Family Consultation to Reduce Early Hospital Readmissions among Patients with End Stage Kidney Disease

Background and objectivesThe US Centers for Medicare and Medicaid Services have mandated reducing early (30-day) hospital readmissions to improve patient care and reduce costs. Patients with ESKD have elevated early readmission rates, due in part to complex medical regimens but also cognitive impairment, literacy difficulties, low social support, and mood problems. We developed a brief family consultation intervention to address these risk factors and tested whether it would reduce early readmissions.Design, setting, participants, & measurementsOne hundred twenty hospitalized adults with ESKD (mean age=58 years; 50% men; 86% black, 14% white) were recruited from an urban, inpatient nephrology unit. Patients were randomized to the family consultation (n=60) or treatment-as-usual control (n=60) condition. Family consultations, conducted before discharge at bedside or via telephone, educated the family about the patient’s cognitive and behavioral risk factors for readmission, particularly cognitive impairment, and how to compensate for them. Blinded medical record reviews were conducted 30 days later to determine readmission status (primary outcome) and any hospital return visit (readmission, emergency department, or observation; secondary outcome). Logistic regressions tested the effects of the consultation versus control on these outcomes.ResultsPrimary analyses were intent-to-treat. The risk of a 30-day readmission after family consultation (n=12, 20%) was 0.54 compared with treatment-as-usual controls (n=19, 32%), although this effect was not statistically significant (odds ratio, 0.54; 95% confidence interval, 0.23 to 1.24; P=0.15). A similar magnitude, nonsignificant result was observed for any 30-day hospital return visit: family consultation (n=19, 32%) versus controls (n=28, 47%; odds ratio, 0.53; 95% confidence interval, 0.25 to 1.1; P=0.09). Per protocol analyses (excluding three patients who did not receive the assigned consultation) revealed similar results.ConclusionsA brief consultation with family members about the patient’s cognitive and psychosocial risk factors had no significant effect on 30-day hospital readmission in patients with ESKD.

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The impact of early-life intelligence quotient on post stroke cognitive impairment

European Stroke Journal ◽

10.1177/2396987317750517 ◽

2018 ◽

Vol 3 (2) ◽

pp. 145-156 ◽

Cited By ~ 13

Author(s):

Stephen DJ Makin ◽

Fergus N Doubal ◽

Kirsten Shuler ◽

Francesca M Chappell ◽

Julie Staals ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Confidence Interval ◽

Odds Ratio ◽

Small Vessel Disease ◽

Reading Test ◽

Adult Reading ◽

One Year ◽

National Adult Reading Test ◽

Addenbrooke’S Cognitive Examination

Background Cognitive impairment can complicate minor stroke, but there is limited information on risk factors including peak cognitive ability earlier in life. Methods We recruited patients with clinically-evident lacunar or minor non-lacunar ischaemic stroke, recorded clinical features, vascular risk factors, magnetic resonance imaging-detected stroke sub-type and small vessel disease burden. At 1–3 and 12 months after stroke, we assessed educational attainment (years of education), current cognition (Addenbrooke’s Cognitive Examination–Revised), pre-morbid intelligence (National Adult Reading Test) and dependency (modified Rankin Scale). Results We recruited 157 patients (87 lacunar, 64 non-lacunar ischaemic strokes), median age 66 (inter-quartile range 56–74) years, 36/157 (23%) patients had a Addenbrooke’s Cognitive Examination–Revised score < 82 at one to three months, 29/151 (19%) had a Addenbrooke’s Cognitive Examination–Revised < 82 at one year. Lower National Adult Reading Test score (cognitive impairment per point on National Adult Reading Test odds ratio 0.91, 95% confidence interval 0.87, 0.95) and older age (per year of age odds ratio 1.04 (95% confidence interval 1.01, 1.08) predicted one-year cognitive impairment more than stroke severity (per point on National Institute of Health Stroke Scale odds ratio 0.96 (95% confidence interval 0.0.68, 1.31)) or vascular risk factors e.g. hypertension (odds ratio for diagnosis of hypertension 0.52 (95% confidence interval 0.24, 1.15). Cognitive impairment was associated with having more white matter hyper-intensities (odds ratio per point increase in Fazekas score 1.42, 95% confidence interval 1.11, 1.83). Discussion This observational study provides evidence that pre-morbid intelligence quotient and education predict cognition after stroke, and confirms the association between cognitive impairment and small vessel disease. Conclusion Pre-morbid intelligence should be considered in future studies of post-stroke cognition.

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Parental risk factors for congenital diaphragmatic hernia – a large German case-control study

BMC Pediatrics ◽

10.1186/s12887-021-02748-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Felicitas Schulz ◽

Ekkehart Jenetzky ◽

Nadine Zwink ◽

Charlotte Bendixen ◽

Florian Kipfmueller ◽

...

Keyword(s):

Risk Factors ◽

Confidence Interval ◽

Environmental Risk ◽

Odds Ratio ◽

Alcohol Intake ◽

Case Control Study ◽

Case Control ◽

Parental Risk Factors ◽

Healthy Control ◽

Control Study

Abstract Background Evidence for periconceptional or prenatal environmental risk factors for the development of congenital diaphragmatic hernia (CDH) is still scarce. Here, in a case-control study we investigated potential environmental risk factors in 199 CDH patients compared to 597 healthy control newborns. Methods The following data was collected: time of conception and birth, maternal BMI, parental risk factors such as smoking, alcohol or drug intake, use of hairspray, contact to animals and parental chronic diseases. CDH patients were born between 2001 and 2019, all healthy control newborns were born in 2011. Patients and control newborns were matched in the ratio of three to one. Results Presence of CDH was significantly associated with maternal periconceptional alcohol intake (odds ratio = 1.639, 95% confidence interval 1.101–2.440, p = 0.015) and maternal periconceptional use of hairspray (odds ratio = 2.072, 95% confidence interval 1.330–3.229, p = 0.001). Conclusion Our study suggests an association between CDH and periconceptional maternal alcohol intake and periconceptional maternal use of hairspray. Besides the identification of novel and confirmation of previously described parental risk factors, our study underlines the multifactorial background of isolated CDH.

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Age and multimorbidities as poor prognostic factors for COVID-19 in hemodialysis: a Lebanese national study

BMC Nephrology ◽

10.1186/s12882-021-02270-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Mabel Aoun ◽

Rabab Khalil ◽

Walid Mahfoud ◽

Haytham Fatfat ◽

Line Bou Khalil ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Coronary Artery Disease ◽

Confidence Interval ◽

Odds Ratio ◽

Death Rate ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

National Study ◽

Artery Disease

Abstract Background Hemodialysis patients with COVID-19 have been reported to be at higher risk for death than the general population. Several prognostic factors have been identified in the studies from Asian, European or American countries. This is the first national Lebanese study assessing the factors associated with SARS-CoV-2 mortality in hemodialysis patients. Methods This is an observational study that included all chronic hemodialysis patients in Lebanon who were tested positive for SARS-CoV-2 from 31st March to 1st November 2020. Data on demographics, comorbidities, admission to hospital and outcome were collected retrospectively from the patients’ medical records. A binary logistic regression analysis was performed to assess risk factors for mortality. Results A total of 231 patients were included. Mean age was 61.46 ± 13.99 years with a sex ratio of 128 males to 103 females. Around half of the patients were diabetics, 79.2% presented with fever. A total of 115 patients were admitted to the hospital, 59% of them within the first day of diagnosis. Hypoxia was the major reason for hospitalization. Death rate was 23.8% after a median duration of 6 (IQR, 2 to 10) days. Adjusted regression analysis showed a higher risk for death among older patients (odds ratio = 1.038; 95% confidence interval: 1.013, 1.065), patients with heart failure (odds ratio = 4.42; 95% confidence interval: 2.06, 9.49), coronary artery disease (odds ratio = 3.27; 95% confidence interval: 1.69, 6.30), multimorbidities (odds ratio = 1.593; 95% confidence interval: 1.247, 2.036), fever (odds ratio = 6.66; 95% confidence interval: 1.94, 27.81), CRP above 100 mg/L (odds ratio = 4.76; 95% confidence interval: 1.48, 15.30), and pneumonia (odds ratio = 19.18; 95% confidence interval: 6.47, 56.83). Conclusions This national study identified older age, coronary artery disease, heart failure, multimorbidities, fever and pneumonia as risk factors for death in patients with COVID-19 on chronic hemodialysis. The death rate was comparable to other countries and estimated at 23.8%.

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Subclinical atherosclerosis in children and adolescents with congenital heart disease

Cardiology in the Young ◽

10.1017/s1047951120004448 ◽

2020 ◽

pp. 1-8

Author(s):

Silvia M. Cardoso ◽

Michele Honicky ◽

Yara M. F. Moreno ◽

Luiz R. A. de Lima ◽

Matheus A. Pacheco ◽

...

Keyword(s):

Risk Factors ◽

Congenital Heart Disease ◽

Confidence Interval ◽

Odds Ratio ◽

Clinical Characteristics ◽

Congenital Heart ◽

Subclinical Atherosclerosis ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Media Thickness

Abstract Background: Subclinical atherosclerosis in childhood can be evaluated by carotid intima-media thickness, which is considered a surrogate marker for atherosclerotic disease in adulthood. The aims of this study were to evaluate carotid intima-media thickness and, to investigate associated factors. Methods: Cross-sectional study with children and adolescents with congenital heart disease (CHD). Socio-demographic and clinical characteristics were assessed. Subclinical atherosclerosis was evaluated by carotid intima-media thickness. Cardiovascular risk factors, such as physical activity, screen time, passive smoke, systolic and diastolic blood pressure, waist circumference, dietary intake, lipid parameters, glycaemia, and C-reactive protein, were also assessed. Factors associated with carotid intima-media thickness were analysed using multiple logistic regression. Results: The mean carotid intima-media thickness was 0.518 mm and 46.7% had subclinical atherosclerosis (carotid intima-media thickness ≥ 97th percentile). After adjusting for confounding factors, cyanotic CHD (odds ratio: 0.40; 95% confidence interval: 0.20; 0.78), cardiac surgery (odds ratio: 3.17; 95% confidence interval: 1.35; 7.48), and be hospitalised to treat infections (odds ratio: 1.92; 95% confidence interval: 1.04; 3.54) were associated with subclinical atherosclerosis. Conclusion: Clinical characteristics related to CHD were associated with subclinical atherosclerosis. This finding suggests that the presence of CHD itself is a risk factor for subclinical atherosclerosis. Therefore, the screen and control of modifiable cardiovascular risk factors should be made early and intensively to prevent atherosclerosis.

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Validity of the LACE index for identifying frequent early readmissions after hospital discharge in children

European Journal of Pediatrics ◽

10.1007/s00431-021-03929-z ◽

2021 ◽

Author(s):

Thang S Han ◽

David Fluck ◽

Christopher H Fry

Keyword(s):

At Risk ◽

Confidence Interval ◽

Hospital Discharge ◽

Odds Ratio ◽

Hospital Readmissions ◽

Index Score ◽

Children At Risk ◽

Increased Risk ◽

Scoring Tool ◽

Event Rates

AbstractThe LACE index scoring tool has been designed to predict hospital readmissions in adults. We aimed to evaluate the ability of the LACE index to identify children at risk of frequent readmissions. We analysed data from alive-discharge episodes (1 April 2017 to 31 March 2019) for 6546 males and 5875 females from birth to 18 years. The LACE index predicted frequent all-cause readmissions within 28 days of hospital discharge with high accuracy: the area under the curve = 86.9% (95% confidence interval = 84.3–89.5%, p < 0.001). Two-graph receiver operating characteristic curve analysis revealed the LACE index cutoff to be 4.3, where sensitivity equals specificity, to predict frequent readmissions. Compared with those with a LACE index score = 0–4 (event rates, 0.3%), those with a score > 4 (event rates, 3.7%) were at increased risk of frequent readmissions: age- and sex-adjusted odds ratio = 12.4 (95% confidence interval = 8.0–19.2, p < 0.001) and death within 30 days of discharge: OR = 5.0 (95% CI = 1.5–16.7). The ORs for frequent readmissions were between 6 and 14 for children of different age categories (neonate, infant, young child and adolescent), except for patients in the child category (6–12 years) where odds ratio was 2.8.Conclusion: The LACE index can be used in healthcare services to identify children at risk of frequent readmissions. Focus should be directed at individuals with a LACE index score above 4 to help reduce risk of readmissions. What is Known:• The LACE index scoring tool has been widely used to predict hospital readmissions in adults. What is New:• Compared with children with a LACE index score of 0–4 (event rates, 0.3%), those with a score > 4 are at increased risk of frequent readmissions by 14-fold.• The cutoff of a LACE index of 4 may be a useful level to identify children at increased risk of frequent readmissions.

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Abstract TP437: Asymptomatic Carotid Stenosis is Associated With Cognitive Impairment in a Chinese Community Population

Stroke ◽

10.1161/str.48.suppl_1.tp437 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Jiaokun Jia ◽

Xingquan Zhao

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Alcohol Consumption ◽

Confidence Interval ◽

Cognitive Functioning ◽

Color Doppler ◽

Chinese Community ◽

Current Smoking ◽

Community Population ◽

Language Abstraction

Purpose: This study aimed to investigate the effects of aCAS on cognitive functioning in a Chinese community population who were over 40 year-old and to find the domains of cognitive impairment which were mainly affected. Methods: Information was collected on the presence of CAS, which was assessed by Color Doppler Ultrasound, from the Asymptomatic Polyvascular Abnormalities Community study, and cognitive functioning was assessed by the score of the Montreal Cognitive Assessment (MoCA). Multivariate logistic regression was used to assess the relationships between aCAS and cognitive impairment. Results: A total of 812 (61.2% men, 55% of 40-60y) patients were included in this study. After adjusting for potential confounding factors, the associations between the aCAS and cognitive impairment remained significant [odds ratio(OR)(95% confidence interval, 95%CI)=1.812(1.049-3.127)]. Also, there were significant relationships between the aCAS and the domains of cognitive function like attention, language, abstraction and recall [OR(95%CI) 2.740(1.494-5.023), 2.005(1.184-3.396), 2.841(1.594-5.065), 4.674(2.478-8.818) respectively, P < 0.05). In addition, there were no interaction effects of age and other possible risk factors on the association. Conclusion: In the over 40 year-old Chinese community population, aCAS was an independent indicator of cognitive impairment, especially affecting the function of attention, language, abstraction and recall. Table 1 Baseline demographic characteristics and cardiovascular risk factors between groups with/without cognitive impairment Values are median (interquartile range) or number (percent). Table 2 Unadjusted and Multivariate-adjusted OR (95% CI) for total and subtests of MoCA, according to groups with vs. without CAS. *P<0.05;**P<0.001 OR: odd ratio; CI: confidence interval Model 1: adjusted for age and gender. Model 2: adjusted for age, gender, BMI, education, current smoking and alcohol consumption. Model 3:adjusted for age, gender, BMI, education, current smoking, alcohol consumption hypertension, diabetes, hyperlipidemia, hs-CRP and Hcy.

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Risk factors for blood-contaminated cerebrospinal fluid collection in dogs

Veterinary Record ◽

10.1136/vr.105192 ◽

2019 ◽

Vol 186 (16) ◽

pp. e8-e8

Author(s):

Aran Nagendran ◽

Daniel Sanchez-Masian ◽

Erika Bersan ◽

Camilla Jayne Cooper ◽

Rita Gonçalves

Keyword(s):

Risk Factors ◽

Cerebrospinal Fluid ◽

Confidence Interval ◽

Odds Ratio ◽

Body Condition Score ◽

Fluid Collection ◽

Final Diagnosis ◽

Time Of Day ◽

Blood Contamination ◽

Potential Risk Factors

ObjectiveTo determine the risk factors for blood contamination during cerebrospinal fluid (CSF) collection in dogs.Study design and methodsThis is a prospective study of 170 CSF samples. Data collected included signalment of the patient, body condition score, site of CSF collection (cerebellomedullary cistern (CMC) or lumbar cistern (LC)), number of attempts, clinician expertise, final diagnosis, time of day, skull conformation and day of the week. Analysis of the CSF samples was then performed, and the presence of blood contamination (red blood cells >500/µl) was recorded. Logistic regression was used to quantify the association of potential risk factors of the procedure. Multivariate analysis was performed on the variables that were statistically significant.ResultsOf the 170 CSF samples, 53 per cent were collected from the CMC (n=90) and 47 per cent from the LC (n=80). Blood contamination was seen in 20 per cent (n=34) of the samples, 8.9 per cent (n=8) in CMC and 32.5 per cent (n=26) in LC samples. Increased odds of obtaining a contaminated CSF sample were associated with lower level of clinician expertise (odds ratio: 2.5; 95 per cent confidence interval: 0.9–6.7; P=0.046) and with LC versus CMC collection site (odds ratio: 8.1; 95 per cent confidence interval: 2.1–12.9; P=0.001).Clinical significanceThere is increased likelihood of blood contamination when collecting CSF from the LC compared with the CMC site. Increased clinician experience reduced the risk of CSF blood contamination, but none of the other variables examined significantly influenced this.

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Prevalence and risk factors of Neospora caninum infection in ovine flocks of central-western Mexico

Acta Veterinaria Hungarica ◽

10.1556/004.2019.006 ◽

2019 ◽

Vol 67 (1) ◽

pp. 51-59 ◽

Cited By ~ 1

Author(s):

Jesús Manuel Romo-Gallegos ◽

Carlos Cruz-Vázquez ◽

Leticia Medina-Esparza ◽

Miguel Ramos-Parra ◽

Dora Romero-Salas

Keyword(s):

Risk Factors ◽

Confidence Interval ◽

Odds Ratio ◽

Animal Species ◽

Neospora Caninum ◽

Domestic Animal ◽

Caninum Infection ◽

Blood Samples ◽

Western Mexico ◽

The Mean

This study, carried out in 13 sheep flocks of central-western Mexico, aimed to identify the prevalence of anti-N. caninum antibodies, to develop a risk analysis of the infection and to estimate the prevalence of parasite DNA in blood. A total of 368 serum and blood samples were subjected to ELISA and PCR tests, respectively, and the association between the prevalence of antibodies and some management factors was estimated. The overall prevalence of anti-N. caninum antibodies was 13.5% [50/368; 95% confidence interval (CI) 10–17], ranging from 2.7 to 90% per flock, and 92% of the farms had seropositive animals. In ewes the prevalence was 14% (48/348, 95% CI 10–17) and in rams 10% (2/20; 95% CI 1– 33). The mean prevalence of Neospora DNA in blood was 27% (99/368, 95% CI 22–31), implying a range between 16 and 82%. In rams, the prevalence was 5% (1/20 95% CI 2–26), while in ewes it was 28% (98/348, 95% CI 23–33). The agreement between the tests was k = 0.19. The presence of other domestic animal species in the farms [odds ratio (OR) 4.4] and the consumption of placental debris, fetuses and stillborn lambs by dogs living in the farms (OR 5.8) were demonstrated to be risk factors.

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Perioperative complications in a paediatric cardiac surgery program with limited systemic resources

Cardiology in the Young ◽

10.1017/s1047951120002486 ◽

2020 ◽

Vol 30 (11) ◽

pp. 1659-1665

Author(s):

Igor V. Polivenok ◽

William M. Novick ◽

Aleksander V. Pyetkov ◽

Marcelo Cardarelli

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Confidence Interval ◽

Odds Ratio ◽

Operative Mortality ◽

Perioperative Complications ◽

Failure To Rescue ◽

Middle Income ◽

Paediatric Cardiac Surgery ◽

Complications Rate

AbstractBackground:The perioperative complications rate in paediatric cardiac surgery, as well as the failure-to-rescue impact, is less known in low- and middle-income countries.Aim:To evaluate perioperative complications rate, mortality related to complications, different patients’ demographics, and procedural risk factors for perioperative complication and post-operative death.Methods:Risk factors for perioperative complications and operative mortality were assessed in a retrospective single-centre study which included 296 consecutive children undergoing cardiac surgery.Results:Overall mortality was 5.7%. Seventy-three patients (24.7%) developed 145 perioperative complications and had 17 operative mortalities (23.3%). There was a strong association between the number of perioperative complications and mortality – 8.1% among patients with only 1 perioperative complication, 35.3% – with 2 perioperative complications, and 42.1% – with 3 or more perioperative complications (p = 0.007). Risk factors of perioperative complications were younger age (odds ratio 0.76; (95% confidence interval 0.61, 0.93), previous cardiac surgery (odds ratio 3.5; confidence interval 1.33, 9.20), extracardiac structural anomalies (odds ratio 3.03; confidence interval 1.27, 7.26), concomitant diseases (odds ratio 3.23; confidence interval 1.34, 7.72), and cardiopulmonary bypass (odds ratio 6.33; confidence interval 2.45, 16.4), whereas the total number of perioperative complications per patient was the only predictor of operative death (odds ratio 1.89; confidence interval 1.06, 3.37).Conclusions:In a program with limited systemic resources, failure-to-rescue is a major contributor to operative mortality in paediatric cardiac surgery. Despite the comparable crude mortality, the operative mortality among patients with perioperative complications in our series was significantly higher than in the developed world. A number of initiatives are needed in order to improve failure-to-rescue rates in low- and middle-income countries.

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Risk Factors for Pressure Ulcers at the Ala of Nose in Oral Surgery

Anesthesia Progress ◽

10.2344/anpr-64-02-11 ◽

2017 ◽

Vol 64 (2) ◽

pp. 104-105 ◽

Cited By ~ 4

Author(s):

Masanori Tsukamoto ◽

Miwa Kobayashi ◽

Takeshi Yokoyama

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Confidence Interval ◽

Odds Ratio ◽

Pressure Ulcers ◽

Oral Surgery ◽

Male Gender ◽

Quality Review ◽

Nasal Tube

A quality review revealed pressure ulcers at the ala of nose in 16 cases (2.2%) over 3 years. We therefore retrospectively investigated the risk factors for alar pressure ulcers from nasal tubes. Male gender was the highest risk factor (odds ratio = 9.1411; 95% confidence interval = 1.680–170.58), and the second highest risk factor was duration of anesthesia (odds ratio = 1.0048/min of anesthesia; 95% confidence interval = 1.0034–1.0065). Male gender and duration of anesthesia appear to be risk factors for nasal tube pressure ulcers at the ala of nose in patients.

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