New risk index can identify elderly people at increased risk for death within a year after hospital discharge

Objective.To estimate the rate of surgical site infection (SSI) occurring after hospital discharge, to evaluate whether limiting surveillance to inpatients underestimates the true rate of SSI, and to select surgical procedures that should be included in a postdischarge surveillance program.Design.Prospective surveillance study.Setting.A surgical ward at a university teaching hospital in Italy.Patients.A total of 264 surgical patients were included in the study.Results.The global SSI rate was 10.6% (28 patients); 17 (60.2%) of patients with an SSI developed the infection after hospital discharge. The overall mean length of postoperative stay (±SD) for patients who acquired a postdischarge SSI was 4.9 ± 3.7 days, and SSI was diagnosed a mean duration (±SD) of 11.5 ± 4.5 days after surgery. Among procedures with postdischarge SSIs, those classified by the National Nosocomial Infections Surveillance system (NNIS) as herniorrhaphy, mastectomy, other endocrine system, and other integumentary system were associated with a mean postoperative stay that was less than the mean time between the operation and the onset of SSI. Four (36%) of in-hospital SSIs occurred after procedures with an NNIS risk index of 0, and 7 (64%) occurred after procedures with an NNIS risk index of 1 or higher. Of the 17 SSIs diagnosed after discharge, 14 procedures (82%) had an NNIS risk index of 0, compared with 3 procedures (18%) with an NNIS risk index of 1 or higher.Conclusions.Our results revealed an increased risk of postdischarge SSI after some types of surgical procedures and suggest that there is an important need to change from generalized to NNIS operative category-directed postdischarge surveillance, at least for procedures locally considered to be high-risk.

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Association Between Potentially Inappropriate Medications and 30-Day Post–Hospital Discharge Outcomes in US Veterans

Annals of Pharmacotherapy ◽

10.1177/10600280211032072 ◽

2021 ◽

pp. 106002802110320

Author(s):

Heather G. Allore ◽

Danijela Gnjidic ◽

Melissa Skanderson ◽

Ling Han

Keyword(s):

Hospital Discharge ◽

Adverse Drug Events ◽

Primary Care Clinic ◽

Care Utilization ◽

Potentially Inappropriate Medications ◽

Care Hospital ◽

Care Clinic ◽

Risk Of Mortality ◽

Increased Risk ◽

Reduced Risk

Background Potentially inappropriate medication (PIMs) use is common in older inpatients and it may lead to increased risk of adverse drug events. Objectives To examine prevalence of PIMs at hospital discharge and its contribution to health care utilization and mortality within 30-days of hospital discharge. Methods This was a prospective cohort of 117 570 veterans aged ≥65 years and hospitalized in 2013. PIMs at discharge were categorized into central nervous system acting (CNS) and non-CNS. Outcomes within 30-days of hospital discharge were: (1) time to first acute care hospital readmission, and all-cause mortality, (2) an emergency room visit, and (3) ≥3 primary care clinic visits. Results The cohort’s mean age was 74.3 years (SD 8.1), with 51.3% exposed to CNS and 62.8% to non-CNS PIMs. Use of CNS and non-CNS PIMs, respectively, was associated with a reduced risk of readmission, with an adjusted hazard ratio (aHR) of 0.93 (95% CI = 0.89-0.96) for ≥2 (vs 0) CNS PIMs and an aHR of 0.85 (95% CI = 0.82-0.88) for ≥2 (vs 0) non-CNS PIMs. Use of CNS PIMs (≥2 vs 0) was associated with increased risk of mortality (aHR = 1.37 [95% CI = 1.25-1.51]), whereas non-CNS PIMs use was associated with a reduced risk of mortality (aHR = 0.75 [95% CI = 0.69-0.82]). Conclusion and Relevance PIMs were highly common in this veteran cohort, and the association with outcomes differed by PIMs. Thus, it is important to consider whether PIMs are CNS acting to optimize short-term posthospitalization outcomes.

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Validity of the LACE index for identifying frequent early readmissions after hospital discharge in children

European Journal of Pediatrics ◽

10.1007/s00431-021-03929-z ◽

2021 ◽

Author(s):

Thang S Han ◽

David Fluck ◽

Christopher H Fry

Keyword(s):

At Risk ◽

Confidence Interval ◽

Hospital Discharge ◽

Odds Ratio ◽

Hospital Readmissions ◽

Index Score ◽

Children At Risk ◽

Increased Risk ◽

Scoring Tool ◽

Event Rates

AbstractThe LACE index scoring tool has been designed to predict hospital readmissions in adults. We aimed to evaluate the ability of the LACE index to identify children at risk of frequent readmissions. We analysed data from alive-discharge episodes (1 April 2017 to 31 March 2019) for 6546 males and 5875 females from birth to 18 years. The LACE index predicted frequent all-cause readmissions within 28 days of hospital discharge with high accuracy: the area under the curve = 86.9% (95% confidence interval = 84.3–89.5%, p < 0.001). Two-graph receiver operating characteristic curve analysis revealed the LACE index cutoff to be 4.3, where sensitivity equals specificity, to predict frequent readmissions. Compared with those with a LACE index score = 0–4 (event rates, 0.3%), those with a score > 4 (event rates, 3.7%) were at increased risk of frequent readmissions: age- and sex-adjusted odds ratio = 12.4 (95% confidence interval = 8.0–19.2, p < 0.001) and death within 30 days of discharge: OR = 5.0 (95% CI = 1.5–16.7). The ORs for frequent readmissions were between 6 and 14 for children of different age categories (neonate, infant, young child and adolescent), except for patients in the child category (6–12 years) where odds ratio was 2.8.Conclusion: The LACE index can be used in healthcare services to identify children at risk of frequent readmissions. Focus should be directed at individuals with a LACE index score above 4 to help reduce risk of readmissions. What is Known:• The LACE index scoring tool has been widely used to predict hospital readmissions in adults. What is New:• Compared with children with a LACE index score of 0–4 (event rates, 0.3%), those with a score > 4 are at increased risk of frequent readmissions by 14-fold.• The cutoff of a LACE index of 4 may be a useful level to identify children at increased risk of frequent readmissions.

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Prognostic significance of international normalised ratio and prothrombin time in Chinese acute ischaemic stroke patients

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2021-141204 ◽

2022 ◽

pp. postgradmedj-2021-141204

Author(s):

Shoujiang You ◽

Qiao Han ◽

Xiaofeng Dong ◽

Chongke Zhong ◽

Huaping Du ◽

...

Keyword(s):

Logistic Regression ◽

Ischaemic Stroke ◽

Prothrombin Time ◽

Hospital Discharge ◽

Acute Ischaemic Stroke ◽

Regression Models ◽

Logistic Regression Models ◽

Risk Of Death ◽

Increased Risk ◽

International Normalised Ratio

BackgroundWe investigated the association between international normalised ratio (INR) and prothrombin time (PT) levels on hospital admission and in-hospital outcomes in acute ischaemic stroke (AIS) patients.MethodsA total of 3175 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included. We divided patients into four groups according to their level of admission INR: (<0.92), Q2 (0.92–0.98), Q3 (0.98–1.04) and Q4 (≥1.04) and PT. Logistic regression models were used to estimate the effect of INR and PT on death or major disability (modified Rankin Scale score (mRS)>3), death and major disability (mRS scores 4–5) separately on discharge in AIS patients.ResultsHaving an INR level in the highest quartile (Q4) was associated with an increased risk of death or major disability (OR 1.69; 95% CI 1.23 to 2.31; P-trend=0.001), death (OR, 2.64; 95% CI 1.12 to 6.19; P-trend=0.002) and major disability on discharge (OR, 1.56; 95% CI 1.13 to 2.15; P-trend=0.008) in comparison to Q1 after adjusting for potential covariates. Moreover, in multivariable logistic regression models, having a PT level in the highest quartile also significantly increased the risk of death (OR, 2.38; 95% CI 1.06 to 5.32; P-trend=0.006) but not death or major disability (P-trend=0.240), major disability (P-trend=0.606) on discharge.ConclusionsHigh INR at admission was independently associated with death or major disability, death and major disability at hospital discharge in AIS patients and increased PT was also associated with death at hospital discharge.

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Evaluation of balance, fall risk, and related factors in patients with fibromyalgia syndrome

Turkish Journal of Physical Medicine and Rehabilitation ◽

10.5606/tftrd.2021.6273 ◽

2021 ◽

Vol 67 (4) ◽

pp. 409-415

Author(s):

Köksal Sarıhan ◽

Hülya Uzkeser ◽

Akın Erdal

Keyword(s):

Social Isolation ◽

Fall Risk ◽

Nottingham Health Profile ◽

Risk Index ◽

Control Group ◽

Healthy Individuals ◽

Increased Risk ◽

Study Results ◽

Significant Difference ◽

Risk Of Falls

Objectives: In this study, we aimed to evaluate whether fibromyalgia patients had a higher fall risk compared to healthy individuals and to identify its relationship, if there was an increase, with clinical features. Patients and methods: Between March 2018 and September 2018, a total of 50 consecutive female patients with fibromyalgia (median age: 35 years; interquantile range [IQR], 27 to 40 years) and 50 healthy female volunteers (median age: 30 years; IQR, 23 to 40 years) were included in the study. Pain was evaluated with the Visual Analog Scale (VAS), life quality with the Nottingham Health Profile (NHP), balance functions with the Berg Balance Test (BBT), and the risk of falls with a posturography device. Disease activity of fibromyalgia patients was evaluated with the Fibromyalgia Impact Questionnaire (FIQ). Results: The mean fall risk index of the fibromyalgia patients was 45%. The fall risk index was significantly higher (p=0.010) and the BBT scores were significantly lower in the patient group (p<0.001). There was a significant difference in terms of fall risk between the control group and drug-free fibromyalgia patients; however, no significant difference was found between the balance scores of the two groups. In the fibromyalgia group, a weak positive relationship was determined between the fall risk index and the social isolation subscale of the NHP. Conclusion: Our study results showed an increased risk of loss of balance and falls in fibromyalgia patients, compared to healthy individuals. This fall risk increase was also detected in fibromyalgia patients who did not use drugs. These findings suggest a possible relationship between social isolation and an increased risk of falls.

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Faktor Determinan yang Berhubungan dengan Upaya Pengendalian Hipertensi di PSTW Budi Luhur Kota Jambi

Jurnal Akademika Baiturrahim Jambi ◽

10.36565/jab.v9i2.222 ◽

2020 ◽

Vol 9 (2) ◽

pp. 234

Author(s):

Fithriyani Fithriyani ◽

Miko Eka Putri

Keyword(s):

Blood Pressure ◽

Elderly People ◽

The Elderly ◽

Smoking History ◽

Bivariate Analysis ◽

Projection Data ◽

Moderate Activity ◽

Cross Sectional ◽

Major Health Problem ◽

Increased Risk

Aging is a natural process that can not be avoided, running continuously, and continuously. Based on population projection data the number of elderly people will increase where the most number is found at the age of 60-64 years 94,012 people. Increasing age decreases bodily functions, decreased organ function and changes in blood pressure, therefore the elderly are advised to check their blood pressure regularly. As they age, blood pressure in the elderly will increase so that there is a higher risk of developing hypertension. Hypertension is a major health problem throughout the world, causing a high prevalence and is associated with an increased risk of cardiovascular disease. Some things that need to be considered in an effort to control hypertension include regular exercise, adequate rest, medical, traditional, regulate diet and reduce salt consumption one teaspoon per day. The purpose of this study was to determine the determinants and factors associated with efforts to control hypertension in the elderly at PSTW Budi Luhur, Jambi City. The research method uses descriptive analysis design with cross sectional approach. Samples were conducted for the elderly with hypertension. The research instrument was in the form of questionnaire sheets by interview. The results obtained 40% of elderly people have a history of smoking, 45% are quite good in consuming food, 60% elderly with moderate activity and 60% elderly are good in controlling hypertension. The results of bivariate analysis showed that there was no correlation between determinant factors (smoking history, food consumption, physical activity) and hypertension control efforts in the elderly in PSTW Budi Luhur, Jambi City

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P1515IMPACT OF POLYPHARMACY ON ALL-CAUSE MORTALITY, ALL-CAUSE HOSPITALIZATION AND CARDIOVASCULAR EVENTS IN INITIAL JAPANESE HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1515 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Tatsunori Toida ◽

Reiko Toida ◽

Shou Ebihara ◽

Shigehiro Uezono ◽

Hiroyuki Komatsu ◽

...

Keyword(s):

Cohort Study ◽

Clinical Outcomes ◽

Cardiovascular Events ◽

Chronic Renal Disease ◽

Risk Index ◽

Hemodialysis Patients ◽

Drug Prescriptions ◽

Increased Risk ◽

All Cause Mortality

Abstract Background and Aims Polypharmacy (PP) is common in end-stage chronic renal disease patients, largely because of the existence of multiple comorbid conditions. PP has the potential for harm and benefits, and the association between PP and mortality and morbidity in hemodialysis patients currently remains unclear. We examined the association of PP and the risk of clinical outcomes, such as all-cause mortality, all-cause hospitalization and cardiovascular events, in initial hemodialysis patients at admission and discharge. Method Study design: Cohort study. Setting: Participants: One hundred and fifty-two initial hemodialysis patients (female vs. male, 88 vs. 64; mean age, 70.3 years) were enrolled between February 2015 and March 2018 at the Nobeoka Prefectural Hospital and Chiyoda Hospital. Predictor: Patients were divided into 2 groups according to PP (6 or more drug prescriptions, or less) during admission and discharge for the initiation of hemodialysis. Outcomes: All-cause mortality, all-cause hospitalization and cardiovascular events (hospitalization due to stroke, ischemic heart disease or peripheral artery disease) during the mean 2.8-year follow-up. Measurements: Hazard ratios (HRs) were estimated using Cox’s model for the relationships between PP and the clinical outcomes, and adjusted for potential confounders, including age, sex, body mass index, systolic and diastolic blood pressure, Charlson comorbidity risk index, hemoglobin, serum levels of albumin, albumin-corrected Ca, phosphate, parathyroid hormone, C-reactive protein and NT-proBNP; and use of erythropoietin stimulating agents. The group with 5 or less drug prescriptions was set as reference. Results Among the patients in this cohort study, the number of prescribed drugs per patient averaged 7.4 at admission and 6.9 at discharge for initial hemodialysis. One hundred (65.8%) and 94 patients (61.8%) had PP at admission and discharge, respectively. During follow-up, 20 patients died, 71 patients were hospitalized and 25 patients had cardiovascular events. PP at admission is significantly associated with cardiovascular events (HR 8.50, 95%CI 1.45-49.68). Furthermore, PP at discharge is significantly associated with all-cause hospitalization and cardiovascular events (HR 1.95, 95%CI 1.01-3.70; HR 53.16, 95%CI 2.70-104.62, respectively). However, PP is not significantly associated with all-cause mortality at admission or discharge. Conclusion Among Japanese patients starting hemodialysis, PP may be associated with clinical outcomes. However, it remains unclear whether PP is the direct cause of the outcomes or is simply a marker for increased risk of outcomes.

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Social Dimensions of Mental Illness among Rural Elderly Populations

The International Journal of Aging and Human Development ◽

10.2190/revp-59g8-3u2u-q2b0 ◽

1988 ◽

Vol 26 (3) ◽

pp. 169-190 ◽

Cited By ~ 6

Author(s):

Jon Hendricks ◽

Howard B. Turner

Keyword(s):

Mental Health ◽

Mental Illness ◽

Physical Health ◽

Elderly People ◽

The Elderly ◽

Rural Elderly ◽

Policy Implications ◽

Elderly Persons ◽

Increased Risk ◽

Elderly Populations

Despite growing concern with rural elderly populations, little attention has focused on their mental health, ways it may correlate with physical health, or how rural mental health patterns compare to urban. Popular wisdom contends that elderly people in general, and rural elderly persons in particular, are at increased risk for mental illness. This article examines these questions. A review of available literature suggests that elderly people may be at only slightly greater risk of mental illness than the population at large, though there are some indications that rates of depression may be somewhat higher among the elderly population. Much of this same literature implies that objective environmental conditions play a significant role in the incidence of depression. Analysis of data gathered in a statewide random poll ( N = 743) indicates that while physical health tends to be poorer among rural populations, when health is held constant there is actually an inverse relationship between age and depression. Therefore, rural elderly persons are no more likely to be depressed than their urban counterparts despite harsher living conditions. Both conceptual and policy implications are discussed.

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Frequent Emergency Department Visits After Spontaneous Intracerebral Hemorrhage: Who Is at Risk?

The Neurohospitalist ◽

10.1177/1941874418755951 ◽

2018 ◽

Vol 8 (4) ◽

pp. 166-170

Author(s):

Jerina Nogueira ◽

Pedro Abreu ◽

Patrícia Guilherme ◽

Ana Catarina Félix ◽

Fátima Ferreira ◽

...

Keyword(s):

At Risk ◽

Emergency Department ◽

Intracerebral Hemorrhage ◽

Hospital Discharge ◽

Transitional Care ◽

Neurological Impairment ◽

Emergency Department Visits ◽

Spontaneous Intracerebral Hemorrhage ◽

Increased Risk ◽

Ed Visits

Background: The long-term prognosis of spontaneous intracerebral hemorrhage (SICH) is poor. Frequent emergency department (ED) visits can signal increased risk of hospitalization and death. There are no studies describing the risk of frequent ED visits after SICH. Methods: Retrospective cohort study of a community representative consecutive SICH survivors (2009-2015) from southern Portugal. Logistic regression analysis was performed to identify sociodemographic and clinical factors associated with frequent ED visits (≥4 visits) within the first year after hospital discharge. Results: A total of 360 SICH survivors were identified, 358 (98.6%) of whom were followed. The median age was 72; 64% were males. The majority of survivors (n = 194, 54.2%) had at least 1 ED visit. Reasons for ED visits included infections, falls with trauma, and isolated neurological symptoms. Forty-four (12.3%) SICH survivors became frequent ED visitors. Frequent ED visitors were older and had more hospitalizations ( P < .001) and ED visits ( P < .001) prior to the SICH, unhealthy alcohol use ( P = .049), longer period of index SICH hospitalization ( P = .032), pneumonia during hospitalization ( P = .001), and severe neurological impairment at discharge ( P = .001). Pneumonia during index hospitalization (odds ratio [OR]: 3.08; confidence interval [CI]: 1.39-6.76; P = .005) and history of ED visits prior to SICH (OR: 1.64; CI: 1.19-2.26, P = .003) increased the likelihood of becoming a frequent ED visitor. Conclusions: Predictors of frequent ED visits are identifiable at hospital discharge and during any ED visit. Improvement of transitional care and identification of at-risk patients may help reduce multiple ED visits.

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