Assessment of acute admissions by middle grade trainees and consultants will reduce the need for overnight hospital admissions

BackgroundThe study aim was to establish and quantify suicide risk following acute admissions for all major physical illnesses, for confirmatory purposes, from two independent information sources from different countries.MethodsRecord linkage of inpatient and death certificate data for 11 004 389 acute admissions for physical illnesses in England and 713 496 in Wales. The main outcome measure was standardised mortality ratios (SMRs) for suicide at 1 year following discharge from hospital.ResultsThere were 1781 suicides within 1 year of discharge in England (SMR = 1.7; 95% = 1.6–1.8) and 131 in Wales (SMR = 2.0; 1.7–2.3). Of 48 major physical illnesses that were associated with at least eight suicides in either country, there was high consistent suicide mortality (significant SMR >3) in both countries for constipation (SMR = 4.1 in England, 7.5 in Wales), gastritis (4.4 and 4.9) and upper gastrointestinal bleeding (3.4 and 4.5). There was high suicide mortality in one country for alcoholic liver disease, other liver disease and chronic pancreatitis; for epilepsy and Parkinson's disease; for diabetes, hypoglycaemia and hypo-osmolality & hyponatraemia; and for pneumonia, back pain and urinary tract infections.ConclusionsThere is little or no increased suicide mortality following acute admissions for most physical illnesses. Much of the increased suicide mortality relates to gastrointestinal disorders that are often alcohol related or specific chronic conditions, which may be linked to side effects from certain therapeutic medications. Acute hospital admissions for physical illnesses may therefore provide an opportunity for targeted suicide prevention among people with certain conditions, particularly alcohol related disorders.

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Abstract P385: Stroke-Related Hospital Admissions During Covid-19 Pandemic in the Latin American Stroke Registry (LASE)

Stroke ◽

10.1161/str.52.suppl_1.p385 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Virginia Pujol-Lereis ◽

Alan Flores ◽

Antonio Arauz ◽

Carlos Abanto-Argomedo ◽

Pablo Amaya ◽

...

Keyword(s):

Latin American ◽

Hospital Admissions ◽

Stroke Care ◽

Stroke Work ◽

Term Outcome ◽

Stroke Registry ◽

Undetermined Etiology ◽

The Impact ◽

Work Up ◽

Acute Admissions

Background: COVID-19 pandemic has forced important changes in health care worldwide. Stroke care networks have been affected, especially acute admissions and ancillary tests availability. We assessed the impact of the pandemic and the lockdowns imposed in stroke admissions in Latin America. Methods: A multinational study (7 countries, 18 centers) of patients admitted since the pandemic outbreak (January - June 2020). These cases were compared with the same period in 2019. We also assessed patterns during the strictest lockdown period (March-June 2020). Number of cases, stroke etiology and severity, acute care and functional outcomes were compared per periods, months, centers and countries. Results: There were 1863 stroke cases in 2019 and 1781 cases in 2020 (p=0.02). We found a significant increase in strokes of undetermined etiology due to incomplete studies in 2020 [16.8% vs 27.6%, p<0.001]). Most countries reported decreases in all-type stroke admissions, except México and Brasil (16% and 36% increases in admissions, respectively). There were no significant differences among months. All-type mortality increased (6.2% vs. 12.6%, p<0.001), and poor functional outcome (mRs 3-6) increased from 32.2% to 38.8% (p=0.007) in 2020. During the period of strict lockdown (March-June 2020), ischemic stroke admissions during the first 24 hours of onset (68.3% vs. 64.4%, p=0.1) and in-hospital stroke code activation (35.1% vs. 27.6%, p=0.005) diminished compared to 2019 period. No differences in total reperfusion treatment rates were observed, with similar door-to-needle and door-to-groin times in both periods. Conclusions: All-type stroke admissions diminished only slightly during the first months of the COVID-19 pandemic. However, in this region, we found substantial deficiencies in stroke work-up, poor short-term outcome and increased mortality.

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The Importance of Stone Retrieval in the Modern Management of Urolithiasis

Journal of Endoluminal Endourology ◽

10.22374/jeleu.v3i1.79 ◽

2020 ◽

Vol 3 (1) ◽

pp. e39-e46

Author(s):

Aman Khela ◽

Manoj Ravindraanandan ◽

Adam Jones ◽

Adnan Asghar ◽

Wasim Mahmalji

Keyword(s):

Hospital Admissions ◽

Cost Effective ◽

Patient Survey ◽

Stone Analysis ◽

Modern Management ◽

Metabolic Conditions ◽

Reducing Costs ◽

Acute Patients ◽

Acute Admissions

Background and ObjectivesWorld urolithiasis is increasing with a 70% increase in hospital admissions between 2000 and 2015. Stone analysis can allow for the identification of metabolic conditions and stone retrieval may decrease the need for follow-up imaging, reducing costs and patient radiation.This study aimed to see if introducing the UroPro© Stone catcher into our practise would increase stone retrieval thus increasing stone analysis rates and reducing the need for follow-up imaging. MethodsBetween November 2018 and July 2019 patients receiving ESWL or being conservatively managed for a ureteric stone were discharged with a Paramount Medical solutions UroPro© Stone Catcher. Both groups of patients were asked to complete a patient survey regarding the product. ResultsThere were 27 patients recruited. 14 from SWL and 13 from acute admissions. 22 responses were received in total: 10 from acute admissions and 12 from ESWL. 5 patients were uncontactable. 30% (n=3) of the acute patients passed and caught a stone negating the need for further imaging. 30% (n=3) did not pass their stone and required either emergency or elective intervention. 1 patient passed his stone into the toilet whilst another had the stone in their bladder when they were taken to theatre. 20% (n=2) patients but did not catch their stone requiring follow-up imaging which revealed the stone had passed. In the ESWL group 16% (n=2) caught a fragment, the rest found they only passed dust. Stone analysis was performed in all 5 patients who returned a fragment. A total of 73% (n=16) of patients reported over 75% compliance with the stone catcher. 59% (n=13) reported that the stone catcher was easy to use whilst 27% (n=6) found it hard. When given a choice of sieving methods. Only 6 patients (27%) would opt to use the stone catcher with over half, 64% (n=14), preferring more traditional methods of sieving urine over the stone catcher. the patient 0.5 to 2.8 mSv of radiation from follow-up imaging, the NHS circa £100 per unnecessary follow-up computed tomography (CT) scan and aids metabolic analysis. Over time both factors may be substantial. Therefore, emphasizing the benefits and importance to patients to sieve their urine regardless of the techniques is paramount in the modern management of urolithiasis.ConclusionThe UroPro© stone catcher did increase the number of stones caught and sent for analysis. However, many patients preferred the older ‘sieving’ methods. Stone catchers retail at £5.50, therefore ‘sieving’ remains more cost-effective. Stone retrieval in any form remains advantageous as confirming stone passage saves

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Rising Incidence of Acute Hospital Admissions due to Gout

The Journal of Rheumatology ◽

10.3899/jrheum.190257 ◽

2019 ◽

Vol 47 (4) ◽

pp. 619-623 ◽

Cited By ~ 2

Author(s):

Mark D. Russell ◽

Mark Yates ◽

Katie Bechman ◽

Andrew I. Rutherford ◽

Sujith Subesinghe ◽

...

Keyword(s):

Hospital Admissions ◽

Acute Hospital ◽

Acute Gout ◽

Prescription Data ◽

Time Period ◽

Prescribing Trends ◽

Rising Incidence ◽

Uk National Health Service ◽

Unplanned Admissions ◽

Acute Admissions

Objective.To describe trends in acute hospital admissions due to gout in England, with rheumatoid arthritis (RA) as a comparator, alongside prescribing trends for common gout medications.Methods.An ecological study was performed using UK National Health Service (NHS) Digital Hospital Episode Statistics data to calculate the incidence of unplanned admissions with primary diagnoses of gout or RA in adults in England between April 2006 and March 2017. NHS Digital Community Prescription data for allopurinol, febuxostat, and colchicine were considered over a similar period.Results.The incidence of unplanned gout admissions increased by 58.4% over the study period, from 7.9 admissions per 100,000 population in 2006/07 to 12.5 admissions per 100,000 population in 2016/17 (p < 0.0001). Gout admissions increased as a proportion of all hospital admissions, and accounted for 349,768 bed-days cumulatively. Unplanned RA admissions halved over the study period, from 8.6 admissions per 100,000 population in 2006/07 to 4.3 admissions per 100,000 population in 2016/17 (p < 0.0001). Community prescriptions dispensed for allopurinol and colchicine have increased by 71.4% and 165.6%, respectively, since 2006 (p < 0.0001). Febuxostat prescriptions have increased 20-fold since 2010 (p < 0.0001), when prescription data became available.Conclusion.Acute gout admissions in England increased between 2006 and 2017, accompanied by increasing prescription of gout therapies. Acute admissions due to RA halved over the same time period. These data call for aggressive target-driven therapy for this highly treatable disease.

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Time for time off? Secondary public holiday shows minimal net hospitalisation benefit

Journal of Epidemiology & Community Health ◽

10.1136/jech-2020-215327 ◽

2020 ◽

pp. jech-2020-215327

Author(s):

Lucy Frances Telfar Barnard

Keyword(s):

New Zealand ◽

Hospital Admissions ◽

Health Effect ◽

The Public ◽

Admission Rates ◽

New Public ◽

Significant Difference ◽

Elective Treatment ◽

Public Holidays ◽

Acute Admissions

BackgroundWe aimed to use New Zealand’s Anzac Day to test the public health effect of secondary public holidays; and to use weekly hospitalisation counts to identify which dates were more health suitable for a potential new public holiday.MethodsWe conducted a retrospective population cohort study of hospital admissions in New Zealand between 23 April and 27 May 1988–2018. We compared acute and arranged hospitalisation and mortality rates in holiday (Anzac Day Monday to Friday) and non-holiday (Anzac Day Saturday or Sunday) years, for mid-week holidays and long weekends; and measured total weekly average acute and arranged hospitalisation counts.ResultsHospitalisation rates were lower in holiday years than non-holiday years (rate ratio (RR) 0.96, 95% CI 0.95 to 0.96, p<0.001), with fewer arranged admissions (RR 0.93, 95% CI 0.93 to 0.94, p<0.001), but no significant difference for acute admissions (RR 1.00, 95% CI 0.99 to 1.00, p=0.087). Holiday year acute admission rates were lower than non-holiday years for children aged 0–4 years, but higher for adults aged 15–44 years. Holidays reduced arranged admissions most in children and areas of higher socioeconomic deprivation. There was no significant difference for mortality. Average weekly acute hospitalisations were higher than arranged admissions between 10 June and 7 October.ConclusionSecondary holidays do not reduce deaths; or acute hospital admissions except in the holiday week; and may delay elective treatment. However, if New Zealand is to add a new public holiday, it would have least detrimental health effect scheduled between 10 June and 7 October.

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