scholarly journals 325 Pretibial Injury and 1 Year Mortality

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
D Peberdy
Keyword(s):  
Plastic Surgery ◽  
Cohort Analysis ◽  
Frail Patients ◽  
Retrospective Cohort Analysis ◽  
Hospital Patients ◽  
The Difference ◽  
Student’S T ◽  
One Year ◽  
The Uk ◽  
Surgery Department

Abstract Aim Frailty is increasingly recognised as an important factor for patients under the care of surgical departments. Pre-tibial injury is a common presenting problem to plastic surgery units across the UK. We wanted to assess the 1-year mortality of this patient cohort presenting to our unit. Method Retrospective cohort analysis of prospectively maintained clinical database across a calendar year from June 2017 to June 2018. This was perforemd at a UK Regional Plastic Surgery Centre analysinig patients presenting to the Royal Devon and Exeter Hospital. Patients were scored as either frail (Rockwood ≥ 5) or Non-Frail (Rockwood ≤ 4) taken from initial clinical assessment proformas. Results A total of 85 patients were included in the study. Mean age was 76.4 (± 18 years), and mean Rockwood Frailty Score of 3.4. Across all patients presenting to the plastic surgery department with pre-tibial injury there was a 20% (17/85) mortality at one year. In frail patients 1 year mortality was 47.6% (10/21). In Non-Frail patients 1 year mortality was 10.9% (7/64). The difference in mortalitly at 1 year was found to be significantly different in Frail vs Non-Frail patients with P = 0.00009 in an unpaired Student's t Test. Conclusions Frailty is a common condition in patients presenting with pre-tibial injury. This is a significant predictor of 1 year mortality in patients presenting with pre-tibial injury. Standardised evidence-based pathways of care for these patients could help optimise their management. Opportunities for MDT involvement in their care may improve outcomes.

scholarly journals Relationship between travel time to primary and tertiary care centres and survival in glioblastoma: the NHS Grampian experience.

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv17-iv17
Author(s):  
Damjan Veljanoski ◽  
Raphae Barlas ◽  
Aimun Jamjoom ◽  
Phyo Myint
Keyword(s):  
Travel Time ◽  
Cohort Analysis ◽  
Tertiary Care ◽  
Healthcare Facility ◽  
Tertiary Care Centre ◽  
Logistic Regression Models ◽  
Retrospective Cohort Analysis ◽  
Treatment Type ◽  
One Year ◽  
The Uk

Abstract Background Studies have demonstrated a distance-decay effect, whereby patients who live further away from their healthcare facility have poorer health outcomes. The geographical catchment area served by the neurosurgical unit in Aberdeen, Grampian region, Scotland is one of the largest in the UK. We aimed to examine the relationship between travel time as a proxy of distance travelled, and survival outcome for glioblastoma. Methods We conducted a retrospective, cohort analysis of patients with glioblastoma referred for treatment from January 2009 to December 2018. Travel time was calculated from the patients’ home to their general practitioner (GP) and to the neurosurgical unit. Logistic regression models were constructed to estimate survival at three, six and 12 months, as well as treatment within 62 days of GP referral, and within 31 days of diagnosis controlling for age, sex and treatment type. Results There were 195 patients (mean age (SD) 64.4 ± 12.9 years)57.9% were men, 65.1% were treated surgically, and 48.2% were alive after one year. Longer time travelled to GP, but not to tertiary care centre, was associated with reduced odds of mortality at three months (OR 0.88 95%CI 0.79–0.98; p=0.005) and six months (OR 0.92 95%CI 0.85–0.99; p=0.01), for each incremental increase in one minute. Conclusions Patients with glioblastoma with longer travel times to their GP were more likely to be alive at three months and six months. Further work is required to identify other factors, including degrees of socio-economic deprivation and rurality, which may influence this finding.

scholarly journals 598 Burns Management at A UK Major Trauma Centre During The COVID-19 Lockdown

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Payne ◽  
E Campbell ◽  
T Welman ◽  
G Pahal ◽  
S Myers
Keyword(s):  
Plastic Surgery ◽  
Major Trauma ◽  
Healthcare Delivery ◽  
Total Body Surface Area ◽  
Trauma Centre ◽  
Control Group ◽  
Major Trauma Centre ◽  
The Government ◽  
The Uk ◽  
Surgery Department

Abstract Aim The COVID-19 pandemic forced huge changes in healthcare delivery in the UK within a matter of weeks. We report our experience of managing burns presenting to a UK Major Trauma Centre during the COVID-19 lockdown period. Method Retrospective patient data was collected on aetiology, severity and management of burns during the first six weeks of the government-enforced lockdown. Data was compared with patients presenting with burns during the same period in 2019 (control) and statistical analysis was performed. Results Fifteen patients were treated during the COVID-19 lockdown and fourteen in the control group. Adults treated during the COVID-19 lockdown had a greater total body surface area (TBSA) (9% vs. 2.9%, p 0.035) and were more likely to suffer full thickness burns (40% vs. 0%). In the COVID-19 group all patients that did not require resuscitation, seven of whom met criteria for referral to burns services, were managed locally by the plastic surgery department with good outcomes. Conclusions Despite the increase in severity of adult burns seen during the COVID-19 lockdown period, local plastic surgery units have been able to adapt their practice and successfully manage more complex burns. This adaptability will be key as we move through the pandemic.

scholarly journals Racial/ethnic disparities in disability outcomes among post-acute home care patients

2017 ◽  
Vol 30 (9) ◽  
pp. 1406-1426 ◽  
Author(s):  
Jo-Ana D. Chase ◽  
Liming Huang ◽  
David Russell ◽  
Alexandra Hanlon ◽  
Melissa O’Connor ◽  
...  
Keyword(s):  
Home Care ◽  
Cohort Analysis ◽  
Ethnic Disparities ◽  
Clinical Intervention ◽  
Retrospective Cohort Analysis ◽  
Hispanic Patients ◽  
Information Set ◽  
The Difference ◽  
Adl Disability ◽  
Racial Ethnic

Objective: To examine activities of daily living (ADL) disability outcomes among racially/ethnically diverse elders receiving home care (HC) after hospitalization. Method: We conducted a retrospective cohort analysis of single-agency, 2013-2014 Outcome and Assessment Information Set data from older adults who received post-hospitalization HC ( n = 20,674). We measured overall change in ADL disability by summing the difference of standardized admission and discharge scores from nine individual ADL. Associations between race/ethnicity and overall ADL change scores were modeled using general linear regression, adjusting for covariates consistent with the Disablement Model. Results: Overall, patients experienced improvement in ADL disability from HC admission to discharge. However, Asian, African American, and Hispanic patients experienced significantly less improvement compared with non-Hispanic Whites (all p < .001), even after controlling for covariates. Discussion: Racial/ethnic disparities exist in ADL disability improvement among HC patients. Research is needed to clarify mechanisms underlying these disparities. Disablement Model factors may be targets for clinical intervention.

scholarly journals Comparison of Direct Medical Costs between Automated and Continuous Ambulatory Peritoneal Dialysis

2013 ◽  
Vol 33 (6) ◽  
pp. 679-686 ◽  
Author(s):  
Laura Cortés–Sanabria ◽  
Brenda E. Rodríguez–Arreola ◽  
Victor R. Ortiz–Juárez ◽  
Herman Soto–Molina ◽  
Leonardo Pazarín–Villaseñor ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Generalized Linear Model ◽  
Laboratory Tests ◽  
Cohort Analysis ◽  
Medical Costs ◽  
Emergency Room Visits ◽  
Direct Medical Costs ◽  
Retrospective Cohort Analysis ◽  
Independent Variable ◽  
The Difference

ObjectiveWe set out to estimate the direct medical costs (DMCs) of peritoneal dialysis (PD) and to compare the DMCs for continuous ambulatory PD (CAPD) and automated PD (APD). In addition, DMCs according to age, sex, and the presence of peritonitis were evaluated.MethodsOur retrospective cohort analysis considered patients initiating PD, calculating 2008 costs and, for comparison, updating the results for 2010. The analysis took the perspective of the Mexican Institute of Social Security, including outpatient clinic and emergency room visits, dialysis procedures, medications, laboratory tests, hospitalizations, and surgeries.ResultsNo baseline differences were observed for the 41 patients evaluated (22 on CAPD, 19 on APD). Median annual DMCs per patient on PD were US$15 072 in 2008 and US$16 452 in 2010. When analyzing percentage distribution, no differences were found in the DMCs for the modality groups. In both APD and CAPD, the main costs pertained to the dialysis procedure (CAPD 41%, APD 47%) and hospitalizations (CAPD 37%, APD 32%). Dialysis procedures cost significantly more ( p = 0.001) in APD (US$7084) than in CAPD (US$6071), but total costs (APD US$15 389 vs CAPD US$14 798) and other resources were not different. The presence of peritonitis increased the total costs (US$16 075 vs US$14 705 for patients without peritonitis, p = 0.05), but in the generalized linear model analysis, DMCs were not predicted by age, sex, dialysis modality, or peritonitis. A similar picture was observed for costs extrapolated to 2010, with a 10% – 20% increase for each component—except for laboratory tests, which increased 52%, and dialysis procedures, which decreased 3%, from 2008.ConclusionsThe annual DMCs per patient on PD in this study were US$15 072 in 2008 and US$16 452 in 2010. Total DMCs for dialysis procedures were higher in APD than in CAPD, but the difference was not statistically significant. In both APD and CAPD, 90% of costs were attributable to the dialysis procedure, hospitalizations, and medications. In a multivariate analysis, no independent variable significantly predicted a higher DMC.

3 Peer-Produced Induction Material for Foundation Year One Doctors in Plastic Surgery – A Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L Dwyer-Hemmings ◽  
L Salfity
Keyword(s):  
Quality Improvement ◽  
Plastic Surgery ◽  
Quality Care ◽  
Smooth Transition ◽  
Junior Doctors ◽  
Free Text ◽  
Post Intervention ◽  
Improvement Project ◽  
One Year ◽  
Surgery Department

Abstract Introduction Induction programmes are recommended for all junior doctors starting new posts and are mandatory for foundation year one doctors (FY1s). Constraints on time and staff mean these guidelines are not always met. This project aimed to improve the efficiency, effectiveness, and timeliness of care by designing and distributing peer-produced induction material to FY1s starting placements in plastic surgery. Method A quality-improvement methodology was utilised. Online questionnaires assessed FY1 experiences in several domains using five-point Likert scales and free-text answers. This information was used to design induction material. Material was distributed to incoming FY1 cohorts, the questionnaire was repeated, and material updated and redistributed. Results Three quality improvement cycles were performed over a one-year period. Four FY1s were surveyed pre-intervention, and four post-intervention. Post-intervention, there was a statistically significant improvement in understanding of responsibilities (+2.2, p &lt; 0.01) and departmental structure (+2.0, p = 0.018). FY1s felt confident in starting (4.75±0.5), prepared for on-calls (4.75±0.5), and satisfaction was high (4.75±0.5) Conclusions Peer-produced induction material for FY1s can improve understanding of responsibilities and structure within a plastic surgery department. This will increase confidence of new starters and facilitate smooth transition of staff, enabling the provision of high-quality care by enhancing its efficiency, effectiveness, and timeliness.

scholarly journals PP040 Hospitalization Costs In Schizophrenia: Long-acting Injectable Antipsychotics Versus Oral Antipsychotic Use

2017 ◽  
Vol 33 (S1) ◽  
pp. 89-89
Author(s):  
Mallik Greene ◽  
Eunice Chang ◽  
Ann Hartry ◽  
Michael Broder
Keyword(s):  
Cohort Analysis ◽  
Charlson Comorbidity Index Score ◽  
Retrospective Cohort Analysis ◽  
Final Sample ◽  
Hospitalization Costs ◽  
Medicaid Population ◽  
Comorbidity Index ◽  
The Difference ◽  
Oral Antipsychotic ◽  
Long Acting

INTRODUCTION:Existing findings on effectiveness of long-acting injectable antipsychotics (LAIs) versus oral antipsychotics in preventing hospitalizations are inconclusive. This study was conducted to compare hospitalization costs between Medicaid patients diagnosed with schizophrenia who initiated a LAI and those who changed from one oral antipsychotic to another.METHODS:This retrospective cohort analysis used the Truven Health Analytics MarketScan® Medicaid claims database to study patients ≥18 years with schizophrenia. The two cohorts were: “LAI”, defined as initiating LAI (no prior LAI therapy) between 1 January 2013 and 30 June 2014; and “oral”, defined as changing from one oral antipsychotic to another during the same period. The first day of LAI or the new oral antipsychotic was the index date. A linear regression model was conducted to estimate hospitalization costs.RESULTS:The final sample included 2,861 (36.7 percent) LAI and 4,926 (63.3 percent) oral users. Compared to oral users, LAI patients were younger (mean (Standard Deviation, SD): 39.9 (13.2) versus 42.7 (13.1); p<.001) and had a lower mean Charlson Comorbidity Index score (mean (SD): 1.1 (1.9) versus 1.7 (2.3); p<.001). Of the 877 LAI initiators and 1,688 oral users who were hospitalized during the 1-year post-index follow-up period, the unadjusted mean hospitalization costs for LAI and oral users were USD32,626 and USD36,048, respectively. After adjusting for patient demographic and clinical characteristics, baseline medication use, and baseline ED or hospitalizations, the adjusted average hospitalization costs were USD1,170 lower in LAI initiators than oral users. None of the unadjusted or adjusted differences were statistically significant.CONCLUSIONS:This real-world study suggests that among hospitalized patients, hospitalization costs are lower in LAI initiators than in oral antipsychotic users, although the difference is not statistically significant. Our study is limited as our results are reflective of a multi-state Medicaid population. Future studies are warranted to confirm the results in non-Medicaid patient populations.

scholarly journals Resource Utilization Among Glaucoma Patients in the UK Treated with Beta-Blocker and Non-Beta-Blocker Adjunctive Therapy: A Retrospective Cohort Analysis

2017 ◽  
Vol 34 (7) ◽  
pp. 1695-1706 ◽  
Author(s):  
Ananth Viswanathan ◽  
Claudio Spera ◽  
Anmol Mullins ◽  
David Covert ◽  
Judit Banhazi ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Beta Blocker ◽  
Adjunctive Therapy ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Retrospective Cohort Analysis ◽  
The Uk
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