scholarly journals Identification of high-risk patients for early death or unplanned readmission using the LACE index in an older Portuguese population

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 1798 ◽  
Author(s):  
João Fonseca ◽  
Flávio Costa ◽  
José Mateus ◽  
Diana Ferreira ◽  
Hugo Clemente ◽  
...  
Keyword(s):  
High Risk ◽  
Hospital Readmissions ◽  
Tertiary Care ◽  
Early Death ◽  
Unplanned Readmission ◽  
High Risk Population ◽  
Care Hospital ◽  
Portuguese Population ◽  
C Statistic ◽  
Risk Patients

Background: Unplanned readmissions are frequent, associated with high costs and potentially preventable. Pre-discharge risk screening is a crucial step to prevent hospital readmissions. This study evaluates the LACE index as a tool capable of identifying patients with high risk of early readmission or death in an older Portuguese population. Methods: We performed a retrospective study in a tertiary care hospital in Portugal. All acute patients, aged ≥ 65 years, discharged from the Internal Medicine Service between 1 January and 30 June 2014 were included. Data was collected from hospital records. The LACE index was calculated for each patient. A comparative analysis was performed based on a cutoff of 10 (≥10 indicates a high-risk population) for the LACE score. Results: 1407 patients were evaluated, with a mean age of 81.7±7.6 years; 41.2% were male, 52.2% were dependent for ≥1 activities of daily living, the average Charlson comorbidity index was 3.54±2.8. There were 236 (16.8%) readmissions, 132 (9.4%) deaths and 307 (21.8%) patients were dead and/or readmitted within 30 days of discharge. At 90 days, 523 (37.2%) patients were dead and/or readmitted. The LACE score was higher in patients who died or were readmitted within 30 days compared with those who were not (13.2±2.7 versus 11.5±3.0, p <0.0001). Patients with LACE score ≥10 had significantly higher mortality and readmission rates compared to those with LACE score <10: at 30 days, 25.5% versus 9.3% (OR 3.34, 95% CI 2.24-4.98, p <0.0001); at 90 days, 43.4% versus 16.2% (OR 3.98, 95% CI 2.89-5.49, p <0.0001). However, the discriminative capacity of LACE index assessed by C-statistic was relatively poor: 0.663 (95% CI 0.630-0.696) and 0.676 (95% CI 0.648-0.704), respectively. Conclusions: This study shows that the LACE index should be used with reservations for predicting 30 and 90-day readmission or death in complex elderly patients.

scholarly journals Risk of COVID-19 Infection in Healthcare Workers Exposed During Use of Non-invasive Ventilation in a Tertiary Care Hospital in OmanRisk of COVID-19 Infection in Healthcare Workers Exposed During Use of Non-invasive Ventilation in a Tertiary Care Hospital in Oman

2021 ◽  
Vol 36 (2) ◽  
pp. e236-e236
Author(s):  
Adil Al Lawati ◽  
Faryal Khamis ◽  
Samiha Al Habsi ◽  
Khazina Al Dalhami
Keyword(s):  
High Risk ◽  
Healthcare Workers ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Significant Risk ◽  
High Risk Population ◽  
Care Hospital ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Objectives: Healthcare workers (HCWs), especially those working on the front line, are considered to be at high risk of nosocomial acquisition of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). Little is known about the effectiveness of the recommended protective methods as few reports have described spread of the disease in hospital settings among this high-risk population. We describe the hospital-based transmission of SARS-CoV-2 related to non-invasive ventilation (NIV) in one of the main tertiary care hospitals in Oman. Methods: All exposed patients and HCWs from Royal Hospital were screened, quarantined, and underwent telephone interviews to stratify their risk factors, clinical symptoms, and exposure risk assessment. Results: A total of 46 HCWs and patients tested positive for SARS-CoV-2 after exposure to an index case who received 48 hours of NIV before diagnosing COVID-19 infection. Over half of the exposed (56.5%; n = 26) were nurses, 26.1% (n = 12) were patients, and 15.2% (n = 7) were doctors. None of the HCWs required hospitalization. Sore throat, fever, and myalgia were the most common symptoms. Conclusions: NIV poses a significant risk for SARS-CoV-2 transmission within hospital settings if appropriate infection control measures are not taken.

scholarly journals Practice of “Defensive Medicine” Among Doctors at a Tertiary Care Hospital

2019 ◽  
Vol 17 (2) ◽  
pp. 28-31
Author(s):  
Binus Bhandari ◽  
Dipendra Khadka ◽  
Prem Saxena ◽  
S.M. Mishra
Keyword(s):  
High Risk ◽  
Tertiary Care ◽  
College Teaching ◽  
Defensive Medicine ◽  
Medical Decision ◽  
Care Hospital ◽  
Care Providers ◽  
High Risk Patients ◽  
Medical College ◽  
Risk Patients

Introduction: Defensive medicine is the short term coined for a defensive medical decision making.It means advising diagnostic tests, prescribing more drugs than required or avoids treating and operating high risk patients. These may not be the best options for the patient but the practice among doctors is currently adopted to avoid litigation. A situation aggravated by the promulgation of tough consumer laws and other criminal laws applicable to health care providers. This study was conducted to assess the frequency of defensive medicine practice among doctors at the teaching medical college hospital of NGMC. Methods: A cross sectional study was conducted at Nepalgunj Medical College, Teaching Hospital, Kohalpur, a tertiary care center in between January to December 2018. A questionnaire was developed to assess the various aspects of defensive medicine practice. In this study, a total of 75 doctors participated. Results: Practice of defensive medicine was common in age between 30-40 years. Fear of caring high risk patients (76%)), ordering un-necessary tests (56%)) followed by avoiding high risk procedures (46%) were common forms of defensive medicine practices observed in sampled doctors. Senior faculties were found practicing more defensive medicine than juniors (69.4% versus 30.6%) and more in surgical field as compared to non-surgical 61% vs. 39%. Conclusion: Defensive medical practice in various ways is common among the doctors. This has produced a positive impact in the form of greater communications with the patients and awareness to have a good medical record keeping. However, the negative impacts on the doctors have been more in the form of prescribing more investigations, drugs, more referral and reluctance to accept high risk patients if there is choice.  

Abstract TP192: Ability of the Khorana Score to Predict Recurrent Thromboembolism in Cancer Patients With Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Dylan Bobrow ◽  
Mary Cushman ◽  
Hooman Kamel ◽  
Alexander E Merkler ◽  
Mitchell S Elkind ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Risk ◽  
Cancer Patients ◽  
Recurrent Events ◽  
Tertiary Care ◽  
Cancer Center ◽  
Future Research ◽  
High Risk Population ◽  
Discriminatory Ability ◽  
C Statistic

Introduction: Cancer patients who develop acute ischemic stroke (AIS) are at high risk for recurrent thromboembolism. No risk stratification model exists to predict recurrent events in this population. The Khorana score is a validated risk score for predicting venous thromboembolism in newly diagnosed cancer patients. Hypothesis: The Khorana score can effectively classify the risk of recurrent thromboembolism (RTE) in cancer patients with AIS. Methods: We retrospectively identified all adults with active systemic cancer diagnosed with AIS by MRI at a tertiary-care cancer center from 2005 through 2009. Two neurologists independently reviewed all available medical records through July 31, 2012. The Khorana score at the time of index stroke was calculated for each patient. Points were assigned for specific cancer sites (2 points for very high-risk sites: stomach or pancreas; 1 point for high-risk sites: lung, lymphoma, gynecologic, bladder, testicular, or renal), platelet count ≥350,000/mcL, hemoglobin <10 g/dl, leukocyte count ≥11,000/mcL, and BMI ≥35 kg/m2. The primary outcome was a composite of RTE, defined as recurrent AIS, TIA, MI, systemic embolism, DVT, or PE. Logistic regression was used to evaluate the association between individual components of the Khorana score and RTE. The c-statistic was used to calculate the discriminatory ability of the Khorana score in predicting RTE. Results: Among 263 study patients, 90 (34%) were diagnosed with RTE, including 36 (14%) with recurrent AIS. The median Khorana score was 2 (IQR 1-2, range 0-5). None of the individual components of the score were independently associated with RTE, although there was a nonsignificant trend for high-risk cancer sites (OR 1.56, 95% CI 0.88-2.77). The rate of RTE was 28% among patients with a score of 0, 36% among patients with a score of 1-2, and 32% among patients with a score of 3-6. The c-statistic was 0.52 (95% CI 0.45-0.58) for predicting RTE and 0.49 (95% CI 0.38-0.59) for predicting recurrent AIS. Discussion: The Khorana score has poor discriminatory ability for predicting RTE in cancer patients with AIS, probably because these patients represent an especially high-risk group. Future research is needed to identify better methods for predicting RTE in this high-risk population.

scholarly journals Image Guided Percutaneous Cholecystostomy–A Single Center Experience

2020 ◽  
Vol 4 (01) ◽  
pp. 20-26
Author(s):  
Sathya Narayanan ◽  
Shyamkumar N. Keshava ◽  
Vinu Moses ◽  
Munawwar Ahmed ◽  
Aswin Padmanabhan ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Tertiary Care ◽  
Hemodynamic Instability ◽  
Care Hospital ◽  
Percutaneous Cholecystostomy ◽  
Image Guided ◽  
Single Center Experience ◽  
Risk Patients ◽  
Emergency Cholecystectomy

Abstract Purpose To assess the technical feasibility of percutaneous cholecystostomy (PCC) for acute cholecystitis and formulate an algorithm for PCC. Materials and methods This is a retrospective study of 35 patients (28 male and 7 female; mean age 60 years) who underwent image-guided PCC from 2008 to 2018 at a tertiary care hospital in South India. Descriptive summary statistics and frequencies were used to assess the technical success and complications. Results The patients (35/35) presented with fever, abdominal pain, and a few of them had severe sepsis. All these patients were high risk for surgery considering the comorbidities (17/35) and hemodynamic instability (18/35). PCC was performed under ultrasoundguidance, through transhepatic approach, and using single puncture and modified single puncture techniques. The procedure was technically successful in all 35 patients (100%). Two patients (2/35) did not improve clinically after PCC; hence, they were taken up for emergency cholecystectomy with high-risk consent. One patient required a repeat procedure after 3 days due to tube dislodgement. There were no major procedure-related complications. Conclusion Image-guided PCC can be performed safely and is effective for treating high-risk patients with acute cholecystitis.

scholarly journals Confronting hidden COVID-19 burden: a telemedical solution for elective urological outpatient clinics

Infection ◽  
2020 ◽  
Vol 48 (6) ◽  
pp. 935-939
Author(s):  
Thilo Westhofen ◽  
Giuseppe Magistro ◽  
Simon Lennartz ◽  
Jozefina Casuscelli ◽  
Christian Stief ◽  
...  
Keyword(s):  
High Risk ◽  
Tertiary Care Hospital ◽  
Quality Care ◽  
Tertiary Care ◽  
Outpatient Clinics ◽  
Care Hospital ◽  
Outpatient Services ◽  
High Quality ◽  
Symptom Monitoring ◽  
Risk Patients

AbstractMaintaining high-quality care for urological patients is a challenge during and after the Coronavirus disease 2019 (COVID-19) pandemic. We observe an increasing volume of postponed elective visits at our tertiary care hospital, holding the risk for deterioration of non-emergency disease conditions. As it is unclear for how long the pandemic will last, we propose to implement telehealth as a solution to provide regular symptom monitoring compatible with social distancing guidelines during the pandemic and beyond. Telemedical assessment and prioritizing of high-risk patients for individual consults at outpatient services will have to be aligned with available outpatient capacity and local outbreak severity.

scholarly journals Correlation of predisposing factors and Esophageal Malignancy in high risk population of Baluchistan

2022 ◽  
Vol 38 (3) ◽  
Author(s):  
Syed Muhammad Ishaque ◽  
Muhammad Sadiq Achackzai ◽  
Zia Ud Din ◽  
Shahid Pervez
Keyword(s):  
High Risk ◽  
Low Socioeconomic Status ◽  
Vegetable Intake ◽  
Tertiary Care ◽  
Predisposing Factors ◽  
Dietary Factors ◽  
High Risk Population ◽  
Care Hospital ◽  
Risk Population ◽  
Esophageal Malignancy

Objectives: To determine frequency of esophageal malignancy in Balochistan and to evaluate its correlation with predisposing and dietary factors. Methods: This cross-sectional study was conducted from Jan 2019 to Dec 2020, at two tertiary care hospital of Quetta which caters to the entire population of province. The total number of 207 cases of esophageal biopsies were received and morphological diagnosis done by H&E staining. Results: Out of 207 (N) esophageal biopsies cases, malignancy were observed in 65%, chronic esophagitis in 19%, benign esophageal lesion in 1% and other esophageal lesions were observed in less than 4% of samples. Association with aggravating factors included tea 80.5%, use of drugs 64%, spicy food 57%, salted food 53%, quid & tobacco taken orally and through nose 44% and cigarette smoking 21.5%. The protective factors include fresh fruit 90%, fish 64% and milk 55% which were never or occasionally taken, meat chicken and beef intake was 63% & 53% and vegetable intake was 52%, but 72.5% of cases never used alcohol and mutton meat was not used by 50%. Conclusion: Esophageal cancer was associated in those groups of people which may regard as having high risk factors. These include increased intake of spicy/salted food, hot beverages, drugs, quid and smoked tobacco, coupled with low intake of fruits and vegetables, lack of awareness and low socioeconomic status. doi: https://doi.org/10.12669/pjms.38.3.4612 How to cite this:Ishaque SM, Achakzai MS, Ziauddin, Pervez S. Correlation of predisposing factors and Esophageal Malignancy in high risk population of Baluchistan. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4612 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals A Study on the Prevalence of Genital Trichomoniasis among Female Outpatients Attending Sexually Transmitted Infection Clinic in a Tertiary Care Hospital

2017 ◽  
Vol 9 (01) ◽  
pp. 016-019 ◽  
Author(s):  
Swapna Muthusamy ◽  
Selvi Elangovan
Keyword(s):  
High Risk ◽  
Sexually Transmitted Infection ◽  
Risk Group ◽  
Tertiary Care ◽  
Giemsa Stain ◽  
High Risk Population ◽  
Care Hospital ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Wet Mount

ABSTRACT Introduction: Women with high-risk sexual behavior accounts for more than half of the sexually transmitted infection (STI) clinic attendees. The prevalence of trichomoniasis is as low as 5% in the general population to as high as 60% in high-risk population. This infection can pave the way to the acquisition of human immunodeficiency virus and other STIs, vice versa and is even associated with cancer. Objectives: To identify, isolate and study the prevalence of Trichomonas vaginalis in genital specimens of female outpatients. Materials and Methods: Total number of subjects involved in the study was 130, among them 85 belonged to high-risk group and 45 belonged to low-risk group. Two high vaginal swabs were collected from each patient. Saline wet mount, Giemsa stain, and culture in modified cysteine peptone liver infusion maltose medium were performed. Results were tabulated and analyzed. Results: Saline wet mount was positive for trichomoniasis in seven individuals, Giemsa detected trichomoniasis in five patients, and culture was positive in eight patients. Of these eight culture positive cases, one was wet mount negative and four were Giemsa stain negative. Conclusion: Culture is more sensitive than wet mount and Giemsa stain.

scholarly journals Improving transitions from acute care to home among complex older adults using the LACE Index and care coordination

2020 ◽  
Vol 9 (2) ◽  
pp. e000814 ◽  
Author(s):  
Lesley Charles ◽  
Lisa Jensen ◽  
Jacqueline M I Torti ◽  
Jasneet Parmar ◽  
Bonnie Dobbs ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Care ◽  
Care Coordination ◽  
Phase 1 ◽  
Hospital Readmissions ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
High Risk Patients ◽  
Phone Calls ◽  
Risk Patients

BackgroundImproving transitions in care is a major focus of healthcare planning. The objective of this study was to determine the improvement in transitions from an intervention identifying complex older adult patients in acute care and supporting their discharge into the community.MethodsThis was a quality assurance study evaluating an intervention on high-risk patients admitted in an acute care hospital. In phase 1, the Length of Stay, Acuity of the Admission, Charlson Comorbidity Index Score, and Emergency Department Use (LACE Index) was selected to assess a patient’s risk for readmission and a standard discharge protocol was developed. In phase 2, the intervention was implemented: (1) all patients were screened for the risk of readmission using the LACE Index; and (2) the high-risk patients were provided care coordination including follow-up phone calls focused on medications, equipment and homecare services. Emergency department (ED) revisits and hospital readmissions were measured.ResultsThe LACE Index identified 433/1621 (27%) patients at high risk for readmission. Care coordination was achieved within 72 hours in 79% of patients. The 433 high-risk patients receiving the intervention, compared with a group without intervention (n=231), had lower lengths of stay (12.7 days vs 16.6 days); similar 7-day ED revisits (10.6% vs 10.8%) and 30-day ED revisits (30.5% vs 33.3%); lower 90-day readmissions (39.3% vs 44.6%); and lower 6-month readmissions (50.9% vs 58.4%). The 7-day and 30-day readmissions were similar in both groups.ConclusionsIdentifying complex patients at high risk for readmission and supporting them during transitions from acute care to home potentially decreases lengths of hospital stay and prevents short-term ED revisits and long-term readmissions.

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