians assessed 738 admissions and predicted mortality in 734 (25.8% of all admissions). AUROC was 0.761 (95% CI: 0.657-0.864) and calibration poor...
M. K. Aouf
Full Text Available We investigate some applications of the differential subordination and the differential superordination of certain admissible classes of multivalent functions in the open unit disk U. Several differential sandwich-type results are also obtained.
Dobkin, Carlos; Finkelstein, Amy; Kluender, Raymond; Notowidigdo, Matthew J
We use an event study approach to examine the economic consequences of hospital admissions for adults in two datasets: survey data from the Health and Retirement Study, and hospitalization data linked to credit reports. For non-elderly adults with health insurance, hospital admissions increase out-of-pocket medical spending, unpaid medical bills and bankruptcy, and reduce earnings, income, access to credit and consumer borrowing. The earnings decline is substantial compared to the out-of-pocket spending increase, and is minimally insured prior to age-eligibility for Social Security Retirement Income. Relative to the insured non-elderly, the uninsured non-elderly experience much larger increases in unpaid medical bills and bankruptcy rates following a hospital admission. Hospital admissions trigger less than 5 percent of all bankruptcies.
Jurajda, Štěpán; Münich, Daniel
Roč. 31, č. 4 (2016), s. 483-498 ISSN 0267-1522 Institutional support: PRVOUK-P23 Keywords : admissions * alphabetical order * order effects Subject RIV: AH - Economics Impact factor: 1.033, year: 2016
Call Admission Control (CAC) and Dynamic Channel Assignments (DCA) are important decision-making problems in mobile cellular communication systems. Current research in mobile communication considers them as two independent problems, although the former greatly depends on the resulting free channels obtained as the outcome of the latter. This book provides a solution to the CAC problem, considering DCA as an integral part of decision-making for call admission. Further, current technical resources ignore movement issues of mobile stations and fluctuation in network load (incoming calls) in the control strategy used for call admission. In addition, the present techniques on call admission offers solution globally for the entire network, instead of considering the cells independently. CAC here has been formulated by two alternative approaches. The first approach aimed at handling the uncertainty in the CAC problem by employing fuzzy comparators. The second approach is concerned with formulation of CAC ...
Home; Journals; Resonance – Journal of Science Education; Volume 18; Issue 2. IISc Undergraduate Programme: Admissions for 2013. Information and Announcements Volume 18 Issue 2 February 2013 pp 200-200. Fulltext. Click here to view fulltext PDF. Permanent link:
Evaluation of a Medical and Mental Health Unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': a controlled clinical trial. Acronym: TEAM: Trial of an Elderly Acute care Medical and mental health unit
Gladman John RF
Full Text Available Abstract Background Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in the 'person-centred' dementia care approach, a programme of meaningful activity was devised, the environment adapted to the needs of people with cognitive impairment, and attention given to communication with family carers. We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective. Methods/design We will perform a controlled clinical trial comparing in-patient management on a specialist Medical and Mental Health Unit with standard care. Study participants are patients over the age of 65, admitted as an emergency to a single general hospital, and identified on the Acute Medical Admissions Unit as being 'confused'. Sample size is 300 per group. The evaluation design has been adapted to accommodate pressures on bed management and patient flows. If beds are available on the specialist Unit, the clinical service allocates patients at random between the Unit and standard care on general or geriatric medical wards. Once admitted, randomised patients and their carers are invited to take part in a follow up study, and baseline data are collected. Quality of care and patient experience are assessed in a non-participant observer study. Outcomes are ascertained at a follow up home visit 90 days after randomisation, by a researcher blind to allocation. The primary outcome is days spent at home (for those admitted from home, or days spent in the same care home (if admitted from a care home. Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of
Johnsen, Nina Føns; Frederiksen, Kirsten; Christensen, Jane
No study has yet investigated the intake of different types of whole grain (WG) in relation to all-cause and cause-specific mortality in a healthy population. The aim of the present study was to investigate the intake of WG products and WG types in relation to all-cause and cause-specific mortali......%CI 0·86, 0·91) for a doubling of intake). In particular, intake of breakfast cereals and non-white bread was associated with lower mortality. We also found lower all-cause mortality with total intake of different WG types (women: MRR 0·88 (95%CI 0·86, 0·92); men: MRR 0·88 (95%CI 0·86, 0...... quartile compared with the lowest for breakfast cereals, non-white bread, total WG products, oat, rye (only men), wheat and total WG types. The MRR for highest v. lowest quartile of intake of total WG products was 0·68 (95% CI 0·62, 0·75, P for trend over quartiles , 0·0001) for women and 0·75 (95%CI 0...
Whalen, Kristine A; Judd, Suzanne; McCullough, Marjorie L; Flanders, W Dana; Hartman, Terryl J; Bostick, Roberd M
Background: Poor diet quality is associated with a higher risk of many chronic diseases that are among the leading causes of death in the United States. It has been hypothesized that evolutionary discordance may account for some of the higher incidence and mortality from these diseases. Objective: We investigated associations of 2 diet pattern scores, the Paleolithic and the Mediterranean, with all-cause and cause-specific mortality in the REGARDS (REasons for Geographic and Racial Differences in Stroke) study, a longitudinal cohort of black and white men and women ≥45 y of age. Methods: Participants completed questionnaires, including a Block food-frequency questionnaire (FFQ), at baseline and were contacted every 6 mo to determine their health status. Of the analytic cohort (n = 21,423), a total of 2513 participants died during a median follow-up of 6.25 y. We created diet scores from FFQ responses and assessed their associations with mortality using multivariable Cox proportional hazards regression models adjusting for major risk factors. Results: For those in the highest relative to the lowest quintiles of the Paleolithic and Mediterranean diet scores, the multivariable adjusted HRs for all-cause mortality were, respectively, 0.77 (95% CI: 0.67, 0.89; P-trend diets closer to Paleolithic or Mediterranean diet patterns may be inversely associated with all-cause and cause-specific mortality. PMID:28179490
Knudsen, N V; Møller, M H
BACKGROUND: Perforated peptic ulcer is a serious emergency surgical condition. The aim of the present nationwide cohort study was to evaluate the association between mortality and out-of-hours admission in patients surgically treated for perforated peptic ulcer. METHODS: All Danish patients...... surgically treated for benign gastric or duodenal perforated peptic ulcer in Denmark between September 1, 2011 and August 31, 2013 were included. Patients were identified through The Danish Clinical Register of Emergency Surgery. The association between 90-day mortality and time and day of admission...... with the primary analysis. The overall 90-day mortality rate was 25.6% (186/726). CONCLUSION: No statistically significant adjusted association between 90-day mortality and out-of-hours admission was found in patients surgically treated for perforated peptic ulcer....
Margaret B. Greenwood-Ericksen
Full Text Available Introduction: Diverticulitis is a common diagnosis in the emergency department (ED. Outpatient management of diverticulitis is safe in selected patients, yet the rates of admission and surgical procedures following ED visits for diverticulitis are unknown, as are the predictive patient characteristics. Our goal is to describe trends in admission and surgical procedures following ED visits for diverticulitis, and to determine which patient characteristics predict admission. Methods: We performed a cross-sectional descriptive analysis using data on ED visits from 2006-2011 to determine change in admission and surgical patterns over time. The Nationwide Emergency Department Sample database, a nationally representative administrative claims dataset, was used to analyze ED visits for diverticulitis. We included patients with a principal diagnosis of diverticulitis (ICD-9 codes 562.11, 562.13. We analyzed the rate of admission and surgery in all admitted patients and in low-risk patients, defined as age <50 with no comorbidities (Elixhauser. We used hierarchical multivariate logistic regression to identify patient characteristics associated with admission for diverticulitis. Results: From 2006 to 2011 ED visits for diverticulitis increased by 21.3% from 238,248 to 302,612, while the admission rate decreased from 55.7% to 48.5% (-7.2%, 95% CI [–7.78 to -6.62]; p<0.001 for trend. The admission rate among low-risk patients decreased from 35.2% in 2006 to 26.8% in 2011 (-8.4%, 95% CI [–9.6 to –7.2]; p<0.001 for trend. Admission for diverticulitis was independently associated with male gender, comorbid illnesses, higher income and commercial health insurance. The surgical rate decreased from 6.5% in 2006 to 4.7% in 2011 (-1.8%, 95% CI [–2.1 to –1.5]; p<0.001 for trend, and among low-risk patients decreased from 4.0% to 2.2% (- 1.8%, 95% CI [–4.5 to –1.7]; p<0.001 for trend. Conclusion: From 2006 to 2011 ED visits for diverticulitis increased
Wilson, Michael S J; Powell-Bowns, Matilda; Robertson, Andrew G; Luhmann, Andreas; Richards, Colin H
Documentation of pregnancy status (PS) is an integral component of the assessment of women of reproductive age when admitted to hospital. Our aim was to determine how accurately PS was documented in a multicentre audit of female admissions to general surgery. A prospective multicentre audit of elective and emergency admissions was performed in 18 Scottish centres between 08:00 on 11 May 2015 and 07:59 on 25 May 2015. The lower age limit was the minimum age for admission to the adult surgical ward and the upper age limit was 55 years. There were 2743 admissions, with 612 (22.3%) women of reproductive age. After 82 exclusions, the final total was 530: 169 (31.9%) elective and 361 (68.1%) emergency. Documentation of PS was achieved in 274 (51.7%) cases: 52 (30.8%) elective and 222 (61.5%) emergency. In 318 (88.1%) of the emergency admissions, the patient had abdominal pain. Of these, 211 (65.1%) had a documented PS. The possibility of pregnancy was established in 237 (44.7%) cases. Establishing the possibility of pregnancy before surgery is poor, particularly in the elective setting. Objective documentation of PS in the emergency setting in those with abdominal pain is also poor. Our study highlights an important safety issue in the management of female patients. We advocate electronic storage of pregnancy test results and new guidelines to cover both elective and emergency surgery. PS should form part of the pre-theatre safety brief and checklist. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Iapichino, Gaetano; Corbella, Davide; Minelli, Cosetta; Mills, Gary H; Artigas, Antonio; Edbooke, David L; Pezzi, Angelo; Kesecioglu, Jozef; Patroniti, Nicolò; Baras, Mario; Sprung, Charles L
To identify factors influencing triage decisions and investigate whether admission to the intensive care unit (ICU) could reduce mortality compared with treatment on the ward. A multicentre cohort study in 11 university hospitals from seven countries, evaluating triage decisions and outcomes of patients referred for admission to ICU who were either accepted, or refused and treated on the ward. Confounding in the estimation of the effect of ICU admission on mortality was controlled by use of a propensity score approach, which adjusted for the probability of being admitted. Variability across centres was accounted for in both analyses of factors influencing ICU admission and effect of ICU admission on mortality. Eligible were 8,616 triages in 7,877 patients referred for ICU admission. Variables positively associated with probability of being admitted to ICU included: ventilators in ward; bed availability; Karnofsky score; absence of comorbidity; presence of haematological malignancy; emergency surgery and elective surgery (versus medical treatment); trauma, vascular involvement, liver involvement; acute physiologic score II; ICU treatment (versus ICU observation). Multiple triages during patient's hospital stay and age were negatively associated with ICU admission. The area under the receiver operating characteristic (ROC) curve of the model was 0.83 [95% confidence interval (CI): 0.81-0.84], with Hosmer-Lemeshow test P = 0.300. ICU admission was associated with a statistically significant reduction of both 28-day mortality [odds ratio (OR): 0.73; 95% CI: 0.62-0.87] and 90-day mortality (0.79; 0.66-0.93). The benefit of ICU admission increased substantially in patients with greater severity of illness. We suggest that intensivists take great care to avoid ICU admission of patients judged not severe enough for ICU or with low performance status, and they tend to admit surgical patients more readily than medical patients. Interestingly, they do not judge age per se as
Brandenburg, Raya; Brinkman, Sylvia; de Keizer, Nicolette F; Kesecioglu, Jozef; Meulenbelt, Jan; de Lange, Dylan W
CONTEXT: Intoxicated patients are frequently admitted from the emergency room to the ICU for observational reasons. The question is whether these admissions are indeed necessary. OBJECTIVE: The aim of this study was to develop a model that predicts the need of ICU treatment (receiving mechanical
Skyum, Florence; Abed, Osama Karim; Backer Mogensen, Christian
INTRODUCTION: The number of admissions for acute gastroenteritis (GE) is increasing. The majority of patients pass through a single high-flow emergency department (ED) area which increases the risk of spreading GE. The aim of this study was to determine the frequency and aetiology of GE for acutely...
Moesgaard Iburg, Kim
the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa......Background Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries......, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey...
Nielsen, Naja Rod; Thygesen, Lau Caspar; Johansen, Ditte
PURPOSE: To investigate whether duration of follow-up influences the association between alcohol and cause-specific mortality in a prospective cohort study with only baseline assessment of alcohol intake. METHODS: In a cohort of 14,223 men and women participating in the first investigation...... of the Copenhagen City Heart Study between 1976 and 1978 and followed until 2001, we assessed whether the association between alcohol and mortality was modified by duration of follow-up. The 24 years of follow-up were divided into four intervals, and Cox survival analyses were conducted separately for these four...... succeeding 6-year periods of follow-up. RESULTS: The authors found differences in the predictive values of alcohol and beverage-specific types of alcohol depending on duration of follow-up both in terms of all-cause mortality and death from coronary heart disease and cancer. The apparent protective effect...
Ostamo Aini I
Full Text Available Abstract Background Psychological factors associated with low social status have been proposed as one possible explanation for the socio-economic gradient in health. The aim of this study is to explore whether different indicators of psychological distress contribute to socio-economic differences in cause-specific mortality. Methods The data source is a nationally representative, repeated cross-sectional survey, "Health Behaviour and Health among the Finnish Adult Population" (AVTK. The survey results were linked with socio-economic register data from Statistics Finland (from the years 1979-2002 and mortality follow-up data up to 2006 from the Finnish National Cause of Death Register. The data included 32451 men and 35420 women (response rate 73.5%. Self-reported measures of depression, insomnia and stress were used as indicators of psychological distress. Socio-economic factors included education, employment status and household income. Mortality data consisted of unnatural causes of death (suicide, accidents and violence, and alcohol-related mortality and coronary heart disease (CHD mortality. Adjusted hazard ratios were calculated using the Cox regression model. Results In unnatural mortality, psychological distress accounted for some of the employment status (11-31% and income level (4-16% differences among both men and women, and for the differences related to the educational level (5-12% among men; the educational level was associated statistically significantly with unnatural mortality only among men. Psychological distress had minor or no contribution to socio-economic differences in CHD mortality. Conclusions Psychological distress partly accounted for socio-economic disparities in unnatural mortality. Further studies are needed to explore the role and mechanisms of psychological distress associated with socio-economic differences in cause-specific mortality.
Li, Se; Rosenberg, Lynn; Wise, Lauren A; Boggs, Deborah A; LaValley, Michael; Palmer, Julie R
Early age at natural menopause has been associated with increased all-cause mortality in several studies, although the literature is not consistent. This relation has not been examined among African American women. Data were from the Black Women's Health Study, a follow-up study of African-American women enrolled in 1995. Among 11,212 women who were naturally menopausal at entry to the study or during follow-up through 2008, we assessed the relation of age at natural menopause to all-cause and cause-specific mortality. At baseline and biennially, participants reported on reproductive and medical history, including gynecologic surgeries and exogenous hormone use. Mortality data were obtained from the National Death Index. Multivariable Cox proportional hazard models were used to estimate mortality rate ratios (MRR) and 95% confidence intervals (CI) for categories of age at menopause. Of 692 deaths identified during 91,829 person years of follow-up, 261 were due to cancer, 199 to cardiovascular diseases and 232 to other causes. Natural menopause before age 40 was associated with increased all-cause mortality (MRR=1.34, 95% CI 0.96-1.84, relative to menopause at 50-54 years; P-trend=0.04) and with the subcategories of death considered - cancer, cardiovascular disease, and all other causes. The associations were present among never and ever users of postmenopausal female hormones and among never and ever smokers. In this large prospective cohort of African-American women, natural menopause before age 40 was associated with a higher rate of all-cause and cause-specific mortality. These findings provide support for the theory that natural menopause before age 40 may be a marker of accelerated somatic aging. Published by Elsevier Ireland Ltd.
Laliotis, Ioannis; Ioannidis, John P A; Stavropoulou, Charitini
Greece was one of the countries hit the hardest by the 2008 financial crisis in Europe. Yet, evidence on the effect of the crisis on total and cause-specific mortality remains unclear. We explored whether the economic crisis affected the trend of overall and cause-specific mortality rates. We used regional panel data from the Hellenic Statistical Authority to assess mortality trends by age, sex, region, and cause in Greece between January, 2001, and December, 2013. We used Eurostat data to calculate monthly age-standardised mortality rates per 100 000 inhabitants for each region. Data were divided into two subperiods: before the crisis (January, 2001, to August, 2008) and after the onset of the crisis (September, 2008, to December, 2013). We tested for changes in the slope of mortality by doing an interrupted time-series analysis. Overall mortality continued to decline after the onset of the financial crisis (-0·065, 95% CI -0·080 to -0·049), but at a slower pace than before the crisis (-0·13, -0·15 to -0·10; trend difference 0·062, 95% CI 0·041 to 0·083; pperiod after the onset of the crisis with extrapolated values based on the period before the crisis, we estimate that an extra 242 deaths per month occurred after the onset of the crisis. Mortality trends have been interrupted after the onset of compared with before the crisis, but changes vary by age, sex, and cause of death. The increase in deaths due to adverse events during medical treatment might reflect the effects of deterioration in quality of care during economic recessions. None. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.
Full Text Available Child undernutrition affects millions of children globally. We investigated associations between suboptimal growth and mortality by pooling large studies.Pooled analysis involving children 1 week to 59 months old in 10 prospective studies in Africa, Asia and South America. Utilizing most recent measurements, we calculated weight-for-age, height/length-for-age and weight-for-height/length Z scores, applying 2006 WHO Standards and the 1977 NCHS/WHO Reference. We estimated all-cause and cause-specific mortality hazard ratios (HR using proportional hazards models comparing children with mild (-2≤Z<-1, moderate (-3≤Z<-2, or severe (Z<-3 anthropometric deficits with the reference category (Z≥-1.53 809 children were eligible for this re-analysis and contributed a total of 55 359 person-years, during which 1315 deaths were observed. All degrees of underweight, stunting and wasting were associated with significantly higher mortality. The strength of association increased monotonically as Z scores decreased. Pooled mortality HR was 1.52 (95% Confidence Interval 1.28, 1.81 for mild underweight; 2.63 (2.20, 3.14 for moderate underweight; and 9.40 (8.02, 11.03 for severe underweight. Wasting was a stronger determinant of mortality than stunting or underweight. Mortality HR for severe wasting was 11.63 (9.84, 13.76 compared with 5.48 (4.62, 6.50 for severe stunting. Using older NCHS standards resulted in larger HRs compared with WHO standards. In cause-specific analyses, all degrees of anthropometric deficits increased the hazards of dying from respiratory tract infections and diarrheal diseases. The study had insufficient power to precisely estimate effects of undernutrition on malaria mortality.All degrees of anthropometric deficits are associated with increased risk of under-five mortality using the 2006 WHO Standards. Even mild deficits substantially increase mortality, especially from infectious diseases.
Greenwood-Ericksen, Margaret B; Havens, Joaquim M; Ma, Jiemin; Weissman, Joel S; Schuur, Jeremiah D
Diverticulitis is a common diagnosis in the emergency department (ED). Outpatient management of diverticulitis is safe in selected patients, yet the rates of admission and surgical procedures following ED visits for diverticulitis are unknown, as are the predictive patient characteristics. Our goal is to describe trends in admission and surgical procedures following ED visits for diverticulitis, and to determine which patient characteristics predict admission. : We performed a cross-sectional descriptive analysis using data on ED visits from 2006-2011 to determine change in admission and surgical patterns over time. The Nationwide Emergency Department Sample database, a nationally representative administrative claims dataset, was used to analyze ED visits for diverticulitis. We included patients with a principal diagnosis of diverticulitis (ICD-9 codes 562.11, 562.13). We analyzed the rate of admission and surgery in all admitted patients and in low-risk patients, defined as age diverticulitis. Fryom 2006 to 2011 ED visits for diverticulitis increased by 21.3% from 238,248 to 302,612, while the admission rate decreased from 55.7% to 48.5% (-7.2%, 95% CI [-7.78 to -6.62]; pdiverticulitis was independently associated with male gender, comorbid illnesses, higher income and commercial health insurance. The surgical rate decreased from 6.5% in 2006 to 4.7% in 2011 (-1.8%, 95% CI [-2.1 to -1.5]; pdiverticulitis increased, while ED admission rates and surgical rates declined, with comorbidity, sociodemographic factors predicting hospitalization. Future work should focus on determining if these differences reflect increased disease prevalence, increased diagnosis, or changes in management.
... 32 National Defense 5 2010-07-01 2010-07-01 false Bar admission and disciplinary matters. 776.66... ADVOCATE GENERAL Rules of Professional Conduct § 776.66 Bar admission and disciplinary matters. (a) Bar admission and disciplinary matters. A covered attorney, in connection with any application for bar admission...
... 45 Public Welfare 1 2010-10-01 2010-10-01 false Admissions and recruitment. 84.42 Section 84.42... Education § 84.42 Admissions and recruitment. (a) General. Qualified handicapped persons may not, on the basis of handicap, be denied admission or be subjected to discrimination in admission or recruitment by...
... 45 Public Welfare 3 2010-10-01 2010-10-01 false Admissions and recruitment. 605.42 Section 605.42... Postsecondary Education § 605.42 Admissions and recruitment. (a) General. Qualified handicapped persons may not... recruitment by a recipient to which this subpart applies. (b) Admissions. In administering its admission...
... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Admission and recruitment. 8b.20... Secondary Education § 8b.20 Admission and recruitment. (a) General. Qualified handicapped may not, on the basis of handicap, be denied admission or be subjected to discrimination in admission or recruitment by...
... 34 Education 1 2010-07-01 2010-07-01 false Admissions and recruitment. 104.42 Section 104.42... ASSISTANCE Postsecondary Education § 104.42 Admissions and recruitment. (a) General. Qualified handicapped... admission or recruitment by a recipient to which this subpart applies. (b) Admissions. In administering its...
Skov Benthien, Kirstine; Nordly, Mie; von Heymann-Horan, Annika
CONTEXT: Avoidable hospital admissions are important negative indicators of quality of end-of-life care. Specialized palliative care (SPC) may support patients remaining at home. OBJECTIVES: Therefore, the purpose of this study was to investigate if SPC at home could prevent hospital admissions...... options and their caregivers. They were included from the Department of Oncology, Rigshospitalet, Denmark, between 2013 and 2016. The control group received usual care. Outcomes were hospital admissions, causes thereof, and patient and caregiver perceptions of place of care (home, hospital, etc...... in patients with incurable cancer. METHODS: These are secondary results of Domus: a randomized controlled trial of accelerated transition to SPC with psychological intervention at home (Clinicaltrials.gov: NCT01885637). Participants were patients with incurable cancer and limited antineoplastic treatment...
The therapeutic relationship is one of the most central and important factors in the treatment of mental health disorders. A better therapeutic relationship is associated with service engagement, medication adherence, and satisfaction with services. This study aimed to compare the demographic and clinical factors associated with the therapeutic relationship in voluntarily and involuntarily admitted psychiatric service users. We found that individuals who had been admitted involuntarily, who had a diagnosis of a psychotic disorder, and who reported higher levels of perceived pressures on admission were more likely to have a poorer therapeutic relationship with their consultant psychiatrist. Greater levels of insight and treatment satisfaction, together with higher levels of procedural justice experienced on admission, were associated with a better therapeutic relationship. We found that the level of perceived coercion on admission was not related to the therapeutic relationship. Targeted interventions to improve the therapeutic relationship, particularly for involuntarily admitted service users, are discussed.
Bunkenborg, G.; Lund, C.; Petersen, John Asger
The aim of medical emergency teams (MET) is to identify and treat deteriorating patients on general wards, and to avoid cardiac arrest, unplanned intensive care unit admission and death. The effectiveness of METs has yet to be proven, as the only two randomised, controlled trials on the subject...... show conflicting results. Despite the lack of evidence, METs are gaining popularity and are being implemented in Danish hospitals as part of Operation Life Udgivelsesdato: 2008/8/25...
Full Text Available Abstract Background As long-term nursing home care is likely to increase with the aging of the population, identifying chronic medical conditions is of particular interest. Although need factors have a strong impact on nursing home (NH admission, the diseases causing these functional disabilities are lacking or unclear in the residents' file. We investigated the medical reason (primary diagnosis of a nursing home admission with respect to the underlying disease. Methods This study is based on two independent, descriptive and comparative studies in Belgium and was conducted at two time points (1993 and 2005 to explore the evolution over twelve years. Data from the subjects were extracted from the resident's file; additional information was requested from the general practitioner, nursing home physician or the head nurse in a face-to-face interview. In 1993 we examined 1332 residents from 19 institutions, and in 2005 691 residents from 7 institutions. The diseases at the time of admission were mapped by means of the International Classification of Diseases - 9th edition (ICD-9. Longitudinal changes were assessed and compared by a chi-square test. Results The main chronic medical conditions associated with NH admission were dementia and stroke. Mental disorders represent 48% of all admissions, somatic disorders 43% and social/emotional problems 8%. Of the somatic disorders most frequently are mentioned diseases of the circulatory system (35% [2/3 sequels of stroke and 1/5 heart failure], followed by diseases of the nervous system (15% [mainly Parkinson's disease] and the musculoskeletal system (14% [mainly osteoarthritis]. The most striking evolution from 1993 to 2005 consisted in complicated diabetes mellitus (from 4.3 to 11.4%; p Conclusion Diseases like stroke, diabetes and mobility problems are only important for institutionalisation if they cause functional disability. Diabetes related complications as cause of admission increased almost three
Full Text Available Universal mobile telecommunications system (UMTS is one of the 3rd generation (3G cell phone technologies. The capacity of UMTS is interference limited. Radio resources management (RRM functions are therefore used. They are responsible for supplying optimum coverage, ensuring efficient use of physical resources, and providing the maximum planned capacity. This paper deals with admission control techniques for UMTS. An own UMTS simulation program and several versions of proposed admission control algorithms are presented in this paper. These algorithms are based on fuzzy logic and genetic algorithms. The performance of algorithms is verified via simulations.
Saxena, Sonia; Bottle, Alex; Gilbert, Ruth; Sharland, Mike
Background Timely care by general practitioners in the community keeps children out of hospital and provides better continuity of care. Yet in the UK, access to primary care has diminished since 2004 when changes in general practitioners' contracts enabled them to ‘opt out’ of providing out-of-hours care and since then unplanned pediatric hospital admission rates have escalated, particularly through emergency departments. We hypothesised that any increase in isolated short stay admissions for childhood illness might reflect failure to manage these cases in the community over a 10 year period spanning these changes. Methods and Findings We conducted a population based time trends study of major causes of hospital admission in children 2 days. By 2006, 67.3% of all unplanned admissions were isolated short stays <2 days. The increases in admission rates were greater for common non-infectious than infectious causes of admissions. Conclusions Short stay unplanned hospital admission rates in young children in England have increased substantially in recent years and are not accounted for by reductions in length of in-hospital stay. The majority are isolated short stay admissions for minor illness episodes that could be better managed by primary care in the community and may be evidence of a failure of primary care services. PMID:19829695
Documentation of the demographic and geographical details of changes in cause-specific neonatal (younger than 1 month) and 1-59-month mortality in India can guide further progress in reduction of child mortality. In this study we report the changes in cause-specific child mortality between 2000 and 2015 in India. Since 2001, the Registrar General of India has implemented the Million Death Study (MDS) in 1·3 million homes in more than 7000 randomly selected areas of India. About 900 non-medical surveyors do structured verbal autopsies for deaths recorded in these homes. Each field report is assigned randomly to two of 404 trained physicians to classify the cause of death, with a standard process for resolution of disagreements. We combined the proportions of child deaths according to the MDS for 2001-13 with annual UN estimates of national births and deaths (partitioned across India's states and rural or urban areas) for 2000-15. We calculated the annual percentage change in sex-specific and cause-specific mortality between 2000 and 2015 for neonates and 1-59-month-old children. The MDS captured 52 252 deaths in neonates and 42 057 deaths at 1-59 months. Examining specific causes, the neonatal mortality rate from infection fell by 66% from 11·9 per 1000 livebirths in 2000 to 4·0 per 1000 livebirths in 2015 and the rate from birth asphyxia or trauma fell by 76% from 9·0 per 1000 livebirths in 2000 to 2·2 per 1000 livebirths in 2015. At 1-59 months, the mortality rate from pneumonia fell by 63% from 11·2 per 1000 livebirths in 2000 to 4·2 per 1000 livebirths in 2015 and the rate from diarrhoea fell by 66% from 9·4 per 1000 livebirths in 2000 to 3·2 per 1000 livebirths in 2015 (with narrowing girl-boy gaps). The neonatal tetanus mortality rate fell from 1·6 per 1000 livebirths in 2000 to less than 0·1 per 1000 livebirths in 2015 and the 1-59-month measles mortality rate fell from 3·3 per 1000 livebirths in 2000 to 0·3 per 1000 livebirths in 2015. By
Full Text Available Most previous studies of meat intake and total or cause-specific mortality were conducted in North America, whereas studies in other areas have been limited and reported inconsistent results. This study investigated the association of red meat or poultry intake with risk of total and cause-specific mortality, including cancer and cardiovascular disease (CVD, in two large population-based prospective cohort studies of 134,290 Chinese adult women and men in Shanghai. Meat intakes were assessed through validated food frequency questionnaires administered in person at baseline. Vital status and dates and causes of deaths were ascertained through annual linkage to the Shanghai Vital Statistics Registry and Shanghai Cancer Registry databases and home visits every 2-3 years. Cox regression was used to calculate hazard ratios (HRs and 95% confidence intervals (CIs for the risk of death associated with quintiles of meat intake. During 803,265 person-years of follow up for women and 334,281 person-years of follow up for men, a total of 4,210 deaths in women and 2,733 deaths in men accrued. The median intakes of red meat were 43 g/day among women and 54 g/day among men, and pork constituted at least 95% of total meat intake for both women and men. Red meat intake was associated with increased total mortality among men, but not among women; the HR (95% CI comparing the highest with the lowest quintiles were 1.18 (1.02-1.35 and 0.92 (0.82-1.03, respectively. This sex difference was statistically significant (P = 0.01. Red meat intake was associated with increased risk of ischemic heart disease mortality (HR = 1.41, 95% CI = 1.05-1.89 and with decreased risk of hemorrhagic stroke mortality (HR = 0.62, 95% CI = 0.45-0.87. There were suggestive inverse associations of poultry intake with risk of total and all-CVD mortality among men, but not among women. Further investigations are needed to elucidate the sex-specific associations between red
Challe, Daniel P; Kamugisha, Mathias L; Mmbando, Bruno P; Francis, Filbert; Chiduo, Mercy G; Mandara, Celine I; Gesase, Samuel; Abdul, Omari; Lemnge, Martha M; Ishengoma, Deus S
Although death records are useful for planning and monitoring health interventions, such information is limited in most developing countries. Verbal autopsy (VA) interviews are alternatively used to determine causes of death in places without or with incomplete hospital records. This study was conducted to determine all causes and cause-specific mortality in Korogwe health and demographic surveillance system (HDSS) undertaken in Korogwe district, northeastern Tanzania. The study was conducted from January 2006 to December 2012 in 14 villages under Korogwe HDSS. Vital events such as births, deaths and migrations were routinely updated quarterly. A standard VA questionnaire was administered to parents/close relatives of the deceased to determine cause of death. Overall, 1325 deaths of individuals with median age of 46 years were recorded in a population with 170,471.4 person years observed (PY). Crude mortality rate was 7.8 per 1000 PY (95% CI 7.2-8.4) and the highest rate was observed in infants (77.9 per 1000 PY; 95% CI 67.4-90.0). The overall mortality increased between 2006 and 2007, followed by a slight decline up to 2011, with the highest decrease observed in 2012. Causes of deaths were established in 942 (71.1%) deaths and malaria (198 deaths, 21.0%) was the leading cause of death in all age groups except adults (15-59 years). HIV/AIDS (17.6%, n = 365) was the leading cause of death in individuals aged 15-59 years followed by malaria (13.9%) and tuberculosis. Non-communicable diseases (NCDs) including stroke, hypertension, cancer, and cardiac failure caused majority of deaths in elderly (60 years and above) accounting for 37.1% (n = 348) of all deaths, although malaria was the single leading cause of death in this group (16.6%). The study showed a significant decline of deaths in the Korogwe HDSS site and malaria was the main cause of death in all age groups (except adults, aged 15-59 years) while HIV/AIDS and NCDs were the main causes in adults and
Panzarella, Tony; Meakin, J. William
Purpose: To describe a statistically valid method for analyzing cause-specific failure data based on simple proportions, that is easy to understand and apply, and outline under what conditions its implementation is well-suited. Methods and Materials: In the comparison of treatment groups, time to first failure (in any site) was analyzed first, followed by an analysis of the pattern of first failure, preferably at the latest complete follow-up time common to each group. Results: A retrospective analysis of time to contralateral breast cancer in 777 early breast cancer patients was undertaken. Patients previously treated by mastectomy plus radiation therapy to the chest wall and regional nodal areas were randomized to receive further radiation and prednisone (R+P), radiation alone (R), or no further treatment (NT). Those randomized to R+P had a statistically significantly delayed time to first failure compared to the group randomized to NT (p = 0.0008). Patients randomized to R also experienced a delayed time to first failure compared to NT, but the difference was not statistically significant (p 0.14). At 14 years from the date of surgery (the latest common complete follow-up time) the distribution of first failures was statistically significantly different between R+P and NT (p = 0.005), but not between R and NT (p = 0.09). The contralateral breast cancer first failure rate at 14 years from surgery was 7.2% for NT, 4.6% for R, and 3.7% for R+P. The corresponding Kaplan-Meier estimates were 13.2%, 8.2%, and 5.4%, respectively. Conclusion: Analyzing cause-specific failure data using methods developed for survival endpoints is problematic. We encourage the use of the two-step analysis strategy described when, as in the example presented, competing causes of failure are not likely to be statistically independent, and when a treatment comparison at a single time-point is clinically relevant and feasible; that is, all patients have complete follow-up to this point
Takata, Yumie; Shu, Xiao-Ou; Gao, Yu-Tang; Li, Honglan; Zhang, Xianglan; Gao, Jing; Cai, Hui; Yang, Gong; Xiang, Yong-Bing; Zheng, Wei
Most previous studies of meat intake and total or cause-specific mortality were conducted in North America, whereas studies in other areas have been limited and reported inconsistent results. This study investigated the association of red meat or poultry intake with risk of total and cause-specific mortality, including cancer and cardiovascular disease (CVD), in two large population-based prospective cohort studies of 134,290 Chinese adult women and men in Shanghai. Meat intakes were assessed through validated food frequency questionnaires administered in person at baseline. Vital status and dates and causes of deaths were ascertained through annual linkage to the Shanghai Vital Statistics Registry and Shanghai Cancer Registry databases and home visits every 2-3 years. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of death associated with quintiles of meat intake. During 803,265 person-years of follow up for women and 334,281 person-years of follow up for men, a total of 4,210 deaths in women and 2,733 deaths in men accrued. The median intakes of red meat were 43 g/day among women and 54 g/day among men, and pork constituted at least 95% of total meat intake for both women and men. Red meat intake was associated with increased total mortality among men, but not among women; the HR (95% CI) comparing the highest with the lowest quintiles were 1.18 (1.02-1.35) and 0.92 (0.82-1.03), respectively. This sex difference was statistically significant (P = 0.01). Red meat intake was associated with increased risk of ischemic heart disease mortality (HR = 1.41, 95% CI = 1.05-1.89) and with decreased risk of hemorrhagic stroke mortality (HR = 0.62, 95% CI = 0.45-0.87). There were suggestive inverse associations of poultry intake with risk of total and all-CVD mortality among men, but not among women. Further investigations are needed to elucidate the sex-specific associations between red meat
Aguinis, Herman; Culpepper, Steven A.; Pierce, Charles A.
We introduce the concept of "differential prediction generalization" in the context of college admissions testing. Specifically, we assess the extent to which predicted first-year college grade point average (GPA) based on high-school grade point average (HSGPA) and SAT scores depends on a student's ethnicity and gender and whether this…
Tricyclic antidepressant (TCA) overdose necessitating intensive care unit (ICU) admission remains a significant problem in the Western Cape. In this retrospective study, we reviewed the course of life-threatening TCA overdose in our centre to identify potential prognostic indicators. TCA levels >1 000 ng/ml were associated ...
Dec 4, 2015 ... Conclusion: Inappropriate ICU admissions were perceived as a common event and were mainly attributed to pressure from seniors, referring clinicians, and hospital management. Further work is ..... Financial support and sponsorship. Nil. Conflicts of interest. There are no conflicts of interest. References. 1.
Jurajda, Štěpán; Münich, Daniel
Roč. 31, č. 4 (2016), s. 483-498 ISSN 0267-1522 R&D Projects: GA ČR(CZ) GBP402/12/G130 Institutional support: RVO:67985998 Keywords : admissions * alphabetical order * order effects Subject RIV: AH - Economics Impact factor: 1.033, year: 2016
... Relations DEPARTMENT OF STATE CIVIL RIGHTS NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR...) Administratively separate units. For the purposes only of this section, §§ 146.225 and 146.230, and §§ 146.300... shall not discriminate on the basis of sex in admission or recruitment in violation of §§ 146.300...
...) NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE... covered by these Title IX regulations. (b) Administratively separate units. For the purposes only of this... which §§ 23.300 through 23.310 apply shall not discriminate on the basis of sex in admission or...
... Commerce and Foreign Trade Office of the Secretary of Commerce NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Coverage § 8a.220 Admissions. (a.... (b) Administratively separate units. For the purposes only of this section, §§ 8a.225 and 8a.230, and...
... DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Coverage § 86.15 Admissions. (a...) Administratively separate units. For the purposes only of this section, §§ 86.16 and 86.17, and Subpart C, each...
... Lands: Interior Office of the Secretary of the Interior NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Coverage § 41.220 Admissions. (a.... (b) Administratively separate units. For the purposes only of this section, §§ 41.225 and 41.230, and...
... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE... covered by these Title IX regulations. (b) Administratively separate units. For the purposes only of this... sex in admission or recruitment in violation of §§ 2555.300 through 2555.310. (d) Educational...
... ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES... separate units. For the purposes only of this section, §§ 1042.225 and 1042.230, and §§ 1042.300 through... apply shall not discriminate on the basis of sex in admission or recruitment in violation of §§ 1042.300...
... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Coverage § 5.220 Admissions. (a.... (b) Administratively separate units. For the purposes only of this section, §§ 5.225 and 5.230, and...
... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE... covered by these Title IX regulations. (b) Administratively separate units. For the purposes only of this... §§ 3.300 through 3.310 apply shall not discriminate on the basis of sex in admission or recruitment in...
Watson, Clarence; Weiss, Kenneth J; Pouncey, Claire
The confession of a criminal defendant serves as a prosecutor's most compelling piece of evidence during trial. Courts must preserve a defendant's constitutional right to a fair trial while upholding the judicial interests of presenting competent and reliable evidence to the jury. When a defendant seeks to challenge the validity of that confession through expert testimony, the prosecution often contests the admissibility of the expert's opinion. Depending on the content and methodology of the expert's opinion, testimony addressing the phenomenon of false confessions may or may not be admissible. This article outlines the scientific and epistemological bases of expert testimony on false confession, notes the obstacles facing its admissibility, and provides guidance to the expert in formulating opinions that will reach the judge or jury. We review the 2006 New Jersey Superior Court decision in State of New Jersey v. George King to illustrate what is involved in the admissibility of false-confession testimony and use the case as a starting point in developing a best-practice approach to working in this area.
Confronting the categories: Equitable admissions without apartheid race classification. Z Erasmus. Abstract. South Africa's government requires information on apartheid race classification to implement and monitor racial redress. This has sparked resistance to race classification as a criterion for redress in higher education ...
Full Text Available Considering the present normative framework, even if in criminal matters the transactions between the judicial organs, which exercise the procedural function of indictment, and the defendant are not permitted, the admission of guilt appears as an incipient form of negotiation of penalty. In anticipation of a future special procedure regarding the accord of admission of guilt, the present institution has generated a great amount of controversy which has, inevitably, caused a matchlessly practice to appear. The purpose of this study is to identify the primary consequences of the norms which now regulate the judgment regarding the admission of guilt and to offer concrete and punctual solutions to the grave problems generated by a defective normative framework. The article has as basic study a documentary material which is comprised not only of normative guidelines, but also of a judicial practice generated by the application of these norms for almost a year. Last, but not least, the actual dimension of the admission of guilt procedure is also underlined by the dealing of the legal issues introduced by the Constitutional Court’s recently handed down decisions in these matters.
... 8 day group in terms of gender, age, substance abuse history, diagnosis and previous admissions. There were more male patients, younger people, and individuals with a history of substance abuse in the ≤ 7 day group, while more patients in the ≥ 8 day group had a diagnosis of schizophrenia or bipolar mood disorder.
Veterinary admission committees are asked to create and implement a fair, reliable, and valid system to select the candidates most likely to succeed in veterinary school from a large pool of applicants. Although numerous studies have explored grade point average (GPA) as a predictive value of later academic success, ...
... 10 Energy 1 2010-01-01 2010-01-01 false Admissions. 2.708 Section 2.708 Energy NUCLEAR REGULATORY... he can neither truthfully admit nor deny them; or (ii) Written objections on the ground that some or... whole or in part. (2) Answers on matters to which such objections are made may be deferred until the...
Sundberg, Louise; Agahi, Neda; Fritzell, Johan; Fors, Stefan
To enhance the understanding of the current increase in life expectancy and decreasing gender gap in life expectancy. We obtained data on underlying cause of death from the National Board of Health and Welfare in Sweden for 1997 and 2014 and used Arriaga's method to decompose life expectancy by age group and 24 causes of death. Decreased mortality from ischemic heart disease had the largest impact on the increased life expectancy of both men and women and on the decreased gender gap in life expectancy. Increased mortality from Alzheimer's disease negatively influenced overall life expectancy, but because of higher female mortality, it also served to decrease the gender gap in life expectancy. The impact of other causes of death, particularly smoking-related causes, decreased in men but increased in women, also reducing the gap in life expectancy. This study shows that a focus on overall changes in life expectancies may hide important differences in age- and cause-specific mortality. It also emphasizes the importance of addressing modifiable lifestyle factors to reduce avoidable mortality.
Duke, Janine M; Randall, Sean M; Fear, Mark W; Boyd, James H; O'Halloran, Emily; Rea, Suzanne; Wood, Fiona M
Currently, limited long-term data on hyperglycaemia and insulin sensitivity in burn patients are available and the data that do exist are primarily related to paediatric severe burns. The aim of this study was to assess if burn is associated with increased post-burn admissions for diabetes mellitus. A population-based longitudinal study using linked hospital morbidity and death data from Western Australia was undertaken of all persons hospitalized for a first burn (n=30,997) in 1980-2012 and a frequency matched non-injury comparison cohort, randomly selected from Western Australia's birth registrations and electoral roll (n=123,399). Crude admission rates and summed length of stay for diabetes mellitus were calculated. Negative binomial and Cox proportional hazards regression modelling were used to generate incidence rate ratios (IRR) and hazard ratios (HR), respectively. After adjustment for socio-demographic factors and pre-existing health status, the burn cohort had 2.21 times (95% Confidence Interval (CI): 1.36-1.56) as many admissions and almost three times the number of days in hospital with a diabetes mellitus diagnosis (IRR, 95% CI: 2.94, 2.12-4.09) than the uninjured cohort. Admission rates were significantly elevated for those burned during childhood (burn cohort during the first 5 years post-burn when compared with the uninjured (HR, 95% CI: 1.96, 1.46-2.64); no significant difference was found beyond 5 years post-burn (HR, 95% CI: 1.08, 0.82-1.41). Findings of increased hospital admission rates and prolonged length of hospital stay for diabetes mellitus in the burn cohort provide evidence that burns have longer term effects on blood glucose and insulin regulation after wound healing. The first five years after burn discharge appears to be a critical period with significantly elevated incident admissions for diabetes mellitus during this time. Results would suggest prolonged clinical management after discharge and or wound healing to minimise post
I will present data showing that significant performance disparities on the GRE general test exist based on the test taker's race and gender . Because of the belief that high GRE scores qualify one for graduate studies, the diversity issues faced by STEM fields may originate, at least in part, in misuse of the GRE scores by graduate admissions committees. I will quantitatively demonstrate this by showing that the combination of a hard cut-off and the different score distributions leads to the systematic underrepresentation of certain groups. I will present data from USF’s PhD program that shows a lack of correlation between GRE scores and research ability; similar null results are emerging from numerous other programs. I will then discuss how assessing non-cognitive competencies in the selection process may lead to a more enlightened search for the next generation of scientists.  C. W. Miller, "Admissions Criteria and Diversity in Graduate School", APS News Vol 22, Issue 2, The Back Page (2013) http://www.aps.org/publications/apsnews/201302/backpage.cfm
Cordero, A; Aguila, J; Massalana, A; Escoto, V; Lopes, L; Susano, R
The authors analyse the appropriateness admissions to the Internal Medicine ward of the Hospital de Santa Luzia (Elvas). A retrospective study was performed during 6 months of 2001, using the Appropriateness Evaluation Protocol (AEP). Non-appropriateness admissions were found in 19% (CI95%: 16-22), and this group of patients had less mean age (63 + 16 vs 69 + 16; p <0.01), and less mean days of admission (7.1 + 6 vs 9.3 + 7; p <0.01) than group with appropriateness admissions. Appropriateness admissions were mainly found in patients admitted from the emergency room (86% vs 49%; p <0.001). Most of patients with non-appropriate admissions were admitted to undergo diagnostic tests (44%; CI95%: 35-53), or to be referred to other medical centres for specialized study and/or treatment (12%; CI95%: 6-18).
Atkinson, Richard W; Samoli, Evangelia; Analitis, Antonis; Fuller, Gary W; Green, David C; Anderson, H Ross; Purdie, Esme; Dunster, Chrissi; Aitlhadj, Layla; Kelly, Frank J; Mudway, Ian S
Particulate matter (PM) from traffic and other sources has been associated with adverse health effects. One unifying theory is that PM, whatever its source, acts on the human body via its capacity to cause damaging oxidation reactions related to its content of pro-oxidants components. Few epidemiological studies have investigated particle oxidative potential (OP) and health. We conducted a time series analysis to assess associations between daily particle OP measures and numbers of deaths and hospital admissions for cardiovascular and respiratory diseases. During 2011 and 2012 particles with an aerodynamic diameter less than 2.5 and 10μm (PM2.5 and PM10 respectively) were collected daily on Partisol filters located at an urban background monitoring station in Central London. Particulate OP was assessed based on the capacity of the particles to oxidize ascorbate (OP(AA)) and glutathione (OP(GSH)) from a simple chemical model reflecting the antioxidant composition of human respiratory tract lining fluid. Particulate OP, expressed as % loss of antioxidant per μg of PM, was then multiplied by the daily concentrations of PM to derive the daily OP of PM mass concentrations (% loss per m(3)). Daily numbers of deaths and age- and cause-specific hospital admissions in London were obtained from national registries. Poisson regression accounting for seasonality and meteorology was used to estimate the percentage change in risk of death or admission associated with an interquartile increment in particle OP. We found little evidence for adverse associations between OP(AA) and OP(GSH) and mortality. Associations with cardiovascular admissions were generally positive in younger adults and negative in older adults with confidence intervals including 0%. For respiratory admissions there was a trend, from positive to negative associations, with increasing age although confidence intervals generally included 0%. Our study, the first to analyse daily particle OP measures and
Cecil, Elizabeth; Bottle, Alex; Sharland, Mike; Saxena, Sonia
We aimed to assess the impact of UK primary care policy reforms implemented in April 2004 on potentially avoidable unplanned short-stay hospital admissions for children with primary care-sensitive conditions. We conducted an interrupted time series analysis of hospital admissions for all children aged younger than 15 years in England between April 2000 and March 2012 using data from National Health Service public hospitals in England. The main outcomes were annual short-stay (short-stay admissions for potentially avoidable infectious and chronic conditions. The primary care policy reforms of April 2004 were associated with an 8% increase in short-stay admission rates for chronic conditions, equivalent to 8,500 additional admissions, above the 3% annual increasing trend. Policy reforms were not associated with an increase in short-stay admission rates for infectious illness, which were increasing by 5% annually before April 2004. The proportion of primary care-referred admissions was falling before the reforms, and there were further sharp reductions in 2004. The introduction of primary care policy reforms coincided with an increase in short-stay admission rates for children with primary care-sensitive chronic conditions, and with more children being admitted through emergency departments. Short-stay admission rates for primary care-sensitive infectious illness increased more steadily and could be related to lowered thresholds for hospital admission. © 2015 Annals of Family Medicine, Inc.
El-Sayed, Charlotte; Radley, Simon; Mytton, Jemma; Evison, Felicity; Ward, Stephen T
Diverticular disease accounts for significant morbidity and mortality and may take the form of recurrent episodes of acute diverticulitis. The role of elective surgery is not clearly defined. This study aimed to define the rate of hospital admission for recurrent acute diverticulitis and risk factors associated with recurrence and surgery. This is a retrospective population-based cohort study. National Health Service hospital admissions for acute diverticulitis in England between April 2006 and March 2011 were reviewed. Hospital Episode Statistics data identified adult patients with the first episode of acute diverticulitis (index admission), and then identified recurrent admissions and elective or emergency surgery for acute diverticulitis during a minimum follow-up period of 4 years. Exclusion criteria included previous diagnoses of acute diverticulitis, colorectal cancer, or GI bleeding, and prior colectomy or surgery or death during the index admission. There were no interventions. The primary outcomes measured were recurrent admissions for acute diverticulitis and patients requiring either elective or emergency surgery during the study period. Some 65,162 patients were identified with the first episode of acute diverticulitis. The rate of hospital admission for recurrent acute diverticulitis was 11.2%. A logistic regression model examined factors associated with recurrent acute diverticulitis and surgery: patient age, female sex, smoking, obesity, comorbidity score >20, dyslipidemia, and complicated acute diverticulitis increased the risk of recurrent acute diverticulitis. There was an inverse relationship between patient age and recurrence. Similar factors were associated with elective and emergency surgery. The cases of acute diverticulitis required inpatient management and the use of Hospital Episode Statistics, relying on the accuracy of diagnostic coding. This is the largest study assessing the rates of hospital admission for recurrent acute
Gallagher, D; Forbes, S; Fagan, P W
The Refugee Act of 1980 is the 1st comprehensive legislation on the admission of refugees to the US; in the 5+ years since its enactment, over 500,000 refugees from more than 25 countries have been admitted to the US. This report assesses the effectiveness of the law in achieving its objectives in making and implementing decisions about the admission of refugees. The objectives of the Act include 1) a desire for a humanitarian response to refugee emergencies and a desire for control over that response, 2) a concern that ideological and geographic restrictions on refugee admissions be removed, and 3) a desire to balance international concerns and domestic impacts in making decisions on refugee admissions. The authors conclude that the refugee program does not serve the broad humanitarian purposes of previous parole programs, due to its stringent review requirements. The formal Congressional Consultations on refugee numbers should be rescheduled to allow regular Congressional input. The program needs a contingency budget for changing situations. The program needs more input from nongovernmental agencies and information sources. Recommendations on refugee admission numbers and allocations have not been well substantiated. Determinations as to which refugees are of "special humanitarian concern" are made solely on the basis of nationality; these decisions should also incorporate other factors. Admissions priorities are generally based on ties to this country, but this makes the refugee program a surrogate immigration program. Although the application of the refugee definition is difficult in practice, it forms the essence of the admission process. US staff must be trained to make these decisions; indecisiveness must not be allowed to jeopardize refugees.
Aune, Dagfinn; Keum, NaNa; Giovannucci, Edward; Fadnes, Lars T; Boffetta, Paolo; Greenwood, Darren C; Tonstad, Serena; Vatten, Lars J; Riboli, Elio; Norat, Teresa
To quantify the dose-response relation between consumption of whole grain and specific types of grains and the risk of cardiovascular disease, total cancer, and all cause and cause specific mortality. PubMed and Embase searched up to 3 April 2016. Prospective studies reporting adjusted relative risk estimates for the association between intake of whole grains or specific types of grains and cardiovascular disease, total cancer, all cause or cause specific mortality. Summary relative risks and 95% confidence intervals calculated with a random effects model. 45 studies (64 publications) were included. The summary relative risks per 90 g/day increase in whole grain intake (90 g is equivalent to three servings-for example, two slices of bread and one bowl of cereal or one and a half pieces of pita bread made from whole grains) was 0.81 (95% confidence interval 0.75 to 0.87; I(2)=9%, n=7 studies) for coronary heart disease, 0.88 (0.75 to 1.03; I(2)=56%, n=6) for stroke, and 0.78 (0.73 to 0.85; I(2)=40%, n=10) for cardiovascular disease, with similar results when studies were stratified by whether the outcome was incidence or mortality. The relative risks for morality were 0.85 (0.80 to 0.91; I(2)=37%, n=6) for total cancer, 0.83 (0.77 to 0.90; I(2)=83%, n=11) for all causes, 0.78 (0.70 to 0.87; I(2)=0%, n=4) for respiratory disease, 0.49 (0.23 to 1.05; I(2)=85%, n=4) for diabetes, 0.74 (0.56 to 0.96; I(2)=0%, n=3) for infectious diseases, 1.15 (0.66 to 2.02; I(2)=79%, n=2) for diseases of the nervous system disease, and 0.78 (0.75 to 0.82; I(2)=0%, n=5) for all non-cardiovascular, non-cancer causes. Reductions in risk were observed up to an intake of 210-225 g/day (seven to seven and a half servings per day) for most of the outcomes. Intakes of specific types of whole grains including whole grain bread, whole grain breakfast cereals, and added bran, as well as total bread and total breakfast cereals were also associated with reduced risks of cardiovascular
Full Text Available This study analyses occupational class inequalities in all-cause mortality and four specific causes of death among men, in Europe in the early 2000s, and is the most extensive comparative analysis of occupational class inequalities in mortality in Europe so far. Longitudinal data, obtained from population censuses and mortality registries in 14 European populations, from around the period 2000-2005, were used. Analyses concerned men aged 30-59 years and included all-cause mortality and mortality from all cancers, all cardiovascular diseases (CVD, all external, and all other causes. Occupational class was analysed according to five categories: upper and lower non-manual workers, skilled and unskilled manual workers, and farmers and self-employed combined. Inequalities were quantified with mortality rate ratios, rate differences, and population attributable fractions (PAF. Relative and absolute inequalities in all-cause mortality were more pronounced in Finland, Denmark, France, and Lithuania than in other populations, and the same countries (except France also had the highest PAF values for all-cause mortality. The main contributing causes to these larger inequalities differed strongly between countries (e.g., cancer in France, all other causes in Denmark. Relative and absolute inequalities in CVD mortality were markedly lower in Southern European populations. We conclude that relative and absolute occupational class differences in all-cause and cause specific mortality have persisted into the early 2000's, although the magnitude differs strongly between populations. Comparisons with previous studies suggest that the relative gap in mortality between occupational classes has further widened in some Northern and Western European populations.
Cleusa P Ferri
Full Text Available Even in low and middle income countries most deaths occur in older adults. In Europe, the effects of better education and home ownership upon mortality seem to persist into old age, but these effects may not generalise to LMICs. Reliable data on causes and determinants of mortality are lacking.The vital status of 12,373 people aged 65 y and over was determined 3-5 y after baseline survey in sites in Latin America, India, and China. We report crude and standardised mortality rates, standardized mortality ratios comparing mortality experience with that in the United States, and estimated associations with socioeconomic factors using Cox's proportional hazards regression. Cause-specific mortality fractions were estimated using the InterVA algorithm. Crude mortality rates varied from 27.3 to 70.0 per 1,000 person-years, a 3-fold variation persisting after standardisation for demographic and economic factors. Compared with the US, mortality was much higher in urban India and rural China, much lower in Peru, Venezuela, and urban Mexico, and similar in other sites. Mortality rates were higher among men, and increased with age. Adjusting for these effects, it was found that education, occupational attainment, assets, and pension receipt were all inversely associated with mortality, and food insecurity positively associated. Mutually adjusted, only education remained protective (pooled hazard ratio 0.93, 95% CI 0.89-0.98. Most deaths occurred at home, but, except in India, most individuals received medical attention during their final illness. Chronic diseases were the main causes of death, together with tuberculosis and liver disease, with stroke the leading cause in nearly all sites.Education seems to have an important latent effect on mortality into late life. However, compositional differences in socioeconomic position do not explain differences in mortality between sites. Social protection for older people, and the effectiveness of health systems in
Ferri, Cleusa P; Acosta, Daisy; Guerra, Mariella; Huang, Yueqin; Llibre-Rodriguez, Juan J; Salas, Aquiles; Sosa, Ana Luisa; Williams, Joseph D; Gaona, Ciro; Liu, Zhaorui; Noriega-Fernandez, Lisseth; Jotheeswaran, A T; Prince, Martin J
Even in low and middle income countries most deaths occur in older adults. In Europe, the effects of better education and home ownership upon mortality seem to persist into old age, but these effects may not generalise to LMICs. Reliable data on causes and determinants of mortality are lacking. The vital status of 12,373 people aged 65 y and over was determined 3-5 y after baseline survey in sites in Latin America, India, and China. We report crude and standardised mortality rates, standardized mortality ratios comparing mortality experience with that in the United States, and estimated associations with socioeconomic factors using Cox's proportional hazards regression. Cause-specific mortality fractions were estimated using the InterVA algorithm. Crude mortality rates varied from 27.3 to 70.0 per 1,000 person-years, a 3-fold variation persisting after standardisation for demographic and economic factors. Compared with the US, mortality was much higher in urban India and rural China, much lower in Peru, Venezuela, and urban Mexico, and similar in other sites. Mortality rates were higher among men, and increased with age. Adjusting for these effects, it was found that education, occupational attainment, assets, and pension receipt were all inversely associated with mortality, and food insecurity positively associated. Mutually adjusted, only education remained protective (pooled hazard ratio 0.93, 95% CI 0.89-0.98). Most deaths occurred at home, but, except in India, most individuals received medical attention during their final illness. Chronic diseases were the main causes of death, together with tuberculosis and liver disease, with stroke the leading cause in nearly all sites. Education seems to have an important latent effect on mortality into late life. However, compositional differences in socioeconomic position do not explain differences in mortality between sites. Social protection for older people, and the effectiveness of health systems in preventing and
Chaix, Basile; Rosvall, Maria; Lynch, John; Merlo, Juan
Various studies have investigated urban/rural differences in cause-specific mortality. A separate body of literature has analysed effects of socioeconomic environment on mortality. Almost no studies have attempted to disentangle effects of population density and socioeconomic environment on mortality, beyond the effects of individual characteristics. Considering all individuals living in the region of Scania, Sweden, from 1970-93, we performed 10 year mortality follow-ups on (i) individuals aged 55, (ii) individuals aged 65, and (iii) individuals aged 75 years at baseline. Cox multilevel models adjusted for individual factors allowed us to investigate the independent effects of population density and median income in the parish of residence on mortality from ischaemic heart disease (IHD), lung cancer, and chronic obstructive pulmonary disease (COPD) among individuals who had lived in the same parish for at least 10 years prior to mortality follow-up. In females, as in males, after adjustment for individual and contextual socioeconomic status, we found a dose-response association between population density and mortality from lung cancer and COPD in all age groups investigated, and from IHD especially in the youngest age group. Overall, the population density effect was the strongest on lung cancer mortality. Median income had an additional impact only in 2 out of 16 subgroups of age x gender x cause of death. In our region-wide study conducted at the parish level, contextual disparities in mortality were dominated by the population density effect. However, it may be unwise to conclude that truly contextual effects exist on mortality, before identification of plausible mediating processes through which urbanicity may influence mortality risk.
To investigate government state and local spending on public goods and income inequality as predictors of the risks of dying. Data on 431,637 adults aged 30-74 and 375,354 adults aged 20-44 in the 48 contiguous US states were used from the National Longitudinal Mortality Study to estimate the impacts of state and local spending and income inequality on individual risks of all-cause and cause-specific mortality for leading causes of death in younger and middle-aged adults and older adults. To reduce bias, models incorporated state fixed effects and instrumental variables. Each additional $250 per capita per year spent on welfare predicted a 3-percentage point (-0.031, 95% CI: -0.059, -0.0027) lower probability of dying from any cause. Each additional $250 per capita spent on welfare and education predicted 1.6-percentage point (-0.016, 95% CI: -0.031, -0.0011) and 0.8-percentage point (-0.008, 95% CI: -0.0156, -0.00024) lower probabilities of dying from coronary heart disease (CHD), respectively. No associations were found for colon cancer or chronic obstructive pulmonary disease; for diabetes, external injury, and suicide, estimates were inverse but modest in magnitude. A 0.1 higher Gini coefficient (higher income inequality) predicted 1-percentage point (0.010, 95% CI: 0.0026, 0.0180) and 0.2-percentage point (0.002, 95% CI: 0.001, 0.002) higher probabilities of dying from CHD and suicide, respectively. Empirical linkages were identified between state-level spending on welfare and education and lower individual risks of dying, particularly from CHD and all causes combined. State-level income inequality predicted higher risks of dying from CHD and suicide. Copyright © 2015 The Author. Published by Elsevier Inc. All rights reserved.
Movahedi, Mohammad; Costello, Ruth; Lunt, Mark; Pye, Stephen Richard; Sergeant, Jamie Christopher; Dixon, William Gregory
Previous studies of glucocorticoid (GC) therapy and mortality have had inconsistent results and have not considered possible perimortal bias—a type of protopathic bias where illness in the latter stages of life influences GC exposure, and might affect the observed relationship between GC use and death. This study aimed to investigate all-cause and cause-specific mortality in association with GC therapy in patients with rheumatoid arthritis (RA), and explore possible perimortal bias. A retrospective cohort study using the primary care electronic medical records. Oral GC exposure was identified from prescriptions. Mortality data were obtained from the UK Office for National Statistics. Multivariable Cox proportional hazards regression models assessed the association between GC use models and death. Several methods to explore perimortal bias were examined. The cohort included 16,762 patients. For ever GC use there was an adjusted hazard ratio for all-cause mortality of 1.97 (95 % CI 1.81–2.15). Current GC dose of below 5 mg per day (prednisolone equivalent dose) was not associated with an increased risk of death, but a dose–response association was seen for higher dose categories. The association between ever GC use and all-cause mortality was partly explained by perimortal bias. GC therapy was associated with an increased risk of mortality for all specific causes considered, albeit to a lesser extent for cardiovascular causes. GC use was associated with an increased risk of death in RA, at least partially explained by perimortal bias. Importantly, GC doses below 5 mg were not associated with an increased risk of death.
Leinonen, Taina; Viikari-Juntura, Eira; Husgafvel-Pursiainen, Kirsti; Solovieva, Svetlana
Objectives We aimed to provide previously unestablished information on population-based differences in cause-specific sickness absence trends between occupational classes and further between four large industrial sectors within the different occupational classes while controlling for other socioeconomic factors and employment patterns. We focused on the period 2005–2013, during which the labour market underwent large economic and structural changes in many countries. Design Register-based panel data study. Setting Large representative datasets on Finnish wage earners aged 25–59 years. Outcome measure Annual risk of sickness absence (>10 working days) based on repeated logistic regression. Results Between 2005 and 2013, the proportion of employees with sickness absence decreased. Occupational class differences in sickness absence trends varied by disease group. Overall, the decrease in absences was smallest among lower non-manual employees. Sickness absence levels were highest in the health and social work sector and in the manufacturing sector within the non-manual and manual classes, respectively. Absences due to musculoskeletal diseases decreased temporarily during the peak of the economic recession in 2009, particularly in the manufacturing sector within the manual class. The decrease in absences due to musculoskeletal diseases was smallest in the trade sector within the lower occupational classes. Overall, education, income and employment patterns partly explained the differences in the absence levels, but not in the trends. Conclusions We found a complex interplay between the associations of occupational class and industrial sector with sickness absence trends. During the economic recession, absences due to musculoskeletal diseases decreased temporarily in a segment of wage earners who were known to have been hit hard by the recession. However, the trend differences were not explained by the measured structural changes in the characteristics of the study
Nakamura, Yasuyuki; Okamura, Tomonori; Kita, Yoshikuni; Okuda, Nagako; Kadota, Aya; Miura, Katsuyuki; Okayama, Akira; Ueshima, Hirotsugu
Egg intake was associated with serum total cholesterol adjusted for age (aTCH) and total mortality in women, but not in men, using data from NIPPON DATA (ND) 80 which followed up for 14 years. Re-evaluation of these associations in a different cohort is needed. We analyzed the associations of egg intake with aTCH and cause-specific and total mortality using the ND90 data set with a 15-year follow-up. A nutritional examination was done at the baseline in 1990 using the food-frequency method and by weighed food records. We followed 4686 female participants (ages ≥30 years), with no history of stroke or myocardial infarction (mean age 52.8 years) for 15 years. The participants were divided into 5 egg intake groups (Egg intake was not associated with aTCH (P = 0.886). There were 183 cardiovascular disease (CVD), 210 cancer, and 599 total mortality cases during follow-up. Cox analysis, adjusted for background factors, found egg intake was directly associated with total and cancer mortality (HR in the ≥2/d vs. the 1 egg/d group: total, 2.05 (95% CI: 1.20-3.52); cancer, 3.20 (1.51-6.76)), and that cancer mortality in the 1-2/w group was significantly less than that in the 1 egg/d group (0.68 (0.47-0.97)). Egg intake was not associated with CVD mortality. Egg intake was associated with cancer and total mortality. Reducing egg intake may have some definitive health benefits in women in Japan, at least.
O'Neill, Lotte Dyhrberg; Vonsild, Maria Cecilie; Wallstedt, B.
Introduction: The underrepresentation of students from lower socioeconomic backgrounds in medical education is an important social issue. There is currently little evidence about whether changes in admission strategy could increase the diversity of medical students. Denmark introduced an “attribute...... of students admitted via the two tracks between the years 2002-2007. Method: This prospective cohort study included 1074 medical students admitted between the years 2002-2007 to the University of Southern Denmark (USD) medical school. Of these, 454 were admitted by grade-based selection and 620 were selected......-based or attribute-based) had no statistically significant effect on the social diversity of medical students admitted to USD. Discussion: It may be a myth that attribute-based admission widens access and increases social diversity. To the contrary, there is evidence that combining grade-based with attribute...
Full Text Available This paper aims at studying how elements of negotiated justice specific to common law systems entered into the Romanian criminal procedural law system. It particularly deals with the admission of guilt and about one of its most controversial aspects – the object of recognition. The research concludes that what is recognized within this simplified procedure it is the deed and not its legal classification given by the criminal prosecution bodies.
This paper aims at studying how elements of negotiated justice specific to common law systems entered into the Romanian criminal procedural law system. It particularly deals with the admission of guilt and about one of its most controversial aspects – the object of recognition. The research concludes that what is recognized within this simplified procedure it is the deed and not its legal classification given by the criminal prosecution bodies.
... Office of the Secretary of Transportation NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR... separate units. For the purposes only of this section, §§ 25.225 and 25.230, and §§ 25.300 through 25.310... discriminate on the basis of sex in admission or recruitment in violation of §§ 25.300 through 25.310. (d...
... Secretary of Labor NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING... units. For the purposes only of this section, §§ 36.225 and 36.230, and §§ 36.300 through 36.310, each... basis of sex in admission or recruitment in violation of §§ 36.300 through 36.310. (d) Educational...
U.S. Department of Health & Human Services — The Treatment Episode Data Set -- Admissions (TEDS-A) is a national census data system of annual admissions to substance abuse treatment facilities. TEDS-A provides...
U.S. Department of Health & Human Services — The Treatment Episode Data Set -- Admissions (TEDS-A) is a national census data system of annual admissions to substance abuse treatment facilities. TEDS-A provides...
U.S. Department of Health & Human Services — The Treatment Episode Data Set -- Admissions (TEDS-A) is a national census data system of annual admissions to substance abuse treatment facilities. TEDS-A provides...
Department of Homeland Security — ACE FTZ Admissions relies on 2 input datasets received from Trade Filers. These are the FT transaction (describes the Admission) and FZ transaction (describes the...
The legal status of service users admitted to psychiatric wards is not synonymous with the level of coercion that they can perceive during the admission. This study aimed to identify and describe the proportion of individuals who were admitted voluntarily but experienced levels of perceived coercion comparable to those admitted involuntarily. Individuals admitted voluntarily and involuntarily to three psychiatric hospitals were interviewed using the MacArthur Admission Experience Interview and the Structured Clinical Interview for DSM-IV diagnoses. One hundered sixty-one individuals were interviewed and 22% of the voluntarily admitted service users had levels of perceived coercion similar to that of the majority of involuntarily admitted service users. Voluntarily admitted service users who experienced high levels of perceived coercion were more likely to have more severe psychotic symptoms, have experienced more negative pressures and less procedural justices on admission. Individuals brought to hospital under mental health legislation but who subsequently agreed to be admitted voluntarily and those treated on a secure ward also reported higher levels of perceived coercion. It needs to be ensured that if any service user, whether voluntary or involuntary, experiences treatment pressures or coercion that there is sufficient oversight of the practice, to ensure that individual\\'s rights are respected.
O'Donoghue, Brian; Roche, Eric; Shannon, Stephen; Lyne, John; Madigan, Kevin; Feeney, Larkin
The legal status of service users admitted to psychiatric wards is not synonymous with the level of coercion that they can perceive during the admission. This study aimed to identify and describe the proportion of individuals who were admitted voluntarily but experienced levels of perceived coercion comparable to those admitted involuntarily. Individuals admitted voluntarily and involuntarily to three psychiatric hospitals were interviewed using the MacArthur Admission Experience Interview and the Structured Clinical Interview for DSM-IV diagnoses. One hundered sixty-one individuals were interviewed and 22% of the voluntarily admitted service users had levels of perceived coercion similar to that of the majority of involuntarily admitted service users. Voluntarily admitted service users who experienced high levels of perceived coercion were more likely to have more severe psychotic symptoms, have experienced more negative pressures and less procedural justices on admission. Individuals brought to hospital under mental health legislation but who subsequently agreed to be admitted voluntarily and those treated on a secure ward also reported higher levels of perceived coercion. It needs to be ensured that if any service user, whether voluntary or involuntary, experiences treatment pressures or coercion that there is sufficient oversight of the practice, to ensure that individual's rights are respected. © 2013 Elsevier Ireland Ltd. All rights reserved.
Rachel E. Scherr; Monica Plisch; Kara E. Gray; Geoff Potvin; Theodore Hodapp
Considering the evidence that standard physics graduate admissions practices tend to exclude women and traditionally marginalized racial and ethnic groups from the discipline, we investigate (a) the characteristics of students that physics graduate admissions committee members seek to admit to their programs and (b) the practices associated with these admissions goals. The data for this investigation are interviews with 18 faculty who chair graduate admissions committees in programs that prio...
Full Text Available Abstract Background Mortality exhibits seasonal variations, which to a certain extent can be considered as mid-to long-term influences of meteorological conditions. In addition to atmospheric effects, the seasonal pattern of mortality is shaped by non-atmospheric determinants such as environmental conditions or socioeconomic status. Understanding the influence of season and other factors is essential when seeking to implement effective public health measures. The pressures of climate change make an understanding of the interdependencies between season, climate and health especially important. Methods This study investigated daily death counts collected within the Sample Vital Registration System (VSRS established by the Bangladesh Bureau of Statistics (BBS. The sample was stratified by location (urban vs. rural, gender and socioeconomic status. Furthermore, seasonality was analyzed for all-cause mortality, and several cause-specific mortalities. Daily deviation from average mortality was calculated and seasonal fluctuations were elaborated using non parametric spline smoothing. A seasonality index for each year of life was calculated in order to assess the age-dependency of seasonal effects. Results We found distinctive seasonal variations of mortality with generally higher levels during the cold season. To some extent, a rudimentary secondary summer maximum could be observed. The degree and shape of seasonality changed with the cause of death as well as with location, gender, and SES and was strongly age-dependent. Urban areas were seen to be facing an increased summer mortality peak, particularly in terms of cardiovascular mortality. Generally, children and the elderly faced stronger seasonal effects than youths and young adults. Conclusion This study clearly demonstrated the complex and dynamic nature of seasonal impacts on mortality. The modifying effect of spatial and population characteristics were highlighted. While tropical regions have
Strongman, Helen; Christopher, Solomon; Majak, Maila; Williams, Rachael; Bahmanyar, Shahram; Linder, Marie; Heintjes, Edith M; Bennett, Dimitri; Korhonen, Pasi; Hoti, Fabian
Describe and compare the risk of cardiovascular and non-cardiovascular mortality in patients whose antidiabetic therapy is modified to include pioglitazone compared with an alternative antidiabetic medication at the same stage of disease progression. This exploratory linked database cohort analysis used pooled health and mortality data from three European countries: Finland, Sweden and the UK. Propensity score together with exact matching was used to match 31 133 patients with type 2 diabetes first prescribed pioglitazone from 2000 to 2011, to 31 133 patients never prescribed pioglitazone. Exact matching variables were treatment stage, history of diabetes, diabetes complications and cardiovascular disease, and year of cohort entry. Mean follow-up time was 2.60 (SD 2.00) and 2.69 (SD 2.31) years in the pioglitazone and non-pioglitazone-exposed groups, respectively. Crude cause-specific mortality rates were ascertained. Association with pioglitazone use was estimated using Cox proportional hazards models adjusted a priori for country, age, sex, the propensity score quintile and time-dependent variables representing use of antidiabetic drugs. Stepwise testing identified no additional confounders to include in adjusted models. The crude mortality rate was lower in the pioglitazone-exposed group than the non-exposed group for both cardiovascular and non-cardiovascular mortality. Adjusted HRs comparing pioglitazone to alternative antidiabetic exposure were 0.58 (95% CI 0.52 to 0.63) and 0.63 (95% CI 0.58 to 0.68) for cardiovascular and non-cardiovascular mortality, respectively. A protective effect associated with pioglitazone was also found for all specific cardiovascular causes. This analysis suggests that pioglitazone is associated with a decrease in both cardiovascular and non-cardiovascular mortality. Results should be interpreted with caution due to the potential for residual confounding in this exploratory analysis. Further studies, specifically designed to test
Full Text Available Tobacco smoking is a major risk factor for many diseases. We sought to quantify the burden of tobacco-smoking-related deaths in Asia, in parts of which men's smoking prevalence is among the world's highest.We performed pooled analyses of data from 1,049,929 participants in 21 cohorts in Asia to quantify the risks of total and cause-specific mortality associated with tobacco smoking using adjusted hazard ratios and their 95% confidence intervals. We then estimated smoking-related deaths among adults aged ≥45 y in 2004 in Bangladesh, India, mainland China, Japan, Republic of Korea, Singapore, and Taiwan-accounting for ∼71% of Asia's total population. An approximately 1.44-fold (95% CI = 1.37-1.51 and 1.48-fold (1.38-1.58 elevated risk of death from any cause was found in male and female ever-smokers, respectively. In 2004, active tobacco smoking accounted for approximately 15.8% (95% CI = 14.3%-17.2% and 3.3% (2.6%-4.0% of deaths, respectively, in men and women aged ≥45 y in the seven countries/regions combined, with a total number of estimated deaths of ∼1,575,500 (95% CI = 1,398,000-1,744,700. Among men, approximately 11.4%, 30.5%, and 19.8% of deaths due to cardiovascular diseases, cancer, and respiratory diseases, respectively, were attributable to tobacco smoking. Corresponding proportions for East Asian women were 3.7%, 4.6%, and 1.7%, respectively. The strongest association with tobacco smoking was found for lung cancer: a 3- to 4-fold elevated risk, accounting for 60.5% and 16.7% of lung cancer deaths, respectively, in Asian men and East Asian women aged ≥45 y.Tobacco smoking is associated with a substantially elevated risk of mortality, accounting for approximately 2 million deaths in adults aged ≥45 y throughout Asia in 2004. It is likely that smoking-related deaths in Asia will continue to rise over the next few decades if no effective smoking control programs are implemented. Please see later in the article for
Objectives. To describe the diarrhoea admissions and the influencing factors in 6 - 60-month-old children at Morogoro Regional Hospital. Design. A retrospective descriptive study of the type of diarrhoea, patient age, home address, nutritional status, diagnosed infection, month of admission, admission duration and outcome ...
McDonough, Patricia; Robertson, Larry
Describes changes that have occurred in high schools, colleges, and the entrepreneurial admission sector. Relates the evolution of the admission officer's job since the early 1960s and the profession's rapid growth. Details the hybrid role of marketer and educator for chief admissions officers, and issues a call for professional standards. (RJM)
Sinutko, Jaime M.
Admission to a baccalaureate nursing school in the United States is currently a challenging proposition for a variety of reasons. This research explored a holistic nursing school admission process at a small, private, baccalaureate college using a retrospective, mixed-method, approach. The holistic method included multiple admission criteria, both…
... recruitment. 18.442 Section 18.442 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS... Postsecondary Education § 18.442 Admissions and recruitment. (a) General. Qualified handicapped persons may not... recruitment by a recipient. (b) Admission. In administering its admission policies, a recipient; (1) May not...
... 45 Public Welfare 3 2010-10-01 2010-10-01 false Admissions and recruitment. 1170.42 Section 1170... FEDERALLY ASSISTED PROGRAMS OR ACTIVITIES Postsecondary Education § 1170.42 Admissions and recruitment. (a... subjected to discrimination in admission or recruitment by a recipient to which this subpart applies. (b...
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Admissions and recruitment. 142.42 Section 142... and recruitment. (a) General. Qualified handicapped persons may not, on the basis of handicap, be denied admission or be subjected to discrimination in admission or recruitment by a recipient to which...
... 7 Agriculture 1 2010-01-01 2010-01-01 false Admissions and recruitment. 15b.30 Section 15b.30... ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Postsecondary Education § 15b.30 Admissions and recruitment... be subjected to discrimination in admission or recruitment by a recipient to which this subpart...
Surgical admissions accounted for 75.8% of admissions while medical admissions were 24.2%. The overall ICU mortality in the elderly was 58.1%.The major predictors of mortality were: need for endotracheal intubation (p=0.001), mechanical ventilation (p=0.001), vasopressor (p=0.001), electrolyte derangement (p=0.001), ...
... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Preference in admission. 113.305 Section 113.305 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NONDISCRIMINATION IN... Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 113.305 Preference in admission. A...
... October 2, 2013 Refugee Admissions for Fiscal Year 2014 Memorandum for the Secretary of State In... authorize the following actions: The admission of up to 70,000 refugees to the United States during fiscal... with Federal refugee resettlement assistance under the Amerasian immigrant admissions program, as...
Objective: To determine the profile of neurological admissions at the Lagos University Teaching Hospital Methods: Neurological admission at the Lagos University Teaching Hospital, Lagos, Nigeria between 1995 and 1999 were reviewed using medical records. Result: Neurological admissions accounted for 19.635 of total ...
Background. Admission to a mental healthcare facility is not always based on the voluntary consent of the patient. Sometimes a patient is unable or unwilling to consent to admission because of his mental status and lack of insight into his mental illness. If a men- tally ill person needs admission because of a threat to himself ...
Medical admissions due to non-communicable diseases were carefully selected and analyzed. There were 1853 cases of various non-communicable diseases out of a total medical admission of 3294 constituting 56.2% of total medical admissions. Diseases of the cardiovascular, endocrine and renal systems were the most ...
Background Medication reconciliation has been mandated by the Irish government at transfer of care. Research is needed to determine the contribution of clinical pharmacists to the process. Objective To describe the contribution of emergency department based clinical pharmacists to admission medication reconciliation in Ireland. Main Outcome Measure Frequency of clinical pharmacist\\'s activities. Setting Two public university teaching hospitals. Methodology Adults admitted via the accident and emergency department, from a non-acute setting, reporting the use of at least three regular prescription medications, were eligible for inclusion. Medication reconciliation was provided by clinical pharmacists to randomly-selected patients within 24-hours of admission. This process includes collecting a gold-standard pre-admission medication list, checking this against the admission prescription and communicating any changes. A discrepancy was defined as any difference between the gold-standard pre-admission medication list and the admission prescription. Discrepancies were communicated to the clinician in the patient\\'s healthcare record. Potentially harmful discrepancies were also communicated verbally. Pharmacist activities and unintentional discrepancies, both resolved and unresolved at 48-hours were measured. Unresolved discrepancies were confirmed verbally by the team as intentional or unintentional. A reliable and validated tool was used to assess clinical significance by medical consultants, clinical pharmacists, community pharmacists and general practitioners. Results In total, 134 patients, involving 1,556 medications, were included in the survey. Over 97 % of patients (involving 59 % of medications) experienced a medication change on admission. Over 90 % of patients (involving 29 % of medications) warranted clinical pharmacy input to determine whether such changes were intentional or unintentional. There were 447 interventions by the clinical pharmacist regarding
Vlayen, Annemie; Verelst, Sandra; Bekkering, Geertruida E; Schrooten, Ward; Hellings, Johan; Claes, Nerée
Adverse events are unintended patient injuries or complications that arise from healthcare management resulting in death, disability or prolonged hospital stay. Adverse events that require critical care are a considerable financial burden to the healthcare system. Medical record review seems to be a reliable method for detecting adverse events. To synthesize the best available evidence regarding the estimates of the incidence and preventability of adverse events that necessitate intensive care admission; to determine the type and consequences (patient harm, mortality, length of ICU stay and direct medical costs) of these adverse events. MEDLINE (from 1966 to present), EMBASE (from 1974 to present) and CENTRAL (version 1-2010) were searched for studies reporting on unplanned admissions to intensive care units (ICUs). Databases of reports, conference proceedings, grey literature, ongoing research, relevant patient safety organizations and two journals were searched for additional studies. Reference lists of retrieved papers were searched and authors were contacted in an attempt to find any further published or unpublished work. Only quantitative studies that used chart review for the detection of adverse events requiring intensive care admission were considered for eligibility. Studies that were published in the English, Dutch, German, French or Spanish language were included. Two reviewers independently extracted data and assessed the methodological quality of the included studies. 28 studies in the English language and one study in French were included. Of these, two were considered duplicate publications and therefore 27 studies were reviewed. Meta-analysis of the data was not appropriate due to statistical heterogeneity between studies; therefore, results are presented in a descriptive way. Studies were categorized according to the population and the providers of care. 1) The majority of the included studies investigated unplanned intensive care admissions after
Shukla, R K; O'Hallaron, R D
This article challenges our present system of afternoon admissions and morning discharges for its inefficiency in utilizing patient stay at the hospital as well as for its insensitivity to consumer convenience. In fact, the tradition of afternoon admissions and morning discharges may have its roots in the hotel industry which sets similar times for arrival and departure of guests. By changing the admission system from afternoon admissions and morning discharges (PM/AM) to morning admissions and evening discharges (AM/PM), the length of stay for most patients can be reduced and used more efficiently.
Berg-Beckhoff, Gabriele; Gulis, Gabriel; Kronborg Bak, Carsten
compensated unemployment and both types of disease specific hospital admission was associated statistically significant in the cross-sectional analysis. With regard to circulatory disease, the cohort approach suggests that social welfare compensated unemployment might lead to hospital admission due......The association between unemployment and hospital admission is known, but the causal relationship is still under discussion. The aim of the present analysis is to compare results of a cross-sectional and a cohort approach considering overall hospital admission and hospital admission due to cancer...
Alam, Mohammed K.; Fahim, F.; Qazi, Shabir A.; Al-Akeely, Mohammad H.A.; Al-Dossary, Nasser F.
Objective was to study the local patient profile, diagnostic methods and treatment outcome in patients with large bowel volvulus to recommend a management plan. A retrospective study of patient's record with a final diagnosis of large bowel volvulus treated at King Saud Medical Complex, Riyadh, Saudi Arabia between January 2000 and December 2007 were performed for patient demography, clinical presentations, co-morbidity, diagnostic methods, anatomical types, management and outcome. Forty-two patients with large bowel volvulus were reviewed. They presented 8.5% of all intestinal obstructions treated. Most had sigmoid volvulus (83%), were less than 60 years of age and were male. Recognized risk factors were present in 12 (29%) patients. Diagnosis was suspected on plain abdominal x-ray in 28 patients (69%), although the characteristic signs of omega and coffee bean were seen only in 16 patients. Eight patients required emergency surgery. Endoscopic decompression was successful in 34 patients, followed by a definitive surgery in 24 patients. Seven patients refused surgery; 3 of them were readmitted with recurrence and were operated. Three patients were unfit for surgery. There were 3 deaths. Large bowel volvulus is uncommon in this area. Abdominal distension with pain, constipation and characteristic gas pattern in plain x-ray can help diagnose most cases. Decompression can be achieved in most patients with sigmoid volvulus, followed by surgery during the same hospital admission. Transverse colon and cecal volvulus usually need emergency surgery. (author)
Vargas, Carlos; Kestin, Larry; Go, Nel; Krauss, Daniel; Chen, Peter; Goldstein, Neal; Martinez, Alvaro; Vicini, Frank A.
Purpose: We reviewed our institution's experience treating patients with ductal carcinoma in situ (DCIS) of the breast to determine risk factors for ipsilateral breast tumor recurrence (IBTR) and cause-specific survival (CSS) after breast-conserving therapy (BCT) or mastectomy. Materials and Methods: Between 1981 and 1999, 410 cases of DCIS (405 patients) were treated at our institution; 367 were managed with breast-conserving surgery (54 with lumpectomy alone and 313 with adjuvant radiation therapy (RT) [median dose, 45 Gy]). Of these 313 patients, 298 received also a supplemental boost of RT to the lumpectomy cavity (median dose, 16 Gy). Forty-three patients underwent mastectomy; 2 (5%) received adjuvant RT to the chest wall. A true recurrence/marginal miss (TR/MM) IBTR was defined as failure within or adjacent to the tumor bed in patients undergoing BCT. Median follow-up for all patients was 7 years (mean: 6.1 years). Results: Thirty patients (8.2%) experienced an IBTR after BCT (25 [8%] after RT, 5 [9.3%] after no RT), and 2 patients (4.7%) developed a chest wall recurrence after mastectomy. Of the 32 local failures, 20 (63%) were invasive (18/30 [60%] after BCT and 2/2 [100%] after mastectomy), and 37% were DCIS alone. Twenty-four (80%) of the IBTRs were classified as TR/MM. The 10-year freedom from local failure, CSS, and overall survival after BCT or mastectomy were 89% vs. 90% (p = 0.4), 98% vs. 100% (p = 0.7), and 89% vs. 100% (p = 0.3), respectively. Factors associated with IBTR on Cox multivariate analysis were younger age (p = 0.02, hazard ratio [HR] 1.06 per year), electron boost energy ≤9 MeV (p = 0.03, HR 1.41), final margins ≤2 mm (p = 0.007; HR, 3.65), and no breast radiation (p = 0.002, HR 5.56). On Cox univariate analysis for BCT patients, IBTR, TR/MM failures, and predominant nuclear Grade 3 were associated with an increased risk of distant metastases and a reduced CSS. Conclusions: After treatment for DCIS, 10-year rates of local control
Vest, J R; Kern, L M; Campion, T R; Silver, M D; Kaushal, R
Relevant patient information is frequently difficult to obtain in emergency department (ED) visits. Improved provider access to previously inaccessible patient information may improve the quality of care and reduce hospital admissions. Health information exchange (HIE) systems enable access to longitudinal, community-wide patient information at the point of care. However, the ability of HIE to avert admissions is not well demonstrated. We sought to determine if HIE system usage is correlated with a reduction in admissions via the ED. We identified 15,645 adults from New York State with an ED visit during a 6-month period, all of whom consented to have their information accessible in the HIE system, and were continuously enrolled in two area health plans. Using claims we determined if the ED encounter resulted in an admission. We used the HIE's system log files to determine usage during the encounter. We determined the association between HIE system use and the likelihood of admission to the hospital from the ED and potential cost savings. The HIE system was accessed during 2.4% of encounters. The odds of an admission were 30% lower when the system was accessed after controlling for confounding (odds ratio = 0.70; 95%C I= 0.52, 0.95). The annual savings in the sample was $357,000. These findings suggest that the use of an HIE system may reduce hospitalizations from the ED with resultant cost savings. This is an important outcome given the substantial financial investment in interventions designed to improve provider access to patient information in the US.
Makransky, Guido; Havmose, Philip S.; Vang, Maria
The aim of this study was to evaluate the predictive validity of a two-step admissions procedure that included a cognitive ability test followed by multiple mini-interviews (MMIs) used to assess non-cognitive skills, compared to grade-based admissions relative to subsequent drop-out rates...... and academic achievement after one and two years of study. The participants consisted of the entire population of 422 psychology students who were admitted to the University of Southern Denmark between 2010 and 2013. The results showed significantly lower drop-out rates after the first year of study, and non...
Full Text Available The article deals with solving the problem of ensuring Quality of Service (QoS in IP Multimedia Subsystem (IMS networks. Admission Control methods (AC are used to prevent network congestion and the decrease of QoS. The main function of AC is to maximize utilization of network resources and to ensure the level of QoS. Four methods were chosen for comparison. These methods are described in the main part of the article. The last part deals with simulations of these methods in the software MATLAB.
Brabrand, Mikkel; Folkestad, Lars; Hallas, Peter
the intern on call at the medical departments of all Danish hospitals listed on sundhed.dk. RESULTS: We received 87 answers from 60 individual MAUs covered by a total of 83 interns on call. The MAUs had a median of eight beds and 14 admissions a day. An intern was on call 24 hours a day at 95% of the MAUs......% answered that selected groups of patients were routinely assessed by a senior physician. CONCLUSION: None of the Danish MAUs uses a validated triage tool to prioritize acutely admitted medical patients. Udgivelsesdato: 2010-May-31...
Full Text Available Background: Research into long-term cause-specific mortality of women diagnosed with breast cancer is important because it allows for the splitting of the population into patients who eventually die from breast cancer and from other causes. The adoption of this approach helps to identify patients with an elevated risk of eventual death from breast cancer. Objective: The primary aim of this study was to examine the associations between both sociodemographic and clinicopathologic characteristics and the underlying risks of death from breast cancer and from other causes for women diagnosed with breast cancer. A second aim was to propose a predictive biomarker of cause-specific mortality in terms of treatment and several important characteristics of a patient. Methods: A cohort of 16 511 female patients diagnosed with breast cancer in 1990 was obtained from the Surveillance, Epidemiology, and End Results cancer registries and followed for 20 years. A mixture model for the regression analysis of competing risks was used to identify factors and confounders that affected either the eventual cause-specific mortality or conditional cause-specific hazard rates, or both. Missing data were handled with multiple imputation. Results: Curvilinear relationships of age at diagnosis along with race, marital status, breast cancer type, tumor size, estrogen receptor status, extension, lymph node status, type of surgery, and radiotherapy status were significant risk factors for the cause-specific mortality, with extension and lymph node status appearing to be confounded with the effects of both type of surgery and radiotherapy status. The score obtained from combining a set of predictors showed to be an accurate predictive biomarker. Conclusions: In cause-specific mortality of women diagnosed breast cancer, prognosis appears to depend on both sociodemographic and clinicopathologic factors. The predictive biomarker proposed in this study may help identifying the
Escarela, Gabriel; Jiménez-Balandra, Alan; Núñez-Antonio, Gabriel; Gordillo-Moscoso, Antonio
BACKGROUND Research into long-term cause-specific mortality of women diagnosed with breast cancer is important because it allows for the splitting of the population into patients who eventually die from breast cancer and from other causes. The adoption of this approach helps to identify patients with an elevated risk of eventual death from breast cancer. OBJECTIVE The primary aim of this study was to examine the associations between both sociodemographic and clinicopathologic characteristics and the underlying risks of death from breast cancer and from other causes for women diagnosed with breast cancer. A second aim was to propose a predictive biomarker of cause-specific mortality in terms of treatment and several important characteristics of a patient. METHODS A cohort of 16 511 female patients diagnosed with breast cancer in 1990 was obtained from the Surveillance, Epidemiology, and End Results cancer registries and followed for 20 years. A mixture model for the regression analysis of competing risks was used to identify factors and confounders that affected either the eventual cause-specific mortality or conditional cause-specific hazard rates, or both. Missing data were handled with multiple imputation. RESULTS Curvilinear relationships of age at diagnosis along with race, marital status, breast cancer type, tumor size, estrogen receptor status, extension, lymph node status, type of surgery, and radiotherapy status were significant risk factors for the cause-specific mortality, with extension and lymph node status appearing to be confounded with the effects of both type of surgery and radiotherapy status. The score obtained from combining a set of predictors showed to be an accurate predictive biomarker. CONCLUSIONS In cause-specific mortality of women diagnosed breast cancer, prognosis appears to depend on both sociodemographic and clinicopathologic factors. The predictive biomarker proposed in this study may help identifying the level of seriousness of the
van der Linden, Christien; Lucas, Cees; van der Linden, Naomi; Lindeboom, Robert
To prevent overcrowding of the emergency department, a flexible acute admission unit (FAAU) was created, consisting of 15 inpatient regular beds located in different departments. We expected the FAAU to result in fewer transfers to other hospitals and in a lower length of stay (LOS) of patients
Reumer, Christoffel; van der Wende, Marijk
This paper explores the emergence of selective admission policies in Dutch university education. Such policies are being developed to promote excellence in a higher education system that is generally known to be “egalitarian” and increasingly criticized for a lack of differentiation. The changing
Folkestad, Lars; Brabrand, Mikkel; Hallas, Peter
at emergency departments, nor how often these patients are debated with an attending doctor. MATERIAL AND METHODS: Questionnaire survey performed January-April 2008, in which medical interns on call at Danish public hospitals completed an online questionnaire. The questions regarded: admissions and follow...... for help from a senior colleague. Udgivelsesdato: 2010-May-31...
Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.
Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation
Wabwoba, Franklin; Mwakondo, Fullgence M.
Every year, the Joint Admission Board (JAB) is tasked to determine those students who are expected to join various Kenyan public universities under the government sponsorship scheme. This exercise is usually extensive because of the large number of qualified students compared to the very limited number of slots at various institutions and the…
Bell, Sue Anne; Abir, Mahshid; Choi, HwaJung; Cooke, Colin; Iwashyna, Theodore
We characterize hospital admissions among older adults for any cause in the 30 days after a significant natural disaster in the United States. The main outcome was all-cause hospital admissions in the 30 days after natural disaster. Separate analyses were conducted to examine all-cause hospital admissions excluding the 72 hours after the disaster, ICU admissions, all-cause inhospital mortality, and admissions by state. A self-controlled case series analysis using the 2011 Medicare Provider and Analysis Review was conducted to examine exposure to natural disaster by elderly adults located in zip codes affected by tornadoes during the 2011 southeastern superstorm. Spatial data of tornado events were obtained from the National Oceanic and Atmospheric Administration's Severe Report database, and zip code data were obtained from the US Census Bureau. All-cause hospital admissions increased by 4% for older adults in the 30 days after the April 27, 2011, tornadoes (incidence rate ratio 1.04; 95% confidence interval 1.01 to 1.07). When the first 3 days after the disaster that may have been attributed to immediate injuries were excluded, hospitalizations for any cause also remained higher than when compared with the other 11 months of the year (incidence rate ratio 1.04; 95% confidence interval 1.01 to 1.07). There was no increase in ICU admissions or inhospital mortality associated with the natural disaster. When data were examined by individual states, Alabama, which had the highest number of persons affected, had a 9% increase in both hospitalizations and ICU admissions. When all time-invariant characteristics were controlled for, this natural disaster was associated with a significant increase in all-cause hospitalizations. This analysis quantifies acute care use after disasters through examining all-cause hospitalizations and represents an important contribution to building models of resilience-the ability to recover from a disaster-and hospital surge capacity
Saz-Parkinson, Zuleika; Medel, A; Cediel-García, P; Castellote, J; Bouza, C; Amate, J M
The deinstitutionalisation reform in Spain started after 1980 with the aim of reducing the need for hospitalisation, length of stay and the number of psychiatric hospital beds, as well as fostering psychiatric patient's involvement in the community. The aim of this study was to review how this reform process has affected the management of schizophrenic patients from 1980 to 2004. Longitudinal (1980-2004) study describing variables related to hospital morbidity in schizophrenia patients. Hospital admission rate has gradually increased from 1980 to 2004 from 3.71 admissions per 10,000 inhabitants to 5.89, respectively. Considering the type of admission, emergency or elective, whilst the latter has slightly decreased from 2.24 in 1980 to 1.72 in 2004, the first has almost tripled from 1.47 to 4.17. The point-prevalence of schizophrenic patients receiving inpatient treatment each year has decreased 78% in this period. Length of stay, in days per admission episode, has also decreased from 148 days in 1980 to 35 days in 2004. One of the main impacts of the psychiatric health care reform in Spain has been the considerable reduction in hospital capacity devoted to schizophrenic patients, based on the significant decrease in point-prevalence. Thus, it seems relevant to design new studies to quantify the resource reallocation to other areas of care, such as pharmacological treatment and community services.
de Almeida, Cesar Cimonari; Boone, M Dustin; Laviv, Yosef; Kasper, Burkhard S; Chen, Clark C; Kasper, Ekkehard M
Patients who have undergone intracranial neurosurgical procedures have traditionally been admitted to an intensive care unit (ICU) for close postoperative neurological observation. The purpose of this study was to systematically review the evidence for routine ICU admission in patients undergoing intracranial neurosurgical procedures and to evaluate the safety of alternative postoperative pathways. We were interested in identifying studies that examined selected patients who presented for elective, non-emergent intracranial surgery whose postoperative outcomes were compared as a function of ICU versus non-ICU admission. A systematic review was performed in July 2016 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist of the Medline database. The search strategy was created based on the following key words: "craniotomy," "neurosurgical procedure," and "intensive care unit." The nine articles that satisfied the inclusion criteria yielded a total of 2227 patients. Of these patients, 879 were observed in a non-ICU setting. The most frequent diagnoses were supratentorial brain tumors, followed by patients with cerebrovascular diseases and infratentorial brain tumors. Three percent (30/879) of the patients originally assigned to floor or intermediate care status were transferred to the ICU. The most frequently observed neurological complications leading to ICU transfer were delayed postoperative neurological recovery, seizures, worsening of neurological deficits, hemiparesis, and cranial nerves deficits. Our systematic review demonstrates that routine postoperative ICU admission may not benefit carefully selected patients who have undergone elective intracranial neurosurgical procedures. In addition, limiting routine ICU admission may result in significant cost savings.
Abelha, Fernando J; Santos, Cristina C; Barros, Henrique
Examining the quality of life (QOL) of patients before ICU admission will allow outcome variables to be compared and analyzed in relation to it. The objective of this study was to analyze QOL of patients before admission to a surgical ICU and to study its relationship to outcome and to the baseline characteristics of the patients. All adult patients consecutively admitted to the surgical ICU between November 2004 and April 2005, who underwent non-cardiac surgery, were enrolled in this observational and prospective study. The following patient characteristics were recorded: age, gender, body mass index, ASA physical status, type and magnitude of surgical procedure, length of stay (LOS), in ICU and in hospital, mortality, Simplified Acute Physiology Score II (SAPS), history of co-morbidities and quality of life survey score (QOLSS). The relationships between QOLSS and ICU variables and outcome were evaluated. The relationship between the total QOLSS and each variable or outcome was assessed by multiple linear regression. One hundred eighty seven patients completed the study. The preadmission QOLSS of the patients studied was 4.43 +/- 4.90; 28% of patients had a normal quality of life (0 points), 38% had between 1 and 5 points (considered mild deterioration), 21% had between 6 and 10 points (moderate deterioration), 10% had between 11 and 15 points (considered major deterioration) and 3% had more than 15 points (severe limitation of quality of life). A worse preadmission QOLSS was associated with higher SAPS II scores, with older patients (age> 65 years) and with ASA physical status (ASA III/IV). Total QOLSS was significantly worse in elderly patients and in patients with co-morbidities and in patients more severely ill at ICU admission. Patients who died in the ICU and in hospital had worse QOLSS scores compared to those who survived. However, no statistical differences in QOLSS were found in relation to longer ICU stays (ICU LOS). Preadmission QOL correlates with
Full Text Available Abstract Background: Examining the quality of life (QOL of patients before ICU admission will allow outcome variables to be compared and analyzed in relation to it. The objective of this study was to analyze QOL of patients before admission to a surgical ICU and to study its relationship to outcome and to the baseline characteristics of the patients. Methods: All adult patients consecutively admitted to the surgical ICU between November 2004 and April 2005, who underwent non-cardiac surgery, were enrolled in this observational and prospective study. The following patient characteristics were recorded: age, gender, body mass index, ASA physical status, type and magnitude of surgical procedure, length of stay (LOS, in ICU and in hospital, mortality, Simplified Acute Physiology Score II (SAPS, history of co-morbidities and quality of life survey score (QOLSS. The relationships between QOLSS and ICU variables and outcome were evaluated. The relationship between the total QOLSS and each variable or outcome was assessed by multiple linear regression. Results: One hundred eighty seven patients completed the study. The preadmission QOLSS of the patients studied was 4.43 ± 4.90; 28% of patients had a normal quality of life (0 points, 38% had between 1 and 5 points (considered mild deterioration, 21% had between 6 and 10 points (moderate deterioration, 10% had between 11 and 15 points (considered major deterioration and 3% had more than 15 points (severe limitation of quality of life. A worse preadmission QOLSS was associated with higher SAPS II scores, with older patients (age> 65 years and with ASA physical status (ASA III/IV. Total QOLSS was significantly worse in elderly patients and in patients with co-morbidities and in patients more severely ill at ICU admission. Patients who died in the ICU and in hospital had worse QOLSS scores compared to those who survived. However, no statistical differences in QOLSS were found in relation to longer ICU stays
... The Marfan Foundation Marfan & Related Disorders What is Marfan Syndrome? What are Related Disorders? What are the Signs? ... Emergencies Eye Emergencies Lung Emergencies Surgeries Eye Emergencies Marfan syndrome significantly increases your risk of retinal detachment, a ...
Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015 : a systematic analysis for the Global Burden of Disease Study 2015
Wang, Haidong; Naghavi, Mohsen; Allen, Christine; Barber, Ryan M.; Bhutta, Zulfiqar A.; Carter, Austin; Casey, Daniel C.; Charlson, Fiona J.; Chen, Alan Zian; Coates, Matthew M.; Coggeshall, Megan; Dandona, Lalit; Dicker, Daniel J.; Erskine, Holly E.; Ferrari, Alize J.; Fitzmaurice, Christina; Foreman, Kyle; Forouzanfar, Mohammad H.; Fraser, Maya S.; Pullman, Nancy; Gething, Peter W.; Goldberg, Ellen M.; Graetz, Nicholas; Haagsma, Juanita A.; Hay, Simon I.; Huynh, Chantal; Johnson, Catherine; Kassebaum, Nicholas J.; Kinfu, Yohannes; Kulikoff, Xie Rachel; Kutz, Michael; Kyu, Hmwe H.; Larson, Heidi J.; Leung, Janni; Liang, Xiaofeng; Lim, Stephen S.; Lind, Margaret; Lozano, Rafael; Marquez, Neal; Mensah, George A.; Mikesell, Joe; Mokdad, Ali H.; Mooney, Meghan D.; Nguyen, Grant; Nsoesie, Elaine; Pigott, David M.; Pinho, Christine; Roth, Gregory A.; Salomon, Joshua A.; Sandar, Logan; Silpakit, Naris; Sligar, Amber; Sorensen, Reed J. D.; Stanaway, Jeffrey; Steiner, Caitlyn; Teeple, Stephanie; Thomas, Bernadette A.; Troeger, Christopher; VanderZanden, Amelia; Vollset, Stein Emil; Wanga, Valentine; Whiteford, Harvey A.; Wolock, Timothy; Zoeckler, Leo; Abate, Kalkidan Hassen; Abbafati, Cristiana; Abbas, Kaja M.; Abd-Allah, Foad; Abera, Semaw Ferede; Abreu, Daisy M. X.; Abu-Raddad, Laith J.; Abyu, Gebre Yitayih; Achoki, Tom; Adelekan, Ademola Lukman; Ademi, Zanfina; Adou, Arsene Kouablan; Adsuar, Jose C.; Afanvi, Kossivi Agbelenko; Afshin, Ashkan; Agardh, Emilie Elisabet; Agarwal, Arnav; Agrawal, Anurag; Kiadaliri, Aliasghar Ahmad; Ajala, Oluremi N.; Akanda, All Shafqat; Akinyemi, Rufus Olusola; Akinyemiju, Tomi F.; Akseer, Nadia; Al Lami, Faris Hasan; Alabed, Samer; Al-Aly, Ziyad; Alam, Khurshid; Alam, Noore K. M.; Alasfoor, Deena; Aldhahri, Saleh Fahed; Aldridge, Robert William; Alegretti, Miguel Angel; Aleman, Alicia V.; Alemu, Zewdie Aderaw; Alexander, Lily T.; Alhabib, Samia; Ali, Raghib; Alkerwi, Ala'a; Alla, Francois; Allebeck, Peter; Al-Raddadi, Rajaa; Alsharif, Ubai; Altirkawi, Khalid A.; Martin, Elena Alvarez; Alvis-Guzman, Nelson; Amare, Azmeraw T.; Amegah, Adeladza Kofi; Ameh, Emmanuel A.; Amini, Heresh; Ammar, Walid; Amrock, Stephen Marc; Andersen, Hjalte H.; Anderson, Benjamin; Anderson, Gregory M.; Antonio, Carl Abelardo T.; Aregay, Atsede Fantahun; Arnlov, Johan; Arsenijevic, Valentina S. Arsic; Al Artaman, Ali; Asayesh, Hamid; Asghar, Rana Jawad; Atique, Suleman; Arthur Avokpaho, Euripide Frinel G.; Awasthi, Ashish; Azzopardi, Peter; Bacha, Umar; Badawi, Alaa; Bahit, Maria C.; Balakrishnan, Kalpana; Banerjee, Amitava; Barac, Aleksandra; Barker-Collo, Suzanne L.; Barnighausen, Till; Barregard, Lars; Barrero, Lope H.; Basu, Arindam; Basu, Sanjay; Bayou, Yibeltal Tebekaw; Bazargan-Hejazi, Shahrzad; Beardsley, Justin; Bedi, Neeraj; Beghi, Ettore; Belay, Haileeyesus Adamu; Bell, Brent; Bell, Michelle L.; Bello, Aminu K.; Bennett, Derrick A.; Bensenor, Isabela M.; Berhane, Adugnaw; Bernabe, Eduardo; Betsu, Balem Demtsu; Beyene, Addisu Shunu; Bhala, Neeraj; Bhalla, Ashish; Biadgilign, Sibhatu; Bikbov, Boris; Bin Abdulhak, Aref A.; Biroscak, Brian J.; Biryukov, Stan; Bjertness, Espen; Blore, Jed D.; Blosser, Christopher D.; Bohensky, Megan A.; Borschmann, Rohan; Bose, Dipan; Bourne, Rupert R. A.; Brainin, Michael; Brayne, Carol E. G.; Brazinova, Alexandra; Breitborde, Nicholas J. K.; Brenner, Hermann; Brewer, Jerry D.; Brown, Alexandria; Brown, Jonathan; Brugha, Traolach S.; Buckle, Geoffrey Colin; Butt, Zahid A.; Calabria, Bianca; Campos-Novato, Ismael Ricardo; Campuzano, Julio Cesar; Carapetis, Jonathan R.; Cardenas, Rosario; Carpenter, David; Carrero, Juan Jesus; Castaneda-Oquela, Carlos A.; Rivas, Jacqueline Castillo; Catala-Lopez, Ferran; Cavalleri, Fiorella; Cercy, Kelly; Cerda, Jorge; Chen, Wanqing; Chew, Adrienne; Chiang, Peggy Pei -Chia; Chibalabala, Mirriam; Chibueze, Chioma Ezinne; Chimed-Ochir, Odgerel; Chisumpa, Vesper Hichilombwe; Choi, Jee-Young Jasmine; Chowdhury, Rajiv; Christensen, Hanne; Christopher, Devasahayam Jesudas; Ciobanu, Liliana G.; Cirillo, Massimo; Cohen, Aaron J.; Colistro, Valentina; Colomar, Mercedes; Colquhoun, Samantha M.; Cooper, Cyrus; Cooper, Leslie Trumbull; Cortinovis, Monica; Cowie, Benjamin C.; Crump, John A.; Damsere-Derry, James; Danawi, Hadi; Dandona, Rakhi; Daoud, Farah; Darby, Sarah C.; Dargan, Paul I.; das Neves, Jose; Davey, Gail; Davis, Adrian C.; Davitoiu, Dragos V.; de Castro, E. Filipa; de Jager, Pieter; De Leo, Diego; Degenhardt, Louisa; Dellavalle, Robert P.; Deribe, Kebede; Deribew, Amare; Dharmaratne, Samath D.; Dhillon, Preet K.; Diaz-Torne, Cesar; Ding, Eric L.; dos Santos, Kadine Priscila Bender; Dossou, Edem; Driscoll, Tim R.; Duan, Leilei; Dubey, Manisha; Bartholow, Bruce; Ellenbogen, Richard G.; Lycke, Christian; Elyazar, Iqbal; Endries, Aman Yesuf; Ermakov, Sergey Petrovich; Eshrati, Babak; Esteghamati, Alireza; Estep, Kara; Faghmous, Imad D. A.; Fahimi, Saman; Jose, Emerito; Farid, Talha A.; Sa Farinha, Carla Sofia e; Faro, Andre; Farvid, Maryam S.; Farzadfar, Farshad; Feigin, Valery L.; Fereshtehnejad, Seyed-Mohammad; Fernandes, Jefferson G.; Fernandes, Joao C.; Fischer, Florian; Fitchett, Joseph R. A.; Flaxman, Abraham; Foigt, Nataliya; Fowkes, F. Gerry R.; Franca, Elisabeth Barboza; Franklin, Richard C.; Friedman, Joseph; Frostad, Joseph; Hirst, Thomas; Futran, Neal D.; Gall, Seana L.; Gambashidze, Ketevan; Gamkrelidze, Amiran; Ganguly, Parthasarathi; Gankpe, Fortune Gbetoho; Gebre, Teshome; Gebrehiwot, Tsegaye Tsewelde; Gebremedhin, Amanuel Tesfay; Gebru, Alemseged Aregay; Geleijnse, Johanna M.; Gessner, Bradford D.; Ghoshal, Aloke Gopal; Gibney, Katherine B.; Gillum, Richard F.; Gilmour, Stuart; Giref, Ababi Zergaw; Giroud, Maurice; Gishu, Melkamu Dedefo; Giussani, Giorgia; Glaser, Elizabeth; Godwin, William W.; Gomez-Dantes, Hector; Gona, Philimon; Goodridge, Amador; Gopalani, Sameer Vali; Gosselin, Richard A.; Gotay, Carolyn C.; Goto, Atsushi; Gouda, Hebe N.; Greaves, Felix; Gugnani, Harish Chander; Gupta, Rahul; Gupta, Rajeev; Gupta, Vipin; Gutierrez, Reyna A.; Hafezi-Nejad, Nima; Haile, Demewoz; Hailu, Alemayehu Desalegne; Hailu, Gessessew Bugssa; Halasa, Yara A.; Hamadeh, Randah Ribhi; Hamidi, Samer; Hancock, Jamie; Handal, Alexis J.; Hankey, Graeme J.; Hao, Yuantao; Harb, Hilda L.; Harikrishnan, Sivadasanpillai; Haro, Josep Maria; Havmoeller, Rasmus; Heckbert, Susan R.; Heredia-Pi, Ileana Beatriz; Heydarpour, Pouria; Hilderink, Henk B. M.; Hoek, Hans W.; Hogg, Robert S.; Horino, Masako; Horita, Nobuyuki; Hosgood, H. Dean; Hotez, Peter J.; Hoy, Damian G.; Hsairi, Mohamed; Htet, Aung Soe; Than Htike, Maung Maung; Hu, Guoqing; Huang, Cheng; Huang, Hsiang; Huiart, Laetitia; Husseini, Abdullatif; Huybrechts, Inge; Huynh, Grace; Iburg, Kim Moesgaard; Innos, Kaire; Inoue, Manami; Iyer, Veena J.; Jacobs, Troy A.; Jacobsen, Kathryn H.; Jahanmehr, Nader; Jakovljevic, Mihajlo B.; James, Peter; Javanbakht, Mehdi; Jayaraman, Sudha P.; Jayatilleke, Achala Upendra; Jeemon, Panniyammakal; Jensen, Paul N.; Jha, Vivekanand; Jiang, Guohong; Jiang, Ying; Jibat, Tariku; Jimenez-Corona, Aida; Jonas, Jost B.; Joshi, Tushar Kant; Kabir, Zubair; Karnak, Ritul; Kan, Haidong; Kant, Surya; Karch, Andre; Karema, Corine Kakizi; Karimkhani, Chante; Karletsos, Dimitris; Karthikeyan, Ganesan; Kasaeian, Amir; Katibeh, Marzieh; Kaul, Anil; Kawakami, Norito; Kayibanda, Jeanne Francoise; Keiyoro, Peter Njenga; Kemmer, Laura; Kemp, Andrew Haddon; Kengne, Andre Pascal; Keren, Andre; Kereselidze, Maia; Kesavachandran, Chandrasekharan Nair; Khader, Yousef Saleh; Khalil, Ibrahim A.; Khan, Abdur Rahman; Khan, Ejaz Ahmad; Khang, Young-Ho; Khera, Sahil; Muthafer Khoja, Tawfik Ahmed; Kieling, Christian; Kim, Daniel; Kim, Yun Jin; Kissela, Brett M.; Kissoon, Niranjan; Knibbs, Luke D.; Knudsen, Ann Kristin; Kokubo, Yoshihiro; Kolte, Dhaval; Kopec, Jacek A.; Kosen, Soewarta; Koul, Parvaiz A.; Koyanagi, Ai; Krog, Norun Hjertager; Defo, Barthelemy Kuate; Bicer, Burcu Kucuk; Kudom, Andreas A.; Kuipers, Ernst J.; Kulkarni, Veena S.; Kumar, G. Anil; Kwan, Gene F.; Lal, Aparna; Lal, Dharmesh Kumar; Lalloo, Ratilal; Lam, Hilton; Lam, Jennifer O.; Langan, Sinead M.; Lansingh, Van C.; Larsson, Anders; Laryea, Dennis Odai; Latif, Asma Abdul; Lawrynowicz, Alicia Elena Beatriz; Leigh, James; Levi, Miriam; Li, Yongmei; Lindsay, M. Patrice; Lipshultz, Steven E.; Liu, Patrick Y.; Liu, Shiwei; Liu, Yang; Lo, Loon-Tzian; Logroscino, Giancarlo; Lotufo, Paulo A.; Lucas, Robyn M.; Lunevicius, Raimundas; Lyons, Ronan A.; Ma, Stefan; Pedro Machado, Vasco Manuel; Mackay, Mark T.; MacLachlan, Jennifer H.; Abd El Razek, Hassan Magdy; Abd El Razek, Mohammed Magdy; Majdan, Marek; Majeed, Azeem; Malekzadeh, Reza; Ayele Manamo, Wondimu Ayele; Mandisarisa, John; Mangalam, Srikanth; Mapoma, Chabila C.; Marcenes, Wagner; Margolis, David Joel; Martin, Gerard Robert; Martinez-Raga, Jose; Marzan, Melvin Barrientos; Masiye, Felix; Mason-Jones, Amanda J.; Massano, Joao; Matzopoulos, Richard; Mayosi, Bongani M.; McGarvey, Stephen Theodore; McGrath, John J.; Mckee, Martin; McMahon, Brian J.; Meaney, Peter A.; Mehari, Alem; Mehndiratta, Man Mohan; Mena-Rodriguez, Fabiola; Mekonnen, Alemayehu B.; Melaku, Yohannes Adama; Memiah, Peter; Memish, Ziad A.; Mendoza, Walter; Meretoja, Atte; Meretoja, Tuomo J.; Mhimbira, Francis Apolinary; Micha, Renata; Miller, Ted R.; Mirarefin, Mojde; Misganaw, Awoke; Mock, Charles N.; Abdulmuhsin Mohammad, Karzan; Mohammadi, Alireza; Mohammed, Shafiu; Mohan, Viswanathan; Mola, Glen Liddell D.; Monasta, Lorenzo; Montanez Hernandez, Julio Cesar; Montero, Pablo; Montico, Marcella; Montine, Thomas J.; Moradi-Lakeh, Maziar; Morawska, Lidia; Morgan, Katherine; Mori, Rintaro; Mozaffarian, Dariush; Mueller, Ulrich; Satyanarayana Murthy, Gudlavalleti Venkata; Murthy, Srinivas; Musa, Kamarul Imran; Nachega, Jean B.; Nagel, Gabriele; Naidoo, Kovin S.; Naik, Nitish; Naldi, Luigi; Nangia, Vinay; Nash, Denis; Nejjari, Chakib; Neupane, Subas; Newton, Charles R.; Newton, John N.; Ng, Marie; Ngalesoni, Frida Namnyak; Ngirabega, Jean de Dieu; Quyen Le Nguyen, [Unknown; Nisar, Muhammad Imran; Nkamedjie Pete, Patrick Martial; Nomura, Marika; Norheim, Ole F.; Norman, Paul E.; Norrving, Bo; Nyakarahuka, Luke; Ogbo, Felix Akpojene; Ohkubo, Takayoshi; Ojelabi, Foluke Adetola; Olivares, Pedro R.; Olusanya, Bolajoko Olubukunola; Olusanya, Jacob Olusegun; Opio, John Nelson; Oren, Eyal; Ortiz, Alberto; Osman, Majdi; Ota, Erika; Ozdemir, Raziye; Pa, Mahesh; Pandian, Jeyaraj D.; Pant, Puspa Raj; Papachristou, Christina; Park, Eun-Kee; Park, Jae-Hyun; Parry, Charles D.; Parsaeian, Mahboubeh; Caicedo, Angel J. Paternina; Patten, Scott B.; Patton, George C.; Paul, Vinod K.; Pearce, Neil; Pedro, Joao Mario; Stokic, Ljiljana Pejin; Pereira, David M.; Perico, Norberto; Pesudovs, Konrad; Petzold, Max; Phillips, Michael Robert; Piel, Frederic B.; Pillay, Julian David; Plass, Dietrich; Platts-Mills, James A.; Polinder, Suzanne; Pope, C. Arden; Popova, Svetlana; Poulton, Richie G.; Pourmalek, Farshad; Prabhakaran, Dorairaj; Qorbani, Mostafa; Quame-Amaglo, Justice; Quistberg, D. Alex; Rafay, Anwar; Rahimi, Kazem; Rahimi-Movaghar, Vafa; Rahman, Mahfuzar; Rahman, Mohammad Hifz Ur; Rahman, Sajjad Ur; Rai, Rajesh Kumar; Rajavi, Zhale; Rajsic, Sasa; Raju, Murugesan; Rakovac, Ivo; Rana, Saleem M.; Ranabhat, Chhabi L.; Rangaswamy, Thara; Rao, Puja; Rao, Sowmya R.; Refaat, Amany H.; Rehm, Jurgen; Reitsma, Marissa B.; Remuzzi, Giuseppe; Resnikofff, Serge; Ribeiro, Antonio L.; Ricci, Stefano; Blancas, Maria Jesus Rios; Roberts, Bayard; Roca, Anna; Rojas-Rueda, David; Ronfani, Luca; Roshandel, Gholamreza; Rothenbacher, Dietrich; Roy, Ambuj; Roy, Nawal K.; Ruhago, George Mugambage; Sagar, Rajesh; Saha, Sukanta; Sahathevan, Ramesh; Saleh, Muhammad Muhammad; Sanabria, Juan R.; Sanchez-Nino, Maria Dolores; Sanchez-Riera, Lidia; Santos, Itamar S.; Sarmiento-Suarez, Rodrigo; Sartorius, Benn; Satpathy, Maheswar; Savic, Miloje; Sawhney, Monika; Schaub, Michael P.; Schmidt, Maria Ines; Schneider, Ione J. C.; Schottker, Ben; Schutte, Aletta E.; Schwebel, David C.; Seedat, Soraya; Sepanlou, Sadaf G.; Servan-Mori, Edson E.; Shackelford, Katya A.; Shaddick, Gavin; Shaheen, Amira; Shahraz, Saeid; Shaikh, Masood Ali; Shakh-Nazarova, Marina; Sharma, Rajesh; She, Jun; Sheikhbahaei, Sara; Shen, Jiabin; Shen, Ziyan; Shepard, Donald S.; Sheth, Kevin N.; Shetty, Balakrishna P.; Shi, Peilin; Shibuya, Kenji; Shin, Min-Jeong; Shiri, Rahman; Shiue, Ivy; Shrime, Mark G.; Sigfusdottir, Inga Dora; Silberberg, Donald H.; Silva, Diego Augusto Santos; Silveira, Dayane Gabriele Alves; Silverberg, Jonathan I.; Simard, Edgar P.; Singh, Abhishek; Singh, Gitanjali M.; Singh, Jasvinder A.; Singh, Om Prakash; Singh, Prashant Kumar; Singh, Virendra; Soneji, Samir; Soreide, Kjetil; Soriano, Joan B.; Sposato, Luciano A.; Sreeramareddy, Chandrashekhar T.; Stathopoulou, Vasiliki; Stein, Dan J.; Stein, Murray B.; Stranges, Saverio; Stroumpoulis, Konstantinos; Sunguya, Bruno F.; Sur, Patrick; Swaminathan, Soumya; Sykes, Bryan L.; Szoeke, Cassandra E. I.; Tabares-Seisdedos, Rafael; Tabb, Karen M.; Takahashi, Ken; Takala, Jukka S.; Talongwa, Roberto Tchio; Tandon, Nikhil; Tavakkoli, Mohammad; Taye, Bineyam; Taylor, Hugh R.; Ao, Braden J. Te; Tedla, Bemnet Amare; Tefera, Worku Mekonnen; Ten Have, Margreet; Terkawi, Abdullah Sulieman; Tesfay, Fisaha Haile; Tessema, Gizachew Assefa; Thomson, Alan J.; Thorne-Lyman, Andrew L.; Thrift, Amanda G.; Thurston, George D.; Tillmann, Taavi; Tirschwell, David L.; Tonelli, Marcello; Topor-Madry, Roman; Topouzis, Fotis; Nx, Jeffrey Allen Towb; Traebert, Jefferson; Tran, Bach Xuan; Truelsen, Thomas; Trujillo, Ulises; Tura, Abera Kenay; Tuzcu, Emin Murat; Uchendu, Uche S.; Ukwaja, Kingsley N.; Undurraga, Eduardo A.; Uthman, Olalekan A.; Van Dingenen, Rita; Van Donkelaar, Aaron; Vasankari, Tommi; Vasconcelos, Ana Maria Nogales; Venketasubramanian, Narayanaswamy; Vidavalur, Ramesh; Vijayakumar, Lakshmi; Villalpando, Salvador; Violante, Francesco S.; Vlassov, Vasiliy Victorovich; Wagner, Joseph A.; Wagner, Gregory R.; Wallin, Mitchell T.; Wang, Linhong; Watkins, David A.; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G.; Werdecker, Andrea; Westerman, Ronny; White, Richard A.; Wijeratne, Tissa; Wilkinson, James D.; Williams, Hywel C.; Wiysonge, Charles Shey; Woldeyohannes, Solomon Meseret; Wolfe, Charles D. A.; Won, Sungho; Wong, John Q.; Woolf, Anthony D.; Xavier, Denis; Xiao, Qingyang; Xu, Gelin; Yakob, Bereket; Yalew, Ayalnesh Zemene; Yan, Lijing L.; Yano, Yuichiro; Yaseri, Mehdi; Ye, Pengpeng; Yebyo, Henock Gebremedhin; Yip, Paul; Yirsaw, Biruck Desalegn; Yonemoto, Naohiro; Yonga, Gerald; Younis, Mustafa Z.; Yu, Shicheng; Zaidi, Zoubida; Zaki, Maysaa El Sayed; Zannad, Faiez; Zavala, Diego E.; Zeeb, Hajo; Zeleke, Berihun M.; Zhang, Hao; Zodpey, Sanjay; Zonies, David; Zuhlke, Liesl Joanna; Vos, Theo; Lopez, Alan D.; Murray, Christopher J. L.
Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes
Wang, Haidong; Naghavi, Mohsen; Allen, Christine; Barber, R.M.; Bhutta, Zulfiqar; Carter, Austin; Casey, Daniel C.; Charlson, Fiona J.; Chen, Alan Z.; Coates, M.; Geleijnse, J.M.
Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249
Full Text Available Diabetic foot complications are a significant source of morbidity and mortality. Patients who undergo recurrent admissions for the same diabetic foot problems represent a difficult subgroup to treat. From July 2007 to June 2008, there were 38 such patients who were admitted recurrently. Eighteen patients (47% were re-admitted because of previous refusal of surgical treatment. Eighteen patients (47% received treatment as necessary but were still readmitted for recurrent infection at the same wound site. Assessment of patients’ compliance to outpatient treatment was found to be generally lacking. As a significant proportion were re-admitted because of previous refusal of surgery, a trained counselor may be suitable in counselling patients for debridement or amputation surgery.
Farrell, T J
Open admissions students tend to be highly oral. Their modes of thinking are different from the modes of thinking demanded in the highly literate (i.e., detached, objective, and scientific) world of college. They can learn the more literate modes of thinking, however, but this requires special awareness and effort on the part of their teachers. Some assumptions and instructional approaches made with traditional students cannot be made with highly oral students in a community college. Moreover, the effort to move the students into the more literate modes of thought cannot be limited to a couple of "remedial" courses in reading and writing. The promise of the open door can be realized for highly oral students only as more and more teachers change their assumptions about student learning and modify their instructional practices accordingly.
Schiødt, F V; Bondesen, S; Petersen, I
Gc-globulin scavenges actin released from necrotic hepatocytes to the extracellular space. In 77 patients with fulminant hepatic failure (FHF) (excluding patients treated with liver transplantation), admission levels of serum Gc-globulin and degree of complexing with monomeric actin (complex ratio......) were determined to evaluate their predictive values in relation to survival/nonsurvival. Gc-globulin levels were significantly reduced in 47 nonsurvivors, compared with 30 survivors (96 +/- 71 mg/L vs. 169 +/- 101 mg/L, P ... of patients with non-acetaminophen-induced FHF, whereas a higher value predicted survival in 60 percent. In patients with acetaminophen-induced FHF, nonsurvival was correctly predicted in 100 percent of patients and survival in 53 percent. In comparison, the King's College Hospital (KCH) criteria correctly...
The 2001 Mental Health Act introduced in 2006, changed how a patient is admitted involuntarily to a psychiatric unit. This paper reports on a national survey of general practitioners\\' experience implementing the Act. Five hundred and sixty eight (568) GPs completed the survey. Twenty five percent (25%) of respondants had not used it. When used, twenty four percent (24%) report that it takes seven hours or more to complete an admission. Fifty percent (50%) of respondents are confident to complete the necessary paperwork. Overall GPs are dissatisfied with arrangements for transport of patients (mean Likert score 3.5), primarily due to the time delay. GPs believe this places risk on the patient, family and GP. Only thirty-three percent (33%) of respondents feel that the Mental Health Act has improved the patient, GP and family experience of involuntary admission.
OBJECTIVES: to describe hospital pharmacy involvement in medication management in Ireland, both generally and at points of transfer of care, and to gain a broad perspective of the hospital pharmacy workforce. METHODS: a survey of all adult, acute, public hospitals with an accident and emergency (A&E) department (n = 36), using a semi-structured telephone interview. KEY FINDINGS: there was a 97% (n = 35) response rate. The majority (n = 25, 71.4%) of hospitals reported delivery of a clinical pharmacy service. On admission, pharmacists were involved in taking or verifying medication histories in a minority (n = 15, 42.9%) of hospitals, while few (n = 6,17.1%) deployed staff to the A&E\\/acute medical admissions unit. On discharge, the majority (n = 30,85.7%) did not supply any take-out medication, a minority (n =5,14.3%) checked the discharge prescription, 51.4% (n = 18) counselled patients, 42.9% (n = 15) provided medication compliance charts and one hospital (2.9%) communicated with the patient\\'s community pharmacy. The number of staff employed in the pharmacy department in each hospital was not proportionate to the number of inpatient beds, nor the volume of admissions from A&E. There were differences identified in service delivery between hospitals of different type: urban hospitals with a high volume of admissions from A&E were more likely to deliver clinical pharmacy. CONCLUSIONS: the frequency and consistency of delivering pharmacy services to facilitate medication reconciliation at admission and discharge could be improved. Workforce constraints may inhibit service expansion. Development of national standards of practice may help to eliminate variation between hospitals and support service development.
Schwebel, David C.; Yang, Jingzhen
Abstract: This commentary addresses the intriguing correspondence of two trends. First, we describe the increasing selectivity for undergraduate admission to elite colleges and universities in the United States and an apparent preference for ?angular? applicants who have demonstrated tremendous accomplishment in a single non-academic pursuit such as music, athletics, or the arts. Second, we describe an apparent increase in overuse injuries among American children and adolescents, a trend that...
Hansen Bruun, Inge; Nørgaard, Birgitte; Backer Mogensen, Christian
a need for post discharge rehabilitation. Until now screening-tools have been based on self-reported information; a challenge as elderly might be confused or unrealistic about their physical abilities. Ethics approval The Regional Scientific Ethical Committees for Southern Denmark has decided......Relevance: Responding to Changing Population Needs. The elderly population is growing and represents an increasing proportion of elderly admitted to a short stay unit in an emergency department (ED). One month after admission a fifth of the elderly patients have low physical ability and therefore...... that no approval is needed. Purpose The study aimed to evaluate if the 30 Second Chair Stand test (30s-CST) combined with other variables was able to predict rehabilitation needs among acutely admitted elderly patient. Low physical ability were defined as a 30s-CST–score ≤ 8 one month after admission...
Lin, Yu-Kai; Wang, Yu-Chun; Ho, Tsung-Jung; Lu, Chensheng
Objective: This study aimed to associate hospital admissions of kidney diseases with extreme temperature and prolonged heat/cold events in 7 regions of Taiwan. Methods: Age-specific ( 10 , O 3 , and NO 2 ) and potential confounders. Results: We observed a V or J-shape association between daily average temperatures and the RR estimates for hospital admissions of kidney diseases in Taiwan. The lowest risk for hospital admissions of kidney diseases was found at around 25 °C, and risk increased as temperatures deviated from 25 °C. The pooled cumulative 8-day RR for all ages of population of the 7 study areas were 1.10 (95% confidence interval (CI): 1.01, 1.19) at 18 °C and 1.45 (95% CI: 1.27, 1.64) at 30 °C. High temperature has more profound influence on hospital admission of kidney diseases than low temperature. Temperature risks for hospital admissions were similar between younger (< 65 years) and elderly (65 + years) population. This study observed no significant effects of prolonged heat extremes on hospital admissions of kidney diseases. Conclusions: The heat effect for kidney morbidities leading to hospital admission was more significant than that of the cold temperature. This study did not find the age-dependent relative risks for temperature associating with hospital admissions of kidney diseases. - Highlights: ► V or J-shaped association was observed between daily temperatures and hospital admissions for renal diseases in Taiwan. ► The pooled relative risks accounting for 8 days of lag for the 7 study areas were 1.1 at 18 °C and 1.46 at 30 °C. ► There is no difference of the relative risk estimates for hospital admissions between younger and elderly population. ► We found significant protective effects of hospital admissions for prolonged cold extremes, but not for heat extremes
Wallace, Emma; McDowell, Ronald; Bennett, Kathleen; Fahey, Tom; Smith, Susan M
Emergency admission is associated with the potential for adverse events in older people and risk prediction models are available to identify those at highest risk of admission. The aim of this study was to externally validate and compare the performance of the Probability of repeated admission (Pra) risk model and a modified version (incorporating a multimorbidity measure) in predicting emergency admission in older community-dwelling people. 15 general practices (GPs) in the Republic of Ireland. n=862, ≥70 years, community-dwelling people prospectively followed up for 2 years (2010-2012). Pra risk model (original and modified) calculated for baseline year where ≥0.5 denoted high risk (patient questionnaire, GP medical record review) of future emergency admission. Emergency admission over 1 year (GP medical record review). descriptive statistics, model discrimination (c-statistic) and calibration (Hosmer-Lemeshow statistic). Of 862 patients, a total of 154 (18%) had ≥1 emergency admission(s) in the follow-up year. 63 patients (7%) were classified as high risk by the original Pra and of these 26 (41%) were admitted. The modified Pra classified 391 (45%) patients as high risk and 103 (26%) were subsequently admitted. Both models demonstrated only poor discrimination (original Pra: c-statistic 0.65 (95% CI 0.61 to 0.70); modified Pra: c-statistic 0.67 (95% CI 0.62 to 0.72)). When categorised according to risk-category model, specificity was highest for the original Pra at cut-point of ≥0.5 denoting high risk (95%), and for the modified Pra at cut-point of ≥0.7 (95%). Both models overestimated the number of admissions across all risk strata. While the original Pra model demonstrated poor discrimination, model specificity was high and a small number of patients identified as high risk. Future validation studies should examine higher cut-points denoting high risk for the modified Pra, which has practical advantages in terms of application in GP. The
Xará, Daniela; Silva, Acácio; Mendonça, Júlia; Abelha, Fernando
To evaluate the frequency, determinants, and outcome of inadequate emergence after elective surgery in the Postanesthesia Care Unit (PACU). Prospective observational study. 12-bed PACU of a tertiary-care hospital in a major metropolitan area. 266 adult patients admitted to the PACU. To evaluate inadequate emergence, the Richmond Agitation and Sedation Scale (RASS) was administered to patients 10 minutes after their admission to the PACU. Demographic data, perioperative variables, and postoperative length of stay (LOS) in the PACU and the hospital were recorded. 40 (15%) patients showed symptoms of inadequate emergence: 17 patients (6.4%) screened positive for emergence delirium and 23 patients (8.6%) showed hypoactive emergence. Determinants of emergence delirium were longer duration of preoperative fasting (P = 0.001), higher visual analog scale (VAS) scores for pain (P = 0.002), and major surgical risk (P = 0.001); these patients had a higher frequency of postoperative delirium (P = 0.017) and had higher nausea VAS score 6 hours after surgery (P = 0.001). Determinants of hypoactive emergence were duration of surgery (P = 0.003), amount of crystalloids administered during surgery (P = 0.002), residual neuromuscular block (P < 0.001), high-risk surgery (P = 0.002), and lower core temperature on PACU admission (P = 0.028); these patients also had more frequent residual neuromuscular block (P < 0.001) postoperative delirium (P < 0.001), and more frequent adverse respiratory events (P = 0.02). Patients with hypoactive emergence had longer PACU and hospital LOS. Preventable determinants for emergence delirium were higher postoperative pain scores and longer fasting times. Hypoactive emergence was associated with longer postoperative PACU and hospital LOSs. © 2013 Elsevier Inc. All rights reserved.
Full Text Available Abstract Background Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. Method We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN. We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. Results We identified three types of intervention: pre-hospital; within the emergency department (ED; and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR – Patients at risk of readmission and ACG – Adjusted Clinical Groups sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. Conclusions Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don’t change.
Background: There is a lot of controversy on the prognostic value of admission blood pressures in acute ischaemic stroke, but in Nigeria, there is no information on this. Objective: The objective of this study was to correlate the effect of blood pressures measured on admission with 30-day mortality and neurological handicap ...
Ghazanfar, Misbah N; Honoré, Per Gustaf Hartvig; Nielsen, Trine R H
The admission interview is an important procedure to reduce medication errors. Studies indicate that physicians do not spend much time on the interview and that the major obstacles are lack of time and heavy workload. The aim of this study was to measure the time physicians spend on admission...... interviews and to describe factors that affect time consumption....
To determine whether hospital admissions for acute childhood asthma were rising in Cape Town in line with the experience of other countries, Red Cross War Memorial Children's Hospital's records for the period 1978 - 1990 were analysed. These were compared with total admissions for non-surgical causes and lower ...
Background: It is not clear if the modality of patient admission into the Intensive Care Unit influences outcome. The Intensive Care Unit was audited to determine the pattern of admission, course of illness and management outcome. Methods: In a retrospective study covering the period January 1, 1994 to December 31, 2003 ...
A retrospective analysis of the records of all neonatal admissions into the Special Baby care unit (SCBU) of LAUTECH Teaching Hospital, Osogbo between January 2006 and December 2007 was undertaken. There were 605 admissions (371 males and 234 females) with 308 (50.9%) being admitted in 2006 and 297 ...
Lown, Maris A.
Predicting success on the NCLEX-RN is of paramount importance to nursing programs as they are held accountable for this outcome by accrediting agencies and by boards of nursing. This action research study examined the relationship between the NET admission test, anatomy and physiology grades, grade point average (GPA) on admission to the program…
... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Admission to control unit. 541.47 Section... INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Control Unit Programs § 541.47 Admission to control unit. Staff shall provide an inmate admitted to a control unit with: (a) Notice of the projected duration of...
Full Text Available The number of visitors to the Bantimurung natural park fluctuated allegedly due to the increase of the price of admission ticket. The aim of the study is to analyze optimal price of admission ticket and willingness of visitors to pay admission ticket to the Park. The study was conducted in Bantimurung natural park, South Sulawsi, from January to April 2013.117 number of samples was taken by using convenience sampling method. Analysis of optimal prices and the willingness of visitors to pay for ecotourism to the Park were conducted by creating tourism demand function, which then simulated the price of admission, into the equation function of tourist demand. The results showed that the optimal price of the admission ticket was at the price of Rp75,000. At the optimal price of admission ticket of Rp75,000 the Park would earn revenues of Rp18,230,700,000. An average value of the visitor willingness to pay was Rp118,032, with price of admission ticket was Rp75,000, then, the average visitor will get consumer surplus of Rp43,032. If the management of Bantimurung natural park desiring to increase the total revenue, then the price of admission ticket can be increased to be Rp75,000.
... 42 Public Health 3 2010-10-01 2010-10-01 false Admission to hospice care. 418.25 Section 418.25... (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Eligibility, Election and Duration of Benefits § 418.25 Admission to hospice care. (a) The hospice admits a patient only on the recommendation of the medical director...
Victor V. Babenko
Full Text Available Admission campaign is an important part of the main business processes system of the university. Admission campaign is analyzed on the base of different modeling tools. The conceptual basis of CRM-system as information support of the process is proposed. It should be significant optimizing resource of business process.
Background/Purpose: The patterns and the factors influencing outcome of paediatric surgical admissions may be crucial to policy formulation. This study reports the pattern and the outcome of paediatric surgical admissions in a developing country. Materials & Methods: The pattern and the outcome of paediatric surgical ...
DesJardins, Stephen L.; Ahlburg, Dennis A.; McCall, Brian Patrick
We jointly model the application, admission, financial aid determination, and enrollment decision process. We find that expectations of admission affect application probabilities, financial aid expectations affect enrollment and application behavior, and deviations from aid expectations are strongly related to enrollment. We also conduct…
Ga-Rankuwa Hospital, situated on the border of the Gauteng and orth West provinces of South Africa and serving a large black population in various stages of urbanisation. Main outcome measures. Trends in admission numbers and demographic characteristics. Results. Asthma admissions were 2.5 times higher in 1996 ...
... 32 National Defense 2 2010-07-01 2010-07-01 false Preference in admission. 196.305 Section 196.305 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED... applicants for admission, on the basis of attendance at any educational institution or other school or entity...
Milstein, Robert M.; And Others
As the first stage of a comprehensive study of admissions, a tree model and a linear model were compared in the prediction of admission process screening decisions for a single year's applicants to the Yale University School of Medicine. Cross-validation of the results was also performed on a sample taken from the following year's applicant class.…
Analyzes undergraduate admission data from the United Kingdom by sex, subject, and qualification level. Finds that admission into male dominated programs is made easier by a greater number of openings for students than female-dominated programs have. Concludes that female students are disadvantaged by the distribution of openings. (DK)
J.H.J.M. Uijen (Hans); F.G. Schellevis (François); P.J.E. Bindels (Patrick); S.P. Willemsen (Sten); J.C. van der Wouden (Hans)
markdownabstractBACKGROUND: Population-based data on hospital admissions for children aged 0-17 years concerning all respiratory diseases are scarce. This study examined hospital admissions in relation to the preceding consultations in general practice in this age group. METHODS: Data on
Eighty six percent were female, 48% were single and 36% had worked as nurses for 8 to 14 years. Two-thirds (60%) of the respondents were registered nurses and only 4% were specialized in critical care nursing. Majority of the respondents had high level of knowledge of ICU admission criteria (94%), and admission ...
Parrot, Teresa Valerio; Tipton, Stacia
Admissions officers around the country are hearing consistent calls to enhance their social media presence. Whether the pressure is from administrators, influential alumni, or peers across institutions, social media are touted as the next big thing in admissions marketing. But are social media strategies truly "strategic," or are they merely…
... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Lawful admission for permanent residence... AMERICAN INDIANS BORN IN CANADA § 289.2 Lawful admission for permanent residence. Any American Indian born... of April 2, 1928 (45 Stat. 401), or section 289 of the Act, and has maintained residence in the...
Pape, C. Dale; Casey, John P.
This study was an attempt to evaluate how well a specific selection formula for admission to a physical therapist assistant program worked. It compared the relative selective admission score with the clinical and academic success of those students who completed the course of study; this necessitated a retrospective analysis. (Author/CT)
... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Validity and effect on admissibility. 223.3... PERMITS, REFUGEE TRAVEL DOCUMENTS, AND ADVANCE PAROLE DOCUMENTS § 223.3 Validity and effect on admissibility. (a) Validity—(1) Reentry permit. Except as provided in § 223.2(c)(2), a reentry permit issued to...
Sireci, Stephen G.; Talento-Miller, Eileen
Admissions data and first-year grade point average (GPA) data from 11 graduate management schools were analyzed to evaluate the predictive validity of Graduate Management Admission Test[R] (GMAT[R]) scores and the extent to which predictive validity held across sex and race/ethnicity. The results indicated GMAT verbal and quantitative scores had…
Pattern of psychiatric inpatient admission in Ibadan: implications for service organisation and planning. ... Introduction: Reports from different parts of the world has shown a seasonal pattern in psychiatric admission. Seasonal changes in climatic and social situations have been attributed. Such audit of psychiatric services is ...
Baker, Helen Hicks; Dunlap, Margaret Reed
The use of admission interview comments to predict clinical clerkship success of medical students was evaluated. Narrative comments made by admissions interviewers regarding an applicant's skills and attitudes were coded, as were narrative evaluations of these students during year III of required clerkships in pediatrics and internal medicine in…
Scully, Maura King
Marketing communications and admissions often have very different needs, priorities, and ways of conducting business, but the two units work toward the same end goal. Brad Ward of BlueFuego, a marketing company that specializes in social Web tools for educational institutions, explains that admissions doesn't necessarily need to [talk] to…
A review of all preterm admissions into the Special Care Bay Unit of the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, over a period of 29 months (May 1998 October 2000) was carried out. Out of a total of 699 neonatal admissions, 133 (19 percent) were preterms with gestational ages ranging from 24 to ...
The aim of the work is to structure individual application environments of the information model of a centralized admission campaign in higher education institutions in Russia by modifying the corresponding structure of the Federal information system supporting state final examination and admission procedures. , The ...
subregional courts are admissible before the African Commission on Human and Peoples' Rights or the African ... subregional courts. Key words. Admissibility, African Commission, African Court, subregional courts, res ...... 189 Communication 233/99, Interights (on behalf of Pan African Movement and. Citizens for Peace in ...
... 29 Labor 9 2010-07-01 2010-07-01 false Requests for admissions. 2200.54 Section 2200.54 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION RULES OF PROCEDURE... requested admissions, including subparts, shall have the burden of persuasion to establish that the...
Background: Globally, trends of medical admission have been changing. This study was carried out to assess the current trend of medical admissions and outcomes in Ethiopia. Methods: Retrospective review of 840 records of patients admitted to medical ward of Saint Paul hospital during April 1, 2012-March 31, 2013 was ...
In response to persistent overcrowding of Emergency Departments in Ireland, the Department of Health and Health Service Executive provided funding for "Transit Lounge" areas to be built. These lounges were to provide a location for patients to wait in beds pending the availability of a ward bed. This research was performed to assess the impact of such a lounge on the overcrowding of the Emergency Department and on patient outcomes. The time period from the opening of the Transit Lounge was compared with the same period a year earlier. The Transit Lounge delivers a comfortable place for patients to wait. It does not reduce Emergency Department overcrowding and has been associated with an increased time waiting for a ward bed. The solution to overcrowding is the creation of real capacity in the system so that ward beds are available in acute hospitals for the "unscheduled unwell".
Højskov, Ida E; Glasdam, Stinne
interviews constitute a basis for reporting by each nurse on the patient to nursing colleagues. This study examined how, by means of the admission interview, nurses constructed written documentation of the patient and his course of treatment for use by fellow nurses. A qualitative case study inspired......The admission interview is usually the first structured meeting between patient and nurse. The interview serves as the basis for personalised nursing and care planning and is the starting point for the clinic's documentation of the patient and his course of treatment. In this way, admission...... by Ricoeur was conducted and consisted of five taped admission interviews, along with the written patient documentation subsequently worked out by the nurse. The findings were presented in four constructed themes: Admission interviews are the nurse's room rather than the patient's; Information on a surgical...
Douzenis, Athanasios; Michopoulos, Ioannis
Involuntary treatment of psychiatric disorders has always been controversial; this is especially true for eating disorders. Patients with anorexia nervosa of life threatening severity frequently refuse psychiatric hospitalization. Ambivalence toward treatment is characteristic of eating disorders and patients are often admitted to inpatient programs under pressure from family and doctors. In this article, we report research on the positive or negative impact of involuntary admission in the treatment of eating disorders, its application and effectiveness as well as the adverse consequences of coercive treatment in eating disorders. A literature review was done. From a total of 134 publications which were retrieved from the literature search, 50 studies were directly relevant to the scope of this review and fulfilled all inclusion criteria. There are trends and arguments for both sides; for and against involuntary treatment in anorexia nervosa. The scientific literature so far is inconclusive, although in the short term, involuntary hospitalization has benefits. This review has also shown that involuntary hospitalization can have adverse long-term consequences for the patient-therapist allegiance. We conclude that in some cases, involuntary treatment can save lives of young patients with anorexia nervosa; however, in other cases, it can break the psychotherapeutic relationship and make the patient abandon treatment. It is the clinician who has to decide for whom and when to approve involuntary treatment or not. Copyright © 2015 Elsevier Ltd. All rights reserved.
Cetinkaya, F; Incioglu, A; Birinci, S; Karaman, B E; Dokucu, A I; Sheikh, A
There are very limited data characterizing the epidemiology of anaphylaxis from low- and middle-income country settings. We aimed to estimate the frequency of anaphylaxis admissions to hospitals in Istanbul. We obtained data from all 45 hospitals in Istanbul over a 12-month period and used ICD-10 codes to extract data on those admitted with a recorded primary diagnosis of anaphylaxis. Because of concerns about possible under-coding, we undertook an additional analysis to identify patients admitted with two or more clinical codes for symptoms and/or signs suggestive of, but not coded as having, anaphylaxis. A total of 114 cases (79 people with anaphylaxis codes and 35 with symptoms and signs suggestive of anaphylaxis) were identified, giving an overall estimate of 1.95 cases per 100 000 person-years. The novel two-stage identification approach employed suggests significant under-recording of anaphylaxis in those admitted to hospitals in Istanbul. © 2012 John Wiley & Sons A/S.
... the uterus CHOICES FOR EMERGENCY CONTRACEPTION Two emergency contraceptive pills may be bought without a prescription. Plan ... to provide ongoing birth control. MORE ABOUT EMERGENCY CONTRACEPTIVE PILLS Women of any age can buy Plan ...
... The Marfan Foundation Marfan & Related Disorders What is Marfan Syndrome? What are Related Disorders? What are the Signs? ... Emergencies Lung Emergencies Surgeries Lung Emergencies People with Marfan syndrome can be at increased risk of sudden lung ...
Møller, Thea Palsgaard; Ersbøll, Annette Kjær; Tolstrup, Janne Schurmann
BACKGROUND: A medical emergency call is citizens' access to pre-hospital emergency care and ambulance services. Emergency medical dispatchers are gatekeepers to provision of pre-hospital resources and possibly hospital admissions. We explored causes for access, emergency priority levels, and temp......BACKGROUND: A medical emergency call is citizens' access to pre-hospital emergency care and ambulance services. Emergency medical dispatchers are gatekeepers to provision of pre-hospital resources and possibly hospital admissions. We explored causes for access, emergency priority levels......: The pattern of citizens' contact causes fell into four overall categories: unclear problems, medical problems, intoxication and accidents. The majority of calls were urgent. The magnitude of unclear problems represents a modifiable factor and highlights the potential for further improvement of supportive...
Thukral, Inderpreet S.; Von Ehr, James; Walsh, Steven Thomas; Groen, Arend J.; van der Sijde, Peter; Adham, Khairul Akmaliah
Academics and practitioners alike have long understood the benefits, if not the risks, of both emerging markets and emerging technologies.Yet it is only recently that foresighted firms have embraced emerging technologies and emerging markets through entrepreneurial activity. Emerging technologies
Hofhuis, José G M; Dijkgraaf, Marcel G W; Hovingh, Aly; Braam, Richard L; van de Braak, Lisa; Spronk, Peter E; Rommes, Johannes H
Evaluating the pre-morbid functional status in critically ill patients is important and frequently done using the physical component score (PCS) of the Short Form 36, although this approach has its limitations. The Academic Medical Center Linear Disability Score (ALDS) is a recently developed generic item bank used to measure the disability status of patients with a broad range of diseases. We aimed to study whether proxy scoring with the ALDS could be used to assess the patients' functional status on admission for cardiac care unit (CCU) or ICU patients and how the ALDS relates to the PCS using the Short Form 12 (SF-12). Patients and proxies completed the ALDS and SF-12 score in the first 72 hours following ICU scheduled surgery (n = 14), ICU emergency admission (n = 56) and CCU emergency admission (n = 70). In all patients (n = 140) a significant intra-class correlation was found for the ALDS (0.857), the PCS (0.798) and the mental component score (0.679) between patients and their proxy. In both scheduled and emergency admissions, a significant correlation was found between patients and their proxy for the ALDS, although the lowest correlation was found for the ICU scheduled admissions (0.755) compared with the ICU emergency admissions (0.889). In CCU patients, the highest significant correlation between patients and proxies was found for the ALDS (0.855), for the PCS (0.807) and for the mental component score (0.740). Relatives in close contact with critically ill patients can adequately reflect the patient's level of disability on ICU and CCU admission when using the ALDS item bank, which performed at least as well as the PCS. The ALDS could therefore be a useful alternative for the PCS of the SF-12.
Suicide Mortality of Suicide Attempt Patients Discharged from Emergency Room, Nonsuicidal Psychiatric Patients Discharged from Emergency Room, Admitted Suicide Attempt Patients, and Admitted Nonsuicidal Psychiatric Patients
Choi, Jae W.; Park, Subin; Yi, Ki K.; Hong, Jin P.
The suicide mortality rate and risk factors for suicide completion of patients who presented to an emergency room (ER) for suicide attempt and were discharged without psychiatric admission, patients who presented to an ER for psychiatric problems other than suicide attempt and were discharged without psychiatric admission, psychiatric inpatients…
Full Text Available The admission examinations represent a first important moment in academic education. If the admission proceedings really are expected to satisfy the intention to select those most capable and fittest candidates for study, proper attention has to be paid to them. Besides checking and confirming satisfactory levels of the results of secondary school studies they also should predict with sufficient reliability the academic success of study in the given branch. The paper brings research results concerning the given problems at the Faculty of Economics and Management CULS in Prague. The paper focused on the examining relationship between study results and admission exam results in Bachelor study at Faculty of Economics and Management CULS over 2008-2011. The current analysis was made for 1 251 students who pass the admission exams in 2008. The relationship between study results and admission exam results was examined by Spearman rank correlation coefficient. The research also concentrates on the question how much the success of study can be predicted based on results of admission proceedings. As a data sample was chosen the Informatics branch of Bachelor ordinary study. The relationship between admission exam results and average progress was examined by regression analysis.
The exponential function is defined for a finite-dimensional real power-associative algebra with unit element. The application of the exponential function is focused on the power-associative (p,q)-mutation of a real or complex associative algebra. Explicit formulas are computed for the (p,q)-mutation of the real envelope of the spin 1 algebra and the Lie algebra so(3) of the rotation group, in light of earlier investigations of the spin 1/2. A slight variant of the mutated exponential is interpreted as a continuous function of the Lie algebra into some isotope of the corresponding linear Lie group. The second part of this paper is concerned with the representation and deformation of a Lie-admissible algebra. The second cohomology group of a Lie-admissible algebra is introduced as a generalization of those of associative and Lie algebras in the Hochschild and Chevalley-Eilenberg theory. Some elementary theory of algebraic deformation of Lie-admissible algebras is discussed in view of generalization of that of associative and Lie algebras. Lie-admissible deformations are also suggested by the representation of Lie-admissible algebras. Some explicit examples of Lie-admissible deformation are given in terms of the (p,q)-mutation of associative deformation of an associative algebra. Finally, we discuss Lie-admissible deformations of order one
Jaime, Francisca; Riutort, Maria C; Alvarez-Lobos, Manuel; Hoyos-Bachiloglu, Rodrigo; Camargo, Carlos A; Borzutzky, Arturo
To explore the associations between latitude and solar radiation with inflammatory bowel disease admission rates in Chile, the country with the largest variation in solar radiation in the world. This is an ecological study, which included data on all hospital-admitted population for inflammatory bowel disease between 2001 and 2012, according to different latitudes and solar radiation exposures in Chile. The data were acquired from the national hospital discharge database from the Department of Health Statistics and Information of the Chilean Ministry of Health. Between 2001 and 2012 there were 12,869 admissions due to inflammatory bowel disease (69% ulcerative colitis, 31% Crohn's disease). Median age was 36 years (IQR: 25-51); 57% were female. The national inflammatory bowel disease admission rate was 6.52 (95% CI: 6.40-6.63) per 100,000 inhabitants with increasing rates over the 12-year period. In terms of latitude, the highest admission rates for pediatric ulcerative colitis and Crohn's disease, as well as adult ulcerative colitis, were observed in the southernmost region with lowest annual solar radiation. Linear regression analysis showed that regional solar radiation was inversely associated with inflammatory bowel disease admissions in Chile (β: -.44, p = .03). Regional solar radiation was inversely associated with inflammatory bowel disease admission rates in Chile; inflammatory bowel disease admissions were highest in the southernmost region with lowest solar radiation. Our results support the potential role of vitamin D deficiency on inflammatory bowel disease flares.
Carmichael, H A; Robertson, E; Austin, J; McCruden, D; Messow, C M; Belcher, P R
Removal of the intensive care unit (ICU) at the Vale of Leven Hospital mandated the identification and transfer out of those acute medical admissions with a high risk of requiring ICU. The aim of the study was to develop triaging tools that identified such patients and compare them with other scoring systems. The methodology included a retrospective analysis of physiological and arterial gas measurements from 1976 acute medical admissions produced PREEMPT-1 (PRE-critical Emergency Medical Patient Triage). A simpler one for ambulance use (PREAMBLE-1 [PRE-Admission Medical Blue-Light Emergency]) was produced by the addition of peripheral oxygen saturation to a modification of MEWS (Modified Early Warning Score). Prospective application of these tools produced a larger database of 4447 acute admissions from which logistic regression models produced PREEMPT-2 and PREAMBLE-2, which were then compared with the original systems and seven other early warning scoring systems. Results showed that in patients with arterial gases, the area under the receiver operator characteristic curve was significantly higher in PREEMPT-2 (89·1%) and PREAMBLE-2 (84.4%) than all other scoring systems. Similarly, in all patients, it was higher in PREAMBLE-2 (92·4%) than PREAMBLE-1 (88·1%) and the other scoring systems. In conclusion, risk of requiring ICU can be more accurately predicted using PREEMPT-2 and PREAMBLE-2, as described here, than by other early warning scoring systems developed over recent years.
Thomsen, Christoffer Torgaard; Benros, Michael Eriksen; Hastrup, Lene Halling
INTRODUCTION: Patient-controlled hospital admission for individuals with severe mental disorders is a novel approach in mental healthcare. Patients can admit themselves to a hospital unit for a short stay without being assessed by a psychiatrist or contacting the emergency department. Previous...... the use of coercive measures and of healthcare services, the use of medications and suicidal behaviour. Descriptive statistics will be used to investigate hospitalisations, global assessment of functioning (GAF) and patient satisfaction with treatment. To minimise selection bias, we will match individuals...
Halonen, Jaana I.; Blangiardo, Marta; Toledano, Mireille B.; Fecht, Daniela; Gulliver, John; Anderson, H. Ross; Beevers, Sean D.; Dajnak, David; Kelly, Frank J.; Tonne, Cathryn
Evidence on the effects of long-term exposure to traffic pollution on health is inconsistent. In Greater London we examined associations between traffic pollution and emergency hospital admissions for cardio-respiratory diseases by applying linear and piecewise linear Poisson regression models in a small-area analysis. For both models the results for children and adults were close to unity. In the elderly, linear models found negative associations whereas piecewise models found non-linear associations characterized by positive risks in the lowest and negative risks in the highest exposure category. An increased risk was observed among those living in areas with the highest socioeconomic deprivation. Estimates were not affected by adjustment for traffic noise. The lack of convincing positive linear associations between primary traffic pollution and hospital admissions agrees with a number of other reports, but may reflect residual confounding. The relatively greater vulnerability of the most deprived populations has important implications for public health. - Highlights: • Evidence concerning associations between traffic pollutants and morbidity is scarce. • We addressed this using state of the art small-area statistical methods. • There was no convincing evidence of positive linear associations with admissions. - In this study, there was no convincing evidence of positive linear associations between long-term exposure to primary traffic pollutants and cardio-respiratory hospitalizations.
Kyle Richard G
Full Text Available Abstract Background Children’s emergency admissions in England are increasing. Community Children’s Nursing Teams (CCNTs have developed services to manage acutely ill children at home to reduce demand for unscheduled care. Referral between General Practitioners (GPs and CCNTs may reduce avoidable admissions and minimise the psychosocial and financial impact of hospitalisation on children, families and the NHS. However, facilitators of GP referral to CCNTs are not known. The aim of this study was to identify facilitators of GP referral to CCNTs. Methods Semi-structured interviews with 39 health professionals were conducted between June 2009 and February 2010 in three Primary Care Trusts served by CCNTs in North West England. Interviewees included GPs, Community Children’s Nurses (CCNs, consultant paediatricians, commissioners, and service managers. Qualitative data were analysed thematically using the Framework approach in NVivo 8. Results Five facilitators were identified: 1 CCN/CCNT visibility; 2 clear clinical governance procedures; 3 financial and organisational investment in the role of CCNTs in acute care pathways; 4 access and out of hours availability; 5 facilitative financial frameworks. Conclusion GPs required confidence in CCNs’ competence to safely manage acutely ill children at home and secure rapid referral if a child’s condition deteriorated. Incremental approaches to developing GP referral to CCNTs underpinned by clear clinical governance protocols are likely to be most effective in building GP confidence and avoiding inappropriate admission.
Skaaby, T; Husemoen, L L N; Thuesen, Betina Heinsbæk
BACKGROUND: Atopy is the familial or personal propensity to develop immunoglobulin E (IgE) antibodies against common environmental allergens and is associated with high risk of allergic disease. It has been proposed that atopy may have effects on risk of cardiovascular disease and cancer. OBJECTI...... of dying from breast cancer, but these associations were not statistically significant when applying the Bonferroni adjusted significance level. Further studies are needed to confirm our findings.......BACKGROUND: Atopy is the familial or personal propensity to develop immunoglobulin E (IgE) antibodies against common environmental allergens and is associated with high risk of allergic disease. It has been proposed that atopy may have effects on risk of cardiovascular disease and cancer...... of 1776 person died during follow-up. The mortality risk for atopics vs. non-atopics was: for all-cause mortality (HR = 1.03, 95% CI: 0.90, 1.17); neoplasms (HR = 0.86, 95% CI: 0.69, 1.06); endocrine, nutritional and metabolic disorders (HR = 1.48, 95% CI: 0.71, 3.08); mental and behavioural disorders (HR...
Carmel, Amanda S; Steel, Peter; Tanouye, Robert; Novikov, Aleksey; Clark, Sunday; Sinha, Sanjai; Tung, Judy
Hospital admissions from the emergency department (ED) now account for approximately 50% of all admissions. Some patients admitted from the ED may not require inpatient care if outpatient care could be optimized. However, access to primary care especially immediately after ED discharge is challenging. Studies have not addressed the extent to which hospital admissions from the ED may be averted with access to rapid (next business day) primary care follow-up. We evaluated the impact of an ED-to-rapid-primary-care protocol on avoidance of hospitalizations in a large, urban medical center. We conducted a retrospective review of patients referred from the ED to primary care (Weill Cornell Internal Medicine Associates - WCIMA) through a rapid-access-to-primary-care program developed at New York-Presbyterian / Weill Cornell Medical Center. Referrals were classified as either an avoided admission or not, and classifications were performed by both emergency physician (EP) and internal medicine physician reviewers. We also collected outcome data on rapid visit completion, ED revisits, hospitalizations and primary care engagement. EPs classified 26 (16%) of referrals for rapid primary care follow-up as avoided admissions. Of the 162 patients referred for rapid follow-up, 118 (73%) arrived for their rapid appointment. There were no differences in rates of ED revisits or subsequent hospitalizations between those who attended the rapid follow-up and those who did not attend. Patients who attended the rapid appointment were significantly more likely to attend at least one subsequent appointment at WCIMA during the six months after the index ED visit [N=55 (47%) vs. N=8 (18%), P=0.001]. A rapid-ED-to-primary-care-access program may allow EPs to avoid admitting patients to the hospital without risking ED revisits or subsequent hospitalizations. This protocol has the potential to save costs over time. A program such as this can also provide a safe and reliable ED discharge option
Background : Acute abdominal conditions are a common reason for emergency admission of children. Little is available in the literature about such conditions in our subregion, especially Ghana. Objective : The aim of this study was to investigate the range of emergency abdominal surgical conditions amongst children in ...