533 READMISSIONS TO GERIATRIC MEDICINE IN A DISTRICT GENERAL HOSPITAL, A THEMATIC ANALYSIS

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
R Whiting ◽  
R Comerford
Keyword(s):  
Assessment Tool ◽  
Geriatric Medicine ◽  
District General Hospital ◽  
Case Note ◽  
Discharge Process ◽  
Post Discharge ◽  
Pareto Analysis ◽  
Key Factor ◽  
The Right ◽  
Case Note Review

Abstract Introduction 621 patients were readmitted within 30 days of discharge from our Geriatric Medicine department between October 2019 and March 2020. This project was undertaken to better understand whether some of these readmissions could be prevented. Methods Analysis showed a clear peak of 78 patients returning at day one post discharge, and a subsequent Pareto analysis revealed that nearly 80% of these were discharged from 2 locations, our frailty unit and MAU. This cohort became the focus of our review. With support from the Acute Frailty Network, a virtual structured case note review was undertaken by a multidisciplinary team including an independent Geriatrician. This considered the patient’s case, whether they were cared for by the right team in the right place, whether they were readmitted with a new diagnosis and whether any improvements in the discharge process or wider service could have prevented their readmission. Results The case note review process was halted early as clear recurring themes emerged. Firstly, feedback showed that all frail patients were identified early in the patient pathway, were cared for by the appropriate team and a CGA was commenced promptly. Secondly, whilst the majority of day one readmissions had a diagnosis of delirium, most were not diagnosed as such until their re-attendance, despite documented confusion. Failure to recognise this, treat their delirium, and plan for fluctuations in cognition upon discharge were found to contribute to a high readmission rate. Conclusion We found that delirium identification was a key factor in early readmissions to our service. We identified clear opportunities to strengthen and formalise delirium diagnoses, and better plan patient management and discharge plans as a result. A multidisciplinary quality improvement group looking at delirium has been initiated and has already achieved a statistically significant improvement in the use of 4AT, a delirium assessment tool.

Abstract W P349: Bridging the Gap: Discharge to Follow-up: A Qualitative Review

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Anh Juntura ◽  
Linda Shields ◽  
Fern Cudlip
Keyword(s):  
Patient Compliance ◽  
Assessment Tool ◽  
Discharge Planning ◽  
Signs And Symptoms ◽  
Well Being ◽  
Qualitative Assessment ◽  
Phone Call ◽  
Discharge Process ◽  
Post Discharge

Background: Discharging patients from the hospital is complex and challenging. The discharge process includes discharge planning, medication reconciliation, discharge summation, and patient instruction. The enormity of information and complexity of the process directly impacts patient compliance and re-admission. Given the extent of this process, efforts toward assuring clarity of knowledge have the potential to improve patient compliance. We sought to identify and address gaps in post discharge patient awareness. Methods: A follow-up phone interview was conducted 1 week post discharge, with 26 stroke patients. All patients had received verbal and written stroke education prior to discharge. The qualitative assessment tool included 10 questions regarding general wellbeing, follow-up appointment compliance, medication utilization, and stroke knowledge. The patient responses were categorized accordingly. A copy of the patient’s discharge instructions was utilized during the interview for verification and clarification of discharge information. Results: Regarding wellbeing, 77% of the patients reported a reasonable sense of well being. The majority (77%) had scheduled follow-up appointments with the remaining 23% requiring clarification. Concerning medication compliance, 92% of the patients were able to obtain and comprehend use of their new medications. Review of stroke type confirmed 54% with understanding, whereas, 44% expressed lack of clarity regarding the subject. The same was true in regards to comprehension of stroke risk factors (56% verbalized understanding and 44% lacked awareness). Lastly, 54% of respondents were unable to identify the signs and symptoms of stroke despite the majority (60%) verbalizing a correct use of the 9-1-1 system Conclusion: Our findings imply that a post discharge phone call practice serves to identify information gaps and provide opportunity to clarify stroke awareness, thus, “bridging the gap” of understanding and compliance regarding stroke management and prevention

scholarly journals Daytime night attire as a therapeutic intervention in an acute adult psychiatric in-patient unit

2008 ◽  
Vol 32 (6) ◽  
pp. 221-224 ◽  
Author(s):  
Camilla Langan ◽  
Colm McDonald
Keyword(s):  
Case Note ◽  
Medical Documentation ◽  
Clinical Implications ◽  
Negative Attitudes ◽  
High Prevalence ◽  
Psychiatric Units ◽  
Self Harm ◽  
The Republic ◽  
The Right ◽  
Case Note Review

Aims and MethodDressing in-patients in night attire during daytime is currently practised in many in-patient psychiatric units, despite the lack of evidence to support its benefit in reducing absconding or self-harm. Using a triangulation design, we investigated the prevalence of, attitudes towards and associations of this practice in an acute psychiatric in-patient setting in the Republic of Ireland.ResultsCase-note review revealed a high prevalence of this practice (57%) and its significant association with involuntary admission. Nursing staff believed that using night attire was effective at reducing absconding and self-harm, and that only voluntary patients should retain the right to choose their clothes. Most patients interviewed were uncomfortable in night clothes and indicated that they should be entitled to choose what to wear.Clinical ImplicationsNight attire is regularly used for risk-management, despite lack of evidence supporting its efficacy and negative attitudes towards it in many patients. This practice and the reasons for its implementation deserve medical documentation.

Can we predict Acute Medical readmissions using the BOOST tool? A retrospective case note review

2016 ◽  
Vol 15 (3) ◽  
pp. 119-123
Author(s):  
Geraldine A Lee ◽  
◽  
D Freedman ◽  
Penelope Beddoes ◽  
Emily Lyness ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Risk Assessment ◽  
Risk Factor ◽  
Hospital Discharge ◽  
Assessment Tool ◽  
Case Note ◽  
Retrospective Case ◽  
The Uk ◽  
Case Note Review

Background: Readmissions within 30-days of hospital discharge are a problem. The aim was to determine if the Better Outcomes for Older Adults through Safe Transitions (BOOST) risk assessment tool was applicable within the UK. Methods: Patients over 65 readmitted were identified retrospectively via a casenote review. BOOST assessment was applied with 1 point for each risk factor. Results: 324 patients were readmitted (mean age 77 years) with a median of 7 days between discharge and readmission. The median BOOST score was 3 (IQR 2-4) with polypharmacy evident in 88% and prior hospitalisation in 70%. The tool correctly predicted 90% of readmissions using two or more risk factors and 99.1% if one risk factor was included. Conclusion: The BOOST assessment tool appears appropriate in predicting readmissions however further analysis is required to determine its precision.

scholarly journals Bone morphogenetic proteins, breast cancer, and bone metastases: striking the right balance

2017 ◽  
Vol 24 (10) ◽  
pp. R349-R366 ◽  
Author(s):  
Catherine Zabkiewicz ◽  
Jeyna Resaul ◽  
Rachel Hargest ◽  
Wen Guo Jiang ◽  
Lin Ye
Keyword(s):  
Breast Cancer ◽  
Cancer Progression ◽  
Bone Morphogenetic Proteins ◽  
Therapeutic Potential ◽  
Current Knowledge ◽  
Breast Tumour ◽  
Cellular Functions ◽  
Foetal Development ◽  
Key Factor ◽  
The Right

Bone morphogenetic proteins (BMPs) belong to the TGF-β super family, and are essential for the regulation of foetal development, tissue differentiation and homeostasis and a multitude of cellular functions. Naturally, this has led to the exploration of aberrance in this highly regulated system as a key factor in tumourigenesis. Originally identified for their role in osteogenesis and bone turnover, attention has been turned to the potential role of BMPs in tumour metastases to, and progression within, the bone niche. This is particularly pertinent to breast cancer, which commonly metastasises to bone, and in which studies have revealed aberrations of both BMP expression and signalling, which correlate clinically with breast cancer progression. Ultimately a BMP profile could provide new prognostic disease markers. As the evidence suggests a role for BMPs in regulating breast tumour cellular function, in particular interactions with tumour stroma and the bone metastatic microenvironment, there may be novel therapeutic potential in targeting BMP signalling in breast cancer. This review provides an update on the current knowledge of BMP abnormalities and their implication in the development and progression of breast cancer, particularly in the disease-specific bone metastasis.

scholarly journals COVID-19-associated rhino-orbital mucormycosis (CAROM)—a case report

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Humsheer Singh Sethi ◽  
Kamal Kumar Sen ◽  
Sudhansu Sekhar Mohanty ◽  
Sangram Panda ◽  
Kolluru Radha Krishna ◽  
...  
Keyword(s):  
Case Report ◽  
Health Care Professionals ◽  
Opportunistic Infections ◽  
Fungal Spores ◽  
Nasal Discharge ◽  
Contributing Factors ◽  
Post Discharge ◽  
Pulmonary Mucormycosis ◽  
The Right

Abstract Background There has been a rapid rise in the number of COVID-19-associated rhino-orbital mucormycosis (CAROM) cases especially in South Asian countries, to an extent that it has been considered an epidemic among the COVID-19 patients in India. As of May 13, 2021, 101 CAROM cases have been reported, of which 82 cases were from India and 19 from the rest of the world. On the other hand, pulmonary mucormycosis associated with COVID-19 has a much lesser reported incidence of only 7% of the total COVID-19-associated mucormycosis cases (Singh AK, Singh R, Joshi SR, Misra A, Diab Metab Syndr: Clin Res Rev, 2021). This case report attempts to familiarize the health care professionals and radiologists with the imaging findings that should alarm for follow-up and treatment in the lines of CAROM. Case presentation Rhino-orbital mucormycosis (ROM) is a manifestation of mucormycosis that is thought to be acquired by inhalation of fungal spores into the paranasal sinuses. Here, we describe a 55-year-old male, post COVID-19 status with long standing diabetes who received steroids and ventilator therapy for the management of the viral infection. Post discharge from the COVID-19 isolation ICU, the patient complained of grayish discharge from the right nostril and was readmitted to the hospital for the nasal discharge. After thorough radiological and pathological investigation, the patient was diagnosed with CAROM and managed. Conclusion Uncontrolled diabetes and imprudent use of steroids are both contributing factors in the increased number of CAROM cases. Our report emphasizes on the radiological aspect of CAROM and reinforces the importance of follow-up imaging in post COVID-19 infection cases with a strong suspicion of opportunistic infections.

scholarly journals Will the imaginary active consumers please stand up? Case note to Walbusch Walter Busch: Case C-430/17 Walbusch Walter Busch GmbH & Co. KG v. Zentrale zur Bekämpfung unlauteren Wettbewerbs Frankfurt am Main eV, EU:C:2019:47

2019 ◽  
Vol 26 (5) ◽  
pp. 713-719
Author(s):  
Joasia Luzak
Keyword(s):  
Consumer Protection ◽  
Case Note ◽  
Recent Case ◽  
Frankfurt Am Main ◽  
Limited Space ◽  
Court Of Justice ◽  
Technological Advances ◽  
The Right ◽  
Right Of Withdrawal ◽  
The Eu

The questions posed to the Court of Justice of the EU in the recent case of Walbusch Walter Busch asked what qualifies as the means of communication with a limited space or time to display the information and how detailed the disclosure on the right of withdrawal needs to be on such a medium. The judgment in this case had to strike a balance between not limiting traders’ opportunities to use technological advances to reach consumers and one of the main objectives of consumer protection: ensuring consumers have a chance to make fully informed transactional decisions.

scholarly journals Anticholinergic burden in older adult inpatients: patterns from admission to discharge and associations with hospital outcomes

2021 ◽  
Vol 12 ◽  
pp. 204209862110125
Author(s):  
Maria Herrero-Zazo ◽  
Rachel Berry ◽  
Emma Bines ◽  
Debi Bhattacharya ◽  
Phyo K. Myint ◽  
...  
Keyword(s):  
Older Adults ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Geriatric Medicine ◽  
Prospective Trial ◽  
Adverse Outcomes ◽  
Prescribing Patterns ◽  
Plain Language ◽  
Post Discharge ◽  
Anticholinergic Medications

Background: Anticholinergic medications are associated with adverse outcomes in older adults and should be prescribed cautiously. We describe the Anticholinergic Risk Scale (ARS) scores of older inpatients and associations with outcomes. Methods: We included all emergency, first admissions of adults ⩾65 years old admitted to one hospital over 4 years. Demographics, discharge specialty, dementia/history of cognitive concern, illness acuity and medications were retrieved from electronic records. ARS scores were calculated as the sum of anticholinergic potential for each medication (0 = limited/none; 1 = moderate; 2 = strong and 3 = very strong). We categorised patients based on admission ARS score [ARS = 0 (reference); ARS = 1; ARS = 2; ARS ⩾ 3] and change in ARS score from admission to discharge [admission and discharge ARS = 0 (reference); same; decreased; increased]. We described anticholinergic prescribing patterns by discharge specialty and explored multivariable associations between ARS score categories and mortality using logistic regression [odds ratios (ORs), 95% confidence intervals (CIs)]. Results: From 33,360 patients, 10,183 (31%) were prescribed an anticholinergic medication on admission. Mean admission ARS scores were: Cardiology and Stroke = 0.56; General Medicine = 0.78; Geriatric Medicine = 0.83; Other medicine = 0.81; Trauma and Orthopaedics = 0.66; Other Surgery = 0.65. Mean ARS did not increase from admission to discharge in any specialty but reductions varied significantly, from 4.6% (Other Surgery) to 27.7% (Geriatric Medicine) ( p < 0.001). The odds of both 30-day inpatient and 30-day post-discharge mortality increased with admission ARS = 1 (OR = 1.21, 95% CI 1.01–1.44 and OR = 1.44, 1.18–1.74) but not with ARS = 2 or ARS ⩾ 3. The odds of 30-day post-discharge mortality were higher in all ARS change categories, relative to no anticholinergic exposure (same: OR = 1.45, 1.21–1.74, decreased: OR = 1.27, 1.01–1.57, increased: OR = 2.48, 1.98–3.08). Conclusion: The inconsistent dose–response associations with mortality may be due to confounding and measurement error which may be addressed by a prospective trial. Definitive evidence for this prevalent modifiable risk factor is required to support clinician behaviour-change, thus reducing variation in anticholinergic deprescribing by inpatient speciality. Plain language summary We describe how commonly medicines which block the chemical acetylcholine are prescribed to older adults admitted to hospital as an emergency and explore links between these medicines and death during or soon after hospital admission Backgroud: Medicines which block the chemical acetylcholine are commonly prescribed to treat symptoms such as itch and difficulty sleeping or to treat medical conditions such as depression. However, some studies in older adults have found potential links between these medicines and confusion and falls. Therefore, doctors are recommended to prescribe these drugs cautiously in adults aged 65 years and over. Methods: In our paper we use data collected as part of routine medical care at one university hospital to describe how often these medicines are prescribed in a large sample of older adults admitted to hospital as an emergency. We look at the medicines patients are prescribed on admission to the hospital and also when they are later discharged. Results: We find that these medicines are frequently prescribed. We also find that, in general, patients are prescribed fewer of these potentially harmful medicines on hospital discharge compared with hospital admission. This suggests that clinicians are aware of advice to prescribe acetylcholine blocking medicines cautiously and they are more often stopped in hospital than started. However, we find a lot of variation in practice depending on which hospital specialty was caring for the patient during their inpatient stay. We also find potential links with these medicines and death during the admission or soon after hospital discharge, but these potential links are not always consistent. Conclusion: Further study is needed to fully understand links between medicines that block acetylcholine and late life health. This will be important to reduce variation in prescribing practices.

scholarly journals The Child's Right to Basic Education in Nigeria: A Commentary on the Decision in SERAP v. Nigeria

2018 ◽  
Vol 26 (4) ◽  
pp. 639-648 ◽  
Author(s):  
Aisosa Jennifer Isokpan ◽  
Ebenezer Durojaye
Keyword(s):  
Basic Education ◽  
Case Note ◽  
Third Parties ◽  
Government Officials ◽  
Right To Education ◽  
The Right ◽  
The Impact

This case note focuses on the justiciability as well as the impact of corruption on the realisation of the right to basic education. Through an assessment of the decision of the ECOWAS Court in SERAP v. Nigeria, it emphasises the role of states in ensuring that corrupt activities of government officials or third parties do not affect the enjoyment of the right. It equally emphasises the role of the Nigerian courts in ensuring a justiciable right to education.

Sign in / Sign up

Export Citation Format

Share Document