scholarly journals Risk of fall among the hospitalized over-49 population. A retrospective cohort study in a hospital

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
F Gilardi ◽  
T Mariani ◽  
G Liotta ◽  
M Musolino ◽  
E Caredda ◽  
...  
Keyword(s):  
Adverse Event ◽  
Risk Factor ◽  
Cohort Study ◽  
Hospital Admission ◽  
Incidence Rate ◽  
Retrospective Cohort ◽  
Hospital Admissions ◽  
The Elderly ◽  
Main Risk Factor ◽  
Inpatient Falls

Abstract Background Despite the copious efforts made to prevent the problem, inpatient falls remain one of the most common adverse events in hospitals, with high risks in term of morbidity and mortality rates, as well as high costs for the healthcare system. This study aims to evaluate the inpatient falls incidence rate in a hospital in Rome, Italy. Methods A retrospective cohort study has been set out based on data collected by a Risk Management Unit concerning the falls of patients over 49 years, which happened in the hospital between 1st July 2008 and 30th June 2013. Data collected from the incident report forms were inserted in a database and analyzed using the statistical program SPSS, 20.0 Illinois version. Results During the period observed, 516 falls were reported. Patients who fell had a mean age of 68.8 years (SD ± 16.2). The falls are distributed for these age groups: 109 (21.1%) in 50-64; 129 (25%) in 65-74; 181 (35.1%) in 75-84; 97 (18.8%) in > 84. Fall incidence rate was calculated on the overall number of hospital admissions in the observed period (N = 35,812) (1.44 per 100 hospital admissions IC95% 1.32-1.56). Most of the patients were men (333; 64.5%) and older than 75 (53.9%). Inpatient falls were more frequent in the medicine wards (incidence rate 2.2 per 100 hospital admissions, IC95% 1.85-2.55,). The 51.6% of falls happened during the night shift. Severe outcome resulted in 13.6% of falls. Most of the falls (52.3%) happened within three days from the hospital admission. At multivariate analysis, a period of 2-3 days from hospital admission is the main risk factor to determine severe outcomes such as death or cranial trauma (p = 0.02; OR 2.87 IC95% 1.16-7.09). Conclusions The study contributes to measure the phenomenon in older adults and age group 50-64, identifying a specific indicator to properly measure inpatient falls incidence rate in the elderly. The study gives indications on the main risk factors related to this adverse event and on prevention strategies. Key messages Falls in hospital is an important adverse event not only in the elderly. The first period of three days from the hospital admission constitutes the main risk factor for the falls.

scholarly journals Association between home insulation and hospital admission rates: retrospective cohort study using linked data from a national intervention programme

BMJ ◽  
2020 ◽  
pp. m4571 ◽  
Author(s):  
Caroline Fyfe ◽  
Lucy Telfar ◽  
Barnard ◽  
Philippa Howden-Chapman ◽  
Jeroen Douwes
Keyword(s):  
Cohort Study ◽  
Heart Disease ◽  
Confidence Interval ◽  
Hospital Admission ◽  
Retrospective Cohort ◽  
Rate Ratio ◽  
Hospital Admissions ◽  
Relative Rate ◽  
Intervention Programme ◽  
Admission Rates

Abstract Objectives To investigate whether retrofitting insulation into homes can reduce cold associated hospital admission rates among residents and to identify whether the effect varies between different groups within the population and by type of insulation. Design A quasi-experimental retrospective cohort study using linked datasets to evaluate a national intervention programme. Participants 994 317 residents of 204 405 houses who received an insulation subsidy through the Energy Efficiency and Conservation Authority Warm-up New Zealand: Heat Smart retrofit programme between July 2009 and June 2014. Main outcome measure A difference-in-difference approach was used to compare the change in hospital admissions of the study population post-insulation with the change in hospital admissions of the control population that did not receive the intervention over the same two timeframes. Relative rate ratios were used to compare the two groups. Results 234 873 hospital admissions occurred during the study period. Hospital admission rates after the intervention increased in the intervention and control groups for all population categories and conditions with the exception of acute hospital admissions among Pacific Peoples (rate ratio 0.94, 95% confidence interval 0.90 to 0.98), asthma (0.92, 0.86 to 0.99), cardiovascular disease (0.90, 0.88 to 0.93), and ischaemic heart disease for adults older than 65 years (0.79, 0.74 to 0.84). Post-intervention increases were, however, significantly lower (11%) in the intervention group compared with the control group (relative rate ratio 0.89, 95% confidence interval 0.88 to 0.90), representing 9.26 (95% confidence interval 9.05 to 9.47) fewer hospital admissions per 1000 in the intervention population. Effects were more pronounced for respiratory disease (0.85, 0.81 to 0.90), asthma in all age groups (0.80, 0.70 to 0.90), and ischaemic heart disease in those older than 65 years (0.75, 0.66 to 0.83). Conclusion This study showed that a national home insulation intervention was associated with reduced hospital admissions, supporting previous research, which found an improvement in self-reported health.

scholarly journals Comparison of incidence, rate and length of all-cause hospital admissions between adults with normoglycaemia, impaired fasting glucose and diabetes: a retrospective cohort study in Geelong, Australia

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020346 ◽  
Author(s):  
Muhammad Amber Sajjad ◽  
Kara L Holloway ◽  
Lelia L F de Abreu ◽  
Mohammadreza Mohebbi ◽  
Mark A Kotowicz ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Admission ◽  
Incidence Rate ◽  
Impaired Fasting Glucose ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Fasting Glucose ◽  
Admission Rate ◽  
Secondary Outcome

ObjectiveTo determine whether adults with normoglycaemia, impaired fasting glucose (IFG) and diabetes differed according to the incidence, rate, length and primary reasons for hospital admission.DesignRetrospective cohort study.SettingBarwon Statistical Division, Geelong, Australia.ParticipantsCohort included 971 men and 924 women, aged 20+ years, participating in the Geelong Osteoporosis Study. Glycaemic status was assessed at cohort entry using fasting plasma glucose, use of antihyperglycaemic medication and/or self-report.Primary and secondary outcome measuresPrimary outcome measure was any admission to the major tertiary public hospital in the study region over the follow-up period. Secondary outcome measures were admission rate and length (days).ResultsOver a median follow-up of 7.4 years (IQR 5.3–9.6), participants with diabetes, compared with those with normoglycaemia, were two times as likely to be hospitalised (OR 2.07, 95% CI 1.42 to 3.02), had a higher admission rate (incidence rate ratio 1.61, 95% CI 1.17 to 2.23) and longer hospital stay (third quartile difference 7.7, 95% CI 1.3 to 14.1 and ninth decile difference 16.2, 95% CI 4.2 to 28.3). IFG group was similar to normoglycaemia for the incidence, rate and length of admission. Cardiovascular disease-related diagnoses were the most common primary reasons for hospitalisation across all glycaemic categories.ConclusionsOur results show increased incidence, rate and length of all-cause hospital admission in adults with diabetes as compared with normoglycaemia; however, we did not detect any associations for IFG. Interventions should focus on preventing IFG-to-diabetes progression and reducing cardiovascular risk in IFG and diabetes.

Nonunion Rates in Hind- and Midfoot Arthrodesis in Current, Ex-, and Nonsmokers

2020 ◽  
pp. 107110072097126
Author(s):  
Jack Allport ◽  
Jayasree Ramaskandhan ◽  
Malik S. Siddique
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Relative Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Smoking Status ◽  
Time Frame ◽  
Modifiable Risk Factor ◽  
Level Of Evidence ◽  
Significant Difference

Background: Nonunion rates in hind or midfoot arthrodesis have been reported as high as 41%. The most notable and readily modifiable risk factor that has been identified is smoking. In 2018, 14.4% of the UK population were active smokers. We examined the effect of smoking status on union rates for a large cohort of patients undergoing hind- or midfoot arthrodesis. Methods: In total, 381 consecutive primary joint arthrodeses were identified from a single surgeon’s logbook (analysis performed on a per joint basis, with a triple fusion reported as 3 separate joints). Patients were divided based on self-reported smoking status. Primary outcome was clinical union. Delayed union, infection, and the need for ultrasound bone stimulation were secondary outcomes. Results: Smoking prevalence was 14.0%, and 32.2% were ex-smokers. Groups were comparable for sex, diabetes, and body mass index. Smokers were younger and had fewer comorbidities. Nonunion rates were higher in smokers (relative risk, 5.81; 95% CI, 2.54-13.29; P < .001) with no statistically significant difference between ex-smokers and nonsmokers. Smokers had higher rates of infection ( P = .05) and bone stimulator use ( P < .001). Among smokers, there was a trend toward slower union with heavier smoking ( P = .004). Conclusion: This large retrospective cohort study confirmed previous evidence that smoking has a considerable negative effect on union in arthrodesis. The 5.81 relative risk in a modifiable risk factor is extremely high. Arthrodesis surgery should be undertaken with extreme caution in smokers. Our study shows that after cessation of smoking, the risk returns to normal, but we were unable to quantify the time frame. Level of Evidence: Level III, retrospective cohort study.

scholarly journals Predictors of the recurrence of surgically removed previous caesarean skin scars at caesarean section: A retrospective cohort study

2021 ◽  
Vol 7 ◽  
pp. 205951312110233 ◽  
Author(s):  
İhsan Bağlı ◽  
Rei Ogawa ◽  
Sait Bakır ◽  
Cuma Taşın ◽  
Ayhan Yıldırım ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Caesarean Section ◽  
Retrospective Cohort ◽  
Treatment Strategies ◽  
Surgical Excision ◽  
Hypertrophic Scars ◽  
Group 2 ◽  
Risk Factor For Recurrence ◽  
Group 1

Background: Caesarean skin scars (CSS; hypertrophic scars and keloids) are very stressful for women and treatment strategies vary. However, there is a lack of knowledge about the outcome of surgical excision of CSS during caesarean section (CS). The study aims to determine the rate of recurrence and risk factors of recurrence for surgically removed CSS. Method: This is a retrospective cohort study that used STROBE guidelines. Pfannenstiel incisions of 145 patients were evaluated. Patients were divided into two groups: recurred (group 1, n = 19) and non-recurred group (group 2, n = 126). The groups were compared. Results: The rate of recurrence of CSS was 13% in the total cohort (19/145), one of the main outcomes of the study. While emergency CS was performed for 12 patients in group 1 (63%), CS was carried out in 25 patients in group 2 (20%); this difference was significant ( P = 0.001). Before surgery, white blood cell and neutrophil counts were significantly higher in group 1 ( P = 0.014 and P = 0.023, respectively). There were 11 dark-skinned women (26%; Fitzpatrick type 4) in group 1 and 31 (74%) in group 2. This difference was statistically significant ( P = 0.031). As the other main outcome, emergency CS could be accepted as a risk factor for recurrence in the multivariate regression analysis ( P = 0.060; odds ratio = 5.07; 95% confidence interval = 0.93–17.51). Conclusion: The rate of recurrence of surgically removed previous CSS at CS is promising without adjunct therapy. Emergency CS was found to be a risk factor for recurrence. Lay Summary Background Caesarean skin scars (CSS; hypertrophic scars and keloids) are very stressful and are generally itchy and painful for women. Treatment strategies vary. However, there is a lack of knowledge about the outcome of only surgical excision of CSS scars during caesarean section (CS). The issue being explored There are few data in the literature for CSS in the lower abdomen. These scars can be removed during the second or third CS, but the results are not known exactly. How was the work conducted? In our clinic, 145 patients with CSS were given a CS and their scars were removed at the same time. While most of these scars were reported as hypertrophic by pathological examination, some were reported as keloid. At the earliest, one year after surgery, the rate of recurrence was found to be 13%. What we learned from the study Asymptomatic patients who are planning another pregnancy and do not want to receive any other radiotherapy or steroid injection therapy can wait to remove their CSS at the next CS, especially elective CS with or without adjunct therapy. Emergency CS was found to be a risk factor for the recurrence of these scars.

scholarly journals Hospital-based acute care in the last 30 days of life among patients with chronic disease that received early, late or no specialist palliative care: a retrospective cohort study of eight chronic disease groups

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044196
Author(s):  
Madalene Earp ◽  
Pin Cai ◽  
Andrew Fong ◽  
Kelly Blacklaws ◽  
Truong-Minh Pham ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Heart Disease ◽  
Chronic Disease ◽  
Acute Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hospital Admissions ◽  
Specialist Palliative Care ◽  
Icu Admission

ObjectiveFor eight chronic diseases, evaluate the association of specialist palliative care (PC) exposure and timing with hospital-based acute care in the last 30 days of life.DesignRetrospective cohort study using administrative data.SettingAlberta, Canada between 2007 and 2016.Participants47 169 adults deceased from: (1) cancer, (2) heart disease, (3) dementia, (4) stroke, (5) chronic lower respiratory disease (chronic obstructive pulmonary disease (COPD)), (6) liver disease, (7) neurodegenerative disease and (8) renovascular disease.Main outcome measuresThe proportion of decedents who experienced high hospital-based acute care in the last 30 days of life, indicated by ≥two emergency department (ED) visit, ≥two hospital admissions,≥14 days of hospitalisation, any intensive care unit (ICU) admission, or death in hospital. Relative risk (RR) and risk difference (RD) of hospital-based acute care given early specialist PC exposure (≥90 days before death), adjusted for patient characteristics.ResultsIn an analysis of all decedents, early specialist PC exposure was associated with a 32% reduction in risk of any hospital-based acute care as compared with those with no PC exposure (RR 0.69, 95% CI 0.66 to 0.71; RD 0.16, 95% CI 0.15 to 0.17). The association was strongest in cancer-specific analyses (RR 0.53, 95% CI 0.50 to 0.55; RD 0.31, 95% CI 0.29 to 0.33) and renal disease-specific analyses (RR 0.60, 95% CI 0.43 to 0.84; RD 0.22, 95% CI 0.11 to 0.34), but a~25% risk reduction was observed for each of heart disease, COPD, neurodegenerative diseases and stroke. Early specialist PC exposure was associated with reducing risk of four out of five individual indicators of high hospital-based acute care in the last 30 days of life, including ≥two ED visit,≥two hospital admission, any ICU admission and death in hospital.ConclusionsEarly specialist PC exposure reduced the risk of hospital-based acute care in the last 30 days of life for all chronic disease groups except dementia.

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