The Adverse Effects of Physical Restraint Use among Older Adult Patients Admitted to the Internal Medicine Wards: A Hospital-Based Retrospective Cohort Study

Background: Delirium in older inpatients is a serious problem. The presence of a window in the intensive care unit has been reported to improve delirium. However, no study has investigated whether window-side bed placement is also effective for delirium prevention in a general ward.Objectives: This study aims to clarify the association between admission to a window-side bed and delirium development in older patients in a general ward.Design: This research is designed as a retrospective cohort study of older patients admitted to the internal medicine departments of Shinshu University Hospital, Japan.Participants: The inclusion criteria were the following: (1) admitted to hospital internal medicine departments between April 2009 and December 2018, (2) older than 75 years, (3) admitted to a multi-patient room in a general ward, and (4) unplanned admission. The number of eligible patients was 1,556.Exposure: This study is a comparison of 495 patients assigned to a window-side bed (window group) with 1,061 patients assigned to a non-window-side bed (non-window group). When patients were transferred to the other type bed after admission, observation was censored.Main Measures: The main outcome of interest was “delirium with event” (e.g., the use of medication or physical restraint for delirium) within 14 days after admission as surveyed by medical chart review in a blinded manner.Key Results: The patients had a median age of 80 years and 38.1% were female. The main outcome was recorded in 36 patients in the window group (10.7 per thousand person-days) and 84 in the non-window group (11.7 per thousand person-days). Log-rank testing showed no significant difference between the groups (p = 0.78). Multivariate analysis with Cox regression modeling also revealed no significant association for the window group with main outcome development (adjusted hazard ratio 0.90, 95% confidence interval of 0.61–1.34).Conclusions: Admission to a window-side bed did not prevent delirium development in older patients admitted to a general ward.

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Mortality and associated factors among adult patients on tuberculosis treatment in Tanzania: A retrospective cohort study

Journal of Clinical Tuberculosis and Other Mycobacterial Diseases ◽

10.1016/j.jctube.2021.100263 ◽

2021 ◽

pp. 100263

Author(s):

Elias M. Bukundi ◽

Francis Mhimbira ◽

Rogath Kishimba ◽

Zuweina Kondo ◽

Candida Moshiro

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Associated Factors ◽

Adult Patients ◽

Tuberculosis Treatment

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Ambulance dispatch of older patients following primary and secondary telephone triage in metropolitan Melbourne, Australia: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-042351 ◽

2020 ◽

Vol 10 (11) ◽

pp. e042351

Author(s):

Kathryn Eastwood ◽

Dhanya Nambiar ◽

Rosamond Dwyer ◽

Judy A Lowthian ◽

Peter Cameron ◽

...

Keyword(s):

Cohort Study ◽

Older Adult ◽

Retrospective Cohort Study ◽

Older Patients ◽

Retrospective Cohort ◽

Vital Signs ◽

Telephone Triage ◽

Ambulance Dispatch ◽

Emergency Ambulance ◽

Primary Triage

BackgroundMost calls to ambulance result in emergency ambulance dispatch (direct dispatch) following primary telephone triage. Ambulance Victoria uses clinician-led secondary telephone triage for patients identified as low-acuity during primary triage to refer them to alternative care pathways; however, some are returned for ambulance dispatch (secondary dispatch). Older adult patients are frequent users of ambulance services; however, little is known about the appropriateness of subsequent secondary dispatches.ObjectivesTo examine the appropriateness of secondary dispatch through a comparison of the characteristics and ambulance outcomes of older patients dispatched an emergency ambulance via direct or secondary dispatch.DesignA retrospective cohort study of ambulance patient data between September 2009 and June 2012 was conducted.SettingThe secondary telephone triage service operated in metropolitan Melbourne, Victoria, Australia during the study period.ParticipantsThere were 90 086 patients included aged 65 years and over who had an emergency ambulance dispatch via direct or secondary dispatch with one of the five most common secondary dispatch paramedic diagnoses.Main outcome measuresDescriptive analyses compared characteristics, treatment and transportation rates between direct and secondary dispatch patients.ResultsThe dispatch groups were similar in demographics, vital signs and hospital transportation rates. However, secondary dispatch patients were half as likely to be treated by paramedics (OR 0.51; CI 0.48 to 0.55; p<0.001). Increasing age was associated with decreasing treatment (p<0.005) and increasing transportation rates (p<0.005).ConclusionSecondary triage could identify patients who would ultimately be transported to an emergency department. However, the lower paramedic treatment rates suggest many secondary dispatch patients may have been suitable for referral to alternative low-acuity transport or referral options.

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