scholarly journals Exploring geographic variation in acute appendectomy in Ireland: results from a national registry study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e025231
Author(s):  
Ola Ahmed ◽  
Ken Mealy ◽  
Jan Sorensen
Keyword(s):  
Geographic Variation ◽  
Hospital Admissions ◽  
Open Appendectomy ◽  
National Registry ◽  
Public Hospitals ◽  
Hospital Data ◽  
Geographic Variations ◽  
A Value ◽  
Systematic Component ◽  
And Gender

ObjectiveTo explore geographic variations in Irish laparoscopic and open appendectomy procedures.DesignAnalysis based on 2014–2017 administrative hospital data from public hospitals.SettingCounties of Ireland.ParticipantsIrish residents with hospital admissions for an appendectomy as the principal procedure.Main outcome measuresAge and gender standardised laparoscopic and open appendectomy rates for 26 counties. Geographic variation measured with the extremal quotient (EQ), coefficient of variation (CV) and the systematic component of variation (SCV).Results23 684 appendectomies were included. 77.6% (n= 18,387) were performed laparoscopically. An EQ of 8.3 for laparoscopy and 10.0 for open appendectomy was determined. A high CV was demonstrated with a value of 36.7 and 80.8 for laparoscopic and open appendectomy, respectively. An SCV of 14.2 and 124.8 for laparoscopic and open appendectomy was observed. A wider variation was determined when children and adults were assessed separately.ConclusionsThe geographic distribution in rates of appendectomy varies considerably across Irish counties. Our data suggest that a patient’s likelihood of undergoing a laparoscopic or open appendectomy is associated with their county of residence.

scholarly journals The association between age and mortality related hospital expenditures: Evidence from a complete national registry

2014 ◽  
Vol 2 (1) ◽  
Author(s):  
Fredrik Alexander Gregersen ◽  
Geir Godager
Keyword(s):  
Hospital Admissions ◽  
Population Aging ◽  
Age Groups ◽  
Health Care Expenditures ◽  
National Registry ◽  
Future Health ◽  
Hospital Expenditures ◽  
And Gender ◽  
The Right ◽  
The Impact

The aim of this paper is to contribute to the debate on population aging and growth in health expenditures, by providing precise estimates on how mortality related expenditures are influenced by age. Using a complete register of inpatient hospital admissions to create gender-cohort specific panels for each of the 430 Norwegian municipalities, we are able to identify mortality related hospital expenditures by separating the impact of mortality on current hospital expenditures from the impact of patients’ age and gender. We apply model estimates to quantify the mortality-related hospital expenditures for twenty age groups. The results suggest that mortality-related hospital expenditures are a decreasing function of age. Furthermore, the results clearly suggest that, both age and mortalities should be included when predicting future health care expenditures. The estimation results suggest that 9.2 % of all hospital expenditures is associated with treating individuals in their last year of life. Our results also suggest that the reduction in mortality rates in the period from 1998 to 2009 have, cet. par. contributed to an estimated reduction in total hospital expenditures of 0.6 billion NOK, a difference corresponding to 2 % of the expenditures in 2009. (The appendix can be found under "Supplementary Files" in the menu to the right)

Description of multimorbidity clusters of admitted patients in medical departments of a general hospital

2021 ◽  
pp. postgradmedj-2020-139361
Author(s):  
María Matesanz-Fernández ◽  
Teresa Seoane-Pillado ◽  
Iria Iñiguez-Vázquez ◽  
Roi Suárez-Gil ◽  
Sonia Pértega-Díaz ◽  
...  
Keyword(s):  
General Hospital ◽  
Multiple Correspondence Analysis ◽  
Hypertensive Heart Disease ◽  
Chronic Kidney Failure ◽  
Hospital Environment ◽  
Heart Valve Disease ◽  
Malignant Neoplasms ◽  
Hospital Data ◽  
Data Set ◽  
And Gender

ObjectiveWe aim to identify patterns of disease clusters among inpatients of a general hospital and to describe the characteristics and evolution of each group.MethodsWe used two data sets from the CMBD (Conjunto mínimo básico de datos - Minimum Basic Hospital Data Set (MBDS)) of the Lucus Augusti Hospital (Spain), hospitalisations and patients, realising a retrospective cohort study among the 74 220 patients discharged from the Medic Area between 01 January 2000 and 31 December 2015. We created multimorbidity clusters using multiple correspondence analysis.ResultsWe identified five clusters for both gender and age. Cluster 1: alcoholic liver disease, alcoholic dependency syndrome, lung and digestive tract malignant neoplasms (age under 50 years). Cluster 2: large intestine, prostate, breast and other malignant neoplasms, lymphoma and myeloma (age over 70, mostly males). Cluster 3: malnutrition, Parkinson disease and other mobility disorders, dementia and other mental health conditions (age over 80 years and mostly women). Cluster 4: atrial fibrillation/flutter, cardiac failure, chronic kidney failure and heart valve disease (age between 70–80 and mostly women). Cluster 5: hypertension/hypertensive heart disease, type 2 diabetes mellitus, ischaemic cardiomyopathy, dyslipidaemia, obesity and sleep apnea, including mostly men (age range 60–80). We assessed significant differences among the clusters when gender, age, number of chronic pathologies, number of rehospitalisations and mortality during the hospitalisation were assessed (p<0001 in all cases).ConclusionsWe identify for the first time in a hospital environment five clusters of disease combinations among the inpatients. These clusters contain several high-incidence diseases related to both age and gender that express their own evolution and clinical characteristics over time.

scholarly journals Effects of the COVID-19 Epidemic on Hospital Admissions for Non-Communicable Diseases in a Large Italian University-Hospital: A Descriptive Case-Series Study

2021 ◽  
Vol 10 (4) ◽  
pp. 880
Author(s):  
Caterina Caminiti ◽  
Giuseppe Maglietta ◽  
Tiziana Meschi ◽  
Andrea Ticinesi ◽  
Mario Silva ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Case Series ◽  
Communicable Diseases ◽  
University Hospital ◽  
Negative Consequences ◽  
Non Communicable Diseases ◽  
Case Series Study ◽  
And Gender ◽  
Long Term Impact ◽  
Series Study

Background: Concern is growing about the negative consequences that response measures to the COVID-19 epidemic may have on the management of other medical conditions. Methods: A retrospective descriptive case-series study conducted at a large University-hospital in northern Italy, an area severely hit by the epidemic. Results: Between 23 February and 14 May 2020, 4160 (52%) COVID-19 and 3778 (48%) non-COVID-19 patients were hospitalized. COVID-19 admissions peaked in the second half of March, a period characterized by an extremely high mortality rate (27.4%). The number of admissions in 2020 was similar to 2019, but COVID-19 patients gradually occupied all available beds. Comparison between COVID-19 and non-COVID-19 admissions in 2020 revealed significant differences concerning all age classes and gender. Specifically, COVID-19 patients were older, predominantly male, and exhibited more comorbidities. Overall, admissions for non-communicable diseases (NCDs) in 2020 vs. 2019 dropped by approximately one third. Statistically significant reductions were observed for acute myocardial infarction (−78, −33.9%), cerebrovascular disease (−235, −41.5%), and cancer (−368, −31.9%). While the first two appeared equally distributed between COVID-19 and non-COVID-19 patients, chronic NCDs were statistically significantly more frequent in the former, except cancer, which was less frequent in COVID-19 patients. Conclusions: Prevention of collateral damage to patients with other diseases should be an integral part of epidemic response plans. Prospective cohort studies are needed to understand the long-term impact.

scholarly journals Implementing an Individual-Centric Discharge Process across Singapore Public Hospitals

2021 ◽  
Vol 18 (16) ◽  
pp. 8700
Author(s):  
Reuben Ng ◽  
Kelvin Bryan Tan
Keyword(s):  
Hospital Admissions ◽  
Public Hospitals ◽  
Gradient Boosting ◽  
Care Utilization ◽  
Public Healthcare ◽  
Successful Implementation ◽  
Discharge Process ◽  
Gradient Boosting Machine ◽  
Cumulative Length ◽  
Risk Patients

Singapore is one of the first known countries to implement an individual-centric discharge process across all public hospitals to manage frequent admissions—a perennial challenge for public healthcare, especially in an aging population. Specifically, the process provides daily lists of high-risk patients to all public hospitals for customized discharge procedures within 24 h of admission. We analyzed all public hospital admissions (N = 150,322) in a year. Among four models, the gradient boosting machine performed the best (AUC = 0.79) with a positive predictive value set at 70%. Interestingly, the cumulative length of stay (LOS) in the past 12 months was a stronger predictor than the number of previous admissions, as it is a better proxy for acute care utilization. Another important predictor was the “number of days from previous non-elective admission”, which is different from previous studies that included both elective and non-elective admissions. Of note, the model did not include LOS of the index admission—a key predictor in other models—since our predictive model identified frequent admitters for pre-discharge interventions during the index (current) admission. The scientific ingredients that built the model did not guarantee its successful implementation—an “art” that requires the alignment of processes, culture, human capital, and senior management sponsorship. Change management is paramount, otherwise data-driven health policies, no matter how well-intended, may not be accepted or implemented. Overall, our study demonstrated the viability of using artificial intelligence (AI) to build a near real-time nationwide prediction tool for individual-centric discharge, and the critical factors for successful implementation.

scholarly journals Treatment outcomes in a rural HIV clinic in South Africa: Implications for health care

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Olufemi B. Omole ◽  
Mary-Anne M.L. Semenya
Keyword(s):  
Treatment Outcomes ◽  
Antiretroviral Treatment ◽  
Hospital Admissions ◽  
Opportunistic Infections ◽  
Limpopo Province ◽  
Cd4 Count ◽  
Viral Rebound ◽  
Hospital Data ◽  
Adherence Support ◽  
Patient Retention

Objective: To assess the treatment outcomes of an HIV clinic in rural Limpopo province, South Africa.Methods: A retrospective cohort study involving medical records review of HIV-positive patients initiated on antiretroviral treatment (ART) was conducted from December 2007 to November 2008 at Letaba Hospital. Data on socio-demographic characteristics, CD4 counts, viral loads (VLs), opportunistic infections, adverse effects of treatment, hospital admissions, and patient retention at 6, 12, 24, and 36 months on ART were collected. Analysis included descriptive statistics, chi-square and t-tests.Results: Of 124 patient records sampled, the majority of patients were female (69%), single (49%), unemployed (56%), living at least 10 km from the hospital (52.4%), and were on treatment at 36 months (69%). Approximately 84% of patients achieved viral suppression (VLs < 400 copies/mL) by 6 months of ART and the mean CD4 count increased from 128 at baseline to 470 cells/mm3 at 24 months. There was a mean weight gain of 5.9 kg over the 36 months and the proportion of patients with opportunistic infections decreased from 54.8% (n = 68) at baseline to 15.3% (n = 19) at 36 months. Although the largest improvements in CD4, VLs, and weights were recorded in the first 6 months of ART, viral rebound became evident thereafter. Of all variables, only age < 50 years and being pregnant were significantly associated with higher VLs (p = 0.03).Conclusion: Good treatment outcomes are achievable in a rural South African ART clinic. However, early viral rebound and higher VLs in pregnancy highlight the need for enhanced treatment adherence support, especially for pregnant women to reduce the risk of mother to child transmission.Keywords: CD4 count; viral load; rura;, treatment outcomes; antiretroviral treatment; patient retention

scholarly journals PERAN RELIGIUSITAS TERHADAP REGULASI EMOSI PADA KOMUNITAS HIJRAH

2020 ◽  
Vol 12 (1) ◽  
pp. 1-20
Author(s):  
Ratna Purnamasyary ◽  
Sito Meiyanto ◽  
Mohammad Khasan
Keyword(s):  
Data Analysis ◽  
Emotional Regulation ◽  
Quantitative Methods ◽  
Positive Role ◽  
A Value ◽  
Simple Regression Analysis ◽  
And Gender ◽  
The One ◽  
Effective Contribution

Hijrah is a changing the one self of a person, from a bad to be a better person. This study aims to examine the role of religiosity on emotional regulation in the hijrah community.The subject in this research are the ikhwan and akhwat in hijrah community “X” with the total of 100 respondents. The measuring instrument used in this study is the religiosity scale and emotional regulation scale. This study used quantitative methods and for the sampling the researcher used incidental sampling techniques.The method used for the data analysis is a simple regression analysis and an additional age and gender analysis using the cross tabulation analysis (crosstab) with the help of SPSS 21.0. The results of data analysis showed a regression coefficient of 0.379 with a value of p = 0,000 (p <0.01), indicating that the hypothesis proposed in this study was accepted, that there was a significant positive role between religiosity towards emotional regulation in ikhwan and akhwat in the hijrah community. The result of the additional analysis using crosstab shows that the most dominant age of the subject are between 20 to 25 years old and the most dominant gender is akhwat. Effective contribution of religiosity towards emotional regulation is 0,144 or 14,4% and the rest is 85.6% influenced by others factors that is gender, age, culture and education.

Effects of the Blair/Brown NHS Reforms on Socioeconomic Equity in Health Care

2012 ◽  
Vol 17 (1_suppl) ◽  
pp. 55-63 ◽  
Author(s):  
Richard Cookson ◽  
Mauro Laudicella ◽  
Paolo Li Donni ◽  
Mark Dusheiko
Keyword(s):  
Health Care ◽  
Hip Replacement ◽  
Large Scale ◽  
Hospital Admissions ◽  
Public Hospitals ◽  
Patient Choice ◽  
Socioeconomically Disadvantaged ◽  
Equity In Health ◽  
Socioeconomic Equity ◽  
Equity In Health Care

The central objectives of the ‘Blair/Brown’ reforms of the English NHS in the 2000s were to reduce hospital waiting times and improve the quality of care. However, critics raised concerns that the choice and competition elements of reform might undermine socioeconomic equity in health care. By contrast, the architects of reform predicted that accelerated growth in NHS spending combined with increased patient choice of hospital would enhance equity for poorer patients. This paper draws together and discusses the findings of three large-scale national studies designed to shed empirical light on this issue. Study one developed methods for monitoring change in neighbourhood level socioeconomic equity in the utilization of health care, and found no substantial change in equity between 2001-02 and 2008-09 for non-emergency hospital admissions, outpatient admissions (from 2004-05) and a basket of specific hospital procedures (hip replacement, senile cataract, gastroscopy and coronary revascularization). Study two found that increased competition between 2003-04 and 2008-09 had no substantial effect on socioeconomic equity in health care. Study three found that potential incentives for public hospitals to select against socioeconomically-disadvantaged hip replacement patients were small, compared with incentives to select against elderly and co-morbid patients. Taken together, these findings suggest that the Blair/Brown reforms had little effect on socioeconomic equity in health care. This may be because the ‘dose’ of competition was small and most hospital services continued to be provided by public hospitals which did not face strong incentives to select against socioeconomically-disadvantaged patients.

scholarly journals Using Action Research and Action Learning (ARAL) to develop a response to the abuse of older people in a healthcare context

2015 ◽  
Vol 7 (1) ◽  
pp. 38-51 ◽  
Author(s):  
Fiona McAlinden
Keyword(s):  
Action Research ◽  
Older People ◽  
Hospital Admissions ◽  
Elder Abuse ◽  
Health Management ◽  
Action Learning ◽  
Public Hospitals ◽  
Public Healthcare ◽  
Content Type ◽  
Policy And Procedure

Purpose The purpose of this paper is to describe Monash Health’s development of a Policy and Procedure on the abuse of older people in metropolitan Australia. Monash Health is a public healthcare network that consists of six public hospitals and over 40 community health care sites throughout the South East of Melbourne. Design/methodology/approach An Action Research Action Learning approach was employed to develop a comprehensive set of policy and procedure documents to ensure that Monash Health became compliant with the State Government’s expectations around responding to the abuse of older people in a consistent manner. Findings Almost 90,000 Monash Health hospital admissions per year are older people aged over 65 years. Senior Monash Health management recognized that staff did not have adequate information, education and resources to consistently identify and respond to situations of elder abuse. What is more, the existing internal Monash Health document Supporting Older People at Risk did not meet obligations stated in the Victorian Government’s Elder Abuse Strategy (2009). Originality/value The project’s emphasis upon participatory action research, cooperative inquiry and action learning further resulted in the identification of an opportunity to develop a strategic response to violence and abuse for all patients of Monash Health, not just older people.

scholarly journals Causal Relations of Factors Representing the Elderly Independence in Doing Activities of Daily Livings Using S3C-Latent Algorithm

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Christantie Effendy ◽  
Nurhaeka Tou ◽  
Ridho Rahmadi
Keyword(s):  
Causal Relationship ◽  
Psychological Health ◽  
Latent Variables ◽  
The Elderly ◽  
Nutrition And Health ◽  
Cross Sectional ◽  
Factors Associated ◽  
A Value ◽  
And Gender ◽  
Relationship Of

The growth of the elderly population in Indonesia from year to year has always increased, followed by the problem of decreasing physical strength and psychological health of the elderly. These problems can affect the increase in dependence and decrease the independence of the elderly in ADL. In previous studies, various factors affect independence in ADLs such as cognitive, psychological, economic, nutrition, and health. However, In general, these studies only focus on predictive analysis or correlation of variables, and no research has attempted to identify the casual relationship of the elderly independence factors. Therefore, this study aimed to determine the mechanism of the causal relationship of the factors that influence the independence of the elderly in ADLs using a casual method called the Stable Specification Search for Cross-Sectional Data With Latent Variables (S3C-Latent). In this research we found strong causal and associative relationships between factors.The causal relationship of elderly independence in ADLs was influenced by cognitive, psychological, nutritional and health factors and gender with α values respectively (0.61; 0.61;1.00, 0.65;0.70). Cognitive factors associated with psychological, economic, nutrition, and health with a value of α (0.77; 1.00; 1.00; 0.64). Furthermore, psychological factors associated with economy, nutrition, and health with a value of α (0.77; 0.95; 0.63). Bisides, economic factors are associated with nutrition and health with α values of ( 0.86; 0.75) and nutrition with health with α values of 0.64. The last association was found between nutritional factors and gender with a value of α 0.76. This research is expected to increase the independence of the elderly in carrying out daily activities.

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