scholarly journals Results of Behavioral Evaluations Predict Length of Stay for Shelter Dogs

Animals ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 3272
Author(s):  
Betty McGuire ◽  
Jordan Chan ◽  
Kennedy Jean-Baptiste ◽  
Philippa Kok ◽  
Emma Rosenbaum
Keyword(s):  
New York ◽  
Length Of Stay ◽  
Challenging Behaviors ◽  
Animal Shelters ◽  
Lengths Of Stay ◽  
Dangerous Behavior ◽  
Shelter Dogs ◽  
Dangerous Behaviors

Most animal shelters conduct behavioral evaluations before making dogs available for adoption. However, little information exists on whether behaviors displayed during these assessments predict a dog’s length of stay at the shelter. We reviewed nearly 5 years of records from 975 dogs released for adoption at a New York shelter to see whether behaviors shown during their evaluation predicted length of stay. For most tests and subtests, the prevalence of concerning and especially dangerous behaviors was low. Nevertheless, dogs’ scores on some tests or subtests—food guarding and meeting another dog—predicted length of stay at the shelter. Dogs evaluated as showing dangerous behavior had longer lengths of stay than dogs evaluated as showing either concerning behavior or no concerning behavior; the latter two groups did not differ from one another in length of stay. The most likely explanation for the relationships found between behavior during the evaluation and length of stay at the shelter is that dogs with challenging behaviors had smaller pools of potential adopters. Understanding the relationships between performance on behavioral evaluations and length of stay may inform shelter management of canine populations and also help identify dogs requiring special adoption efforts to avoid long shelter stays.

scholarly journals Characteristics and Adoption Success of Shelter Dogs Assessed as Resource Guarders

Animals ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. 982 ◽  
Author(s):  
McGuire
Keyword(s):  
Public Health ◽  
New York ◽  
Demographic Characteristics ◽  
Domestic Dogs ◽  
Comprehensive Description ◽  
Animal Shelters ◽  
Dog Bites ◽  
Shelter Dogs ◽  
Almost All ◽  
Shelter Dog

Some domestic dogs aggressively guard resources. Canine resource guarding impacts public health through dog bites and affects dog welfare through adoption and euthanasia policies at animal shelters. However, little is known about the demographic characteristics and adoption success of dogs assessed as resource guarders during shelter behavioral evaluations. I reviewed nearly five years of records from a New York (NY) SPCA and categorized 1016 dogs by sex; age; size; reproductive status; and resource guarding. I then examined how these characteristics influenced the returns of dogs by adopters. The prevalence of resource guarding in this shelter dog population was 15%. Resource guarding was more common in adult and senior dogs than in juvenile dogs; and it was more common in small and large dogs than medium-sized dogs. Spayed females were more likely than intact females to guard food; neutered males and intact males did not differ in their likelihood of food guarding. Most dogs identified as resource guarders showed mild to moderate guarding. Severe guarders were more likely to be returned by adopters; although almost all were eventually re-adopted and not returned to the shelter. Data presented here provide the most comprehensive description of resource guarders in a shelter dog population and show the successful re-homing of most.

The Effect of Patient and Hospital Characteristics on Total Costs of Peripheral Bypass in New York State

2021 ◽  
pp. 153857442199331
Author(s):  
Nicole Ilonzo ◽  
Cody Goldberger ◽  
Songhon Hwang ◽  
Ajit Rao ◽  
Peter Faries ◽  
...  
Keyword(s):  
New York ◽  
Length Of Stay ◽  
Bypass Surgery ◽  
New York State ◽  
Severity Of Illness ◽  
Factors Associated ◽  
Peripheral Bypass ◽  
Extreme Risk ◽  
Risk Of Mortality ◽  
Fourth Quartile

Introduction: With the aging U.S. population, peripheral vascular procedures will become increasingly common. The objective of this study is to characterize the factors associated with increased total costs after peripheral bypass surgery. Methods: Data for 34,819 patients undergoing peripheral bypass surgery in NY State were extracted using the Statewide Planning and Research Cooperative System (SPARCS) database for years 2009-2017. Patient demographics, All Patient Refined Diagnostic Related Groups (APR) severity score, mortality risk, hospital volume, and length of stay data were collected. Primary outcomes were total costs and length of stay. Data were analyzed using univariate and multivariate analysis. Results: 28.1% of peripheral bypass surgeries were performed in New York City. 7.9% of patients had extreme APR severity of illness whereas 32.0% had major APR severity of illness. 6.3% of patients had extreme risk of mortality and 1 in every 5 patients (20%) had major risk of mortality. 24.9% of patients were discharged to a facility. The mean length of stay (LOS) was 9.9 days. Patient LOS of 6-11 days was associated with +$2,791.76 total costs. Mean LOS of ≥ 12 days was associated with + $27,194.88 total costs. Multivariate analysis revealed risk factors associated with an admission listed in the fourth quartile of total costs (≥$36,694.44) for peripheral bypass surgery included NYC location (2.82, CI 2.62-3.04), emergency surgery (1.12, CI 1.03-1.22), extreme APR 2.08, 1.78-2.43, extreme risk of mortality (2.73, 2.34-3.19), emergency room visit (1.68, 1.57-1.81), discharge to a facility (1.27, CI 1.15-1.41), and LOS in the third or fourth quartile (11.09, 9.87-12.46). Conclusion: The cost of peripheral bypass surgery in New York State is influenced by a variety of factors including LOS, patient comorbidity and disease severity, an ER admission, and discharge to a facility.

Relationship of hospital volume on outcomes in patients with acute pulmonary embolism: Analysis of a 70,000 patient database

2020 ◽  
pp. 1358863X2097026
Author(s):  
Mark Finkelstein ◽  
Mario A Cedillo ◽  
David C Kestenbaum ◽  
Obaib S Shoaib ◽  
Aaron M Fischman ◽  
...  
Keyword(s):  
New York ◽  
Pulmonary Embolism ◽  
Length Of Stay ◽  
New York State ◽  
Multivariable Analysis ◽  
High Volume ◽  
Categorical Variables ◽  
Patient Database ◽  
Very High ◽  
Total Charges

Positive relationships between volume and outcome have been seen in several surgical and medical conditions, resulting in more centralized and specialized care structures. Currently, there is a scarcity of literature involving the volume–outcome relationship in pulmonary embolism (PE). Using a state-wide dataset that encapsulates all non-federal admissions in New York State, we performed a retrospective cohort study on admitted patients with a diagnosis of PE. A total of 70,443 cases were separated into volume groups stratified by hospital quartile. Continuous and categorical variables were compared between cohorts. Multivariable regression analysis was conducted to assess predictors of 1-year mortality, 30-day all-cause readmission, 30-day PE-related readmission, length of stay, and total charges. Of the 205 facilities that were included, 128 (62%) were labeled low volume, 39 (19%) medium volume, 23 (11%) high volume, and 15 (7%) very high volume. Multivariable analysis showed that very high volume was associated with decreased 30-day PE-related readmission (OR 0.64; 95% CI, 0.55 to 0.73), decreased 30-day all-cause readmission (OR 0.84; 95% CI, 0.79 to 0.89), decreased 1-year mortality (OR 0.85; 95% CI, 0.80 to 0.91), decreased total charges (OR 0.96; 95% CI, 0.94 to 0.98), and decreased length of stay (OR 0.94; 95% CI, 0.92 to 0.96). In summary, facilities with higher volumes of acute PE were found to have less 30-day PE-related readmissions, less all-cause readmissions, shorter length of stay, decreased 1-year mortality, and decreased total charges.

scholarly journals Healthcare Utilization Due to Suicide Attempts among Homeless Youth in New York State

2021 ◽  
Author(s):  
Rie Sakai-Bizmark ◽  
Hiraku Kumamaru ◽  
Dennys Estevez ◽  
Emily H Marr ◽  
Edith Haghnazarian ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
Length Of Stay ◽  
Suicide Attempt ◽  
Healthcare Utilization ◽  
Regression Models ◽  
Homeless Youth ◽  
Suicide Attempts ◽  
New York State ◽  
Individual Characteristics

Abstract Suicide remains the leading cause of death among homeless youth. We assessed differences in healthcare utilization between homeless and non-homeless youth presenting to the emergency department or hospital after a suicide attempt. New York Statewide Inpatient and Emergency Department Databases (2009–2014) were used to identify homeless and non-homeless youth ages 10 to 17 who utilized healthcare services following a suicide attempt. To evaluate associations with homelessness, we used logistic regression models for mortality, use of violent means, intensive care unit utilization, log-transformed linear regression models for hospitalization cost, and negative binomial regression models for length of stay. All models were adjusted by individual characteristics with a hospital random effect and year fixed effect. We identified 18,026 suicide attempts with healthcare utilization rates of 347.2 (95% Confidence Interval [CI]: 317.5, 377.0) and 67.3 (95%CI: 66.3, 68.3) per 100,000 person-years for homeless and non-homeless youth, respectively. Length of stay for homeless youth was statistically longer than non-homeless youth (Incidence Rate Ratio 1.53; 95%CI: 1.32, 1.77). All homeless youth who visited the emergency department after a suicide attempt were subsequently hospitalized. This could suggest a higher acuity upon presentation among homeless youth compared with non-homeless youth. Interventions tailored to homeless youth should be developed.

Analysis of the Effects of Applying Federal Diagnosis-Related Grouping (DRG) Guidelines to a Population of High-Risk Newborn Infants

PEDIATRICS ◽  
1985 ◽  
Vol 76 (1) ◽  
pp. 104-109
Author(s):  
Ronald L. Poland ◽  
Robert O. Bollinger ◽  
Mary P. Bedard ◽  
Sanford N. Cohen
Keyword(s):  
High Risk ◽  
Length Of Stay ◽  
Geometric Mean ◽  
Tertiary Care ◽  
Newborn Infants ◽  
Frequency Distributions ◽  
Federal Register ◽  
Children's Hospital ◽  
Lengths Of Stay ◽  
Children’S Hospital

Length of stay data collected for high-risk newborn infants admitted to a tertiary care children's hospital neonatal unit over a 6-year period were compared with mean and outlier lengths of stay published in the Federal Register as part of a proposed system for prospective payment of hospital cost by diagnosis-related groupings (DRGs). We found that the classification system for newborns markedly underestimated the number of days required for the treatment of these infants. The use of the geometric mean instead of the arithmetic mean as the measure of central tendency was a significant contributor to the discrepancy, especially in those sub-groups with bimodal frequency distributions of lengths of stay. Another contributor to the discrepancy was the lack of inborn patients in the children's hospital cohort. The system of prospective payments, as outlined, does not take into account several factors that have a strong influence on length of stay such as birth weight (which requires more than three divisions to serve as an effective predictor), surgery, outborn status, and ventilation. Implementation of the system described in the Federal Register would severely discourage tertiary care referral hospitals from providing neonatal intensive care.

A High-Fidelity Model to Predict Length of Stay in the Neonatal Intensive Care Unit

2021 ◽  
Author(s):  
Kanix Wang ◽  
Walid Hussain ◽  
John R. Birge ◽  
Michael D. Schreiber ◽  
Daniel Adelman
Keyword(s):  
Length Of Stay ◽  
Clinical Data ◽  
Neonatal Intensive Care ◽  
Large Scale ◽  
Expert Knowledge ◽  
Clinical Analysis ◽  
Healthcare Operations ◽  
Lengths Of Stay ◽  
Health Trajectories ◽  
Widespread Implementation

Having an interpretable, dynamic length-of-stay model can help hospital administrators and clinicians make better decisions and improve the quality of care. The widespread implementation of electronic medical record (EMR) systems has enabled hospitals to collect massive amounts of health data. However, how to integrate this deluge of data into healthcare operations remains unclear. We propose a framework grounded in established clinical knowledge to model patients’ lengths of stay. In particular, we impose expert knowledge when grouping raw clinical data into medically meaningful variables that summarize patients’ health trajectories. We use dynamic, predictive models to output patients’ remaining lengths of stay, future discharges, and census probability distributions based on their health trajectories up to the current stay. Evaluated with large-scale EMR data, the dynamic model significantly improves predictive power over the performance of any model in previous literature and remains medically interpretable. Summary of Contribution: The widespread implementation of electronic health systems has created opportunities and challenges to best utilize mounting clinical data for healthcare operations. In this study, we propose a new approach that integrates clinical analysis in generating variables and implementations of computational methods. This approach allows our model to remain interpretable to the medical professionals while being accurate. We believe our study has broader relevance to researchers and practitioners of healthcare operations.

scholarly journals Surveillance of antimicrobial-resistant Escherichia coli in Sheltered dogs in the Kanto Region of Japan

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Akihisa Hata ◽  
Noboru Fujitani ◽  
Fumiko Ono ◽  
Yasuhiro Yoshikawa
Keyword(s):  
Escherichia Coli ◽  
Multidrug Resistant ◽  
Quinolone Resistance ◽  
Resistant Bacteria ◽  
Animal Shelters ◽  
E Coli ◽  
Chiba Prefecture ◽  
Shelter Dogs ◽  
Kanagawa Prefecture ◽  
Kanto Region

AbstractThere is a lack of an established antimicrobial resistance (AMR) surveillance system in animal welfare centers. Therefore, the AMR prevalence in shelter dogs is rarely known. Herein, we conducted a survey in animal shelters in Chiba and Kanagawa prefectures, in the Kanto Region, Japan, to ascertain the AMR status of Escherichia coli  (E. coli) prevalent in shelter dogs. E. coli was detected in the fecal samples of all 61 and 77 shelter dogs tested in Chiba and Kanagawa, respectively. The AMR was tested against 20 antibiotics. E. coli isolates derived from 16.4% and 26.0% of samples from Chiba and Kanagawa exhibited resistance to at least one antibiotic, respectively. E. coli in samples from Chiba and Kanagawa prefectures were commonly resistant to ampicillin, piperacillin, streptomycin, kanamycin, tetracycline, and nalidixic acid; that from the Kanagawa Prefecture to cefazolin, cefotaxime, aztreonam, ciprofloxacin, and levofloxacin and that from Chiba Prefecture to chloramphenicol and imipenem. Multidrug-resistant bacteria were detected in 18 dogs from both regions; β-lactamase genes (blaTEM, blaDHA-1, blaCTX-M-9 group CTX-M-14), quinolone-resistance protein genes (qnrB and qnrS), and mutations in quinolone-resistance-determining regions (gyrA and parC) were detected. These results could partially represent the AMR data in shelter dogs in the Kanto Region of Japan.

scholarly journals Decreasing hospital burden of COVID-19 during the first wave in Regione Lombardia: an emergency measures context

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Grosso Francesca Maria ◽  
Presanis Anne Margaret ◽  
Kunzmann Kevin ◽  
Jackson Chris ◽  
Corbella Alice ◽  
...  
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Median Length ◽  
Calendar Time ◽  
Fatality Risk ◽  
Lengths Of Stay ◽  
Hospital Beds ◽  
Hospital Patients ◽  
Poor Outcomes ◽  
Emergency Measures

Abstract Background The aim of this study is to quantify the hospital burden of COVID-19 during the first wave and how it changed over calendar time; to interpret the results in light of the emergency measures introduced to manage the strain on secondary healthcare. Methods This is a cohort study of hospitalised confirmed cases of COVID-19 admitted from February–June 2020 and followed up till 17th July 2020, analysed using a mixture multi-state model. All hospital patients with confirmed COVID-19 disease in Regione Lombardia were involved, admitted from February–June 2020, with non-missing hospital of admission and non-missing admission date. Results The cohort consists of 40,550 patients hospitalised during the first wave. These patients had a median age of 69 (interquartile range 56–80) and were more likely to be men (60%) than women (40%). The hospital-fatality risk, averaged over all pathways through hospital, was 27.5% (95% CI 27.1–28.0%); and steadily decreased from 34.6% (32.5–36.6%) in February to 7.6% (6.3–10.6%) in June. Among surviving patients, median length of stay in hospital was 11.8 (11.6–12.3) days, compared to 8.1 (7.8–8.5) days in non-survivors. Averaged over final outcomes, median length of stay in hospital decreased from 21.4 (20.5–22.8) days in February to 5.2 (4.7–5.8) days in June. Conclusions The hospital burden, in terms of both risks of poor outcomes and lengths of stay in hospital, has been demonstrated to have decreased over the months of the first wave, perhaps reflecting improved treatment and management of COVID-19 cases, as well as reduced burden as the first wave waned. The quantified burden allows for planning of hospital beds needed for current and future waves of SARS-CoV-2 i.

scholarly journals Mortality is not increased with Diabetes in Hospitalised Very Old Adults: A multi-site review.

2020 ◽  
Author(s):  
Peter Smerdely
Keyword(s):  
Length Of Stay ◽  
Adverse Events ◽  
Negative Binomial ◽  
Negative Impact ◽  
Outcome Data ◽  
Teaching Hospitals ◽  
Very Old ◽  
Old Adults ◽  
Lengths Of Stay ◽  
Hospital Acquired

Abstract Background: Few data exist regarding hospital outcomes in people with diabetes aged beyond 75 years. This study aimed to explore the association of diabetes with hospital outcome in the very old patient.Methods: A retrospective review was conducted of all presentations of patients aged 65 years or more admitted to three Sydney teaching hospitals over six years (2012-2018), exploring primarily the outcomes of in-hospital mortality, and secondarily the outcomes of length of stay, the development of hospital-acquired adverse events and unplanned re-admission to hospital within 28 days of discharge. Demographic and outcome data, the presence of diabetes and comorbidities were determined from ICD10 coding within the hospital's electronic medical record. Logistic and negative binomial regression models were used to assess the association of diabetes with outcome. Results: A total of 139130 separations (mean age 80 years, range 65 to 107 years; 51% female) were included, with 49% having documented comorbidities and 26.1% a diagnosis of diabetes. When compared to people without diabetes, diabetes was not associated with increased odds of mortality (OR: 0.89 SE (0.02), p<0.001). Further, because of a significant interaction with age, diabetes was associated with decreased odds of mortality beyond 80 years of age. While people with diabetes overall had longer lengths of stay (10.2 days SD (13.4) v 9.4 days SD (12.3), p<0.001), increasing age was associated with shorter lengths of stay in people aged more than 90 years. Diabetes was associated with increased odds of hospital-acquired adverse events (OR: 1.09 SE (0.02), p<0.001) and but not 28-day re-admission (OR: 0.88 SE (0.18), p=0.523).Conclusion: Diabetes has not been shown to have a negative impact on mortality or length of stay in hospitalised very old adults from data derived from hospital administrative records. This may allow a more measured application of diabetic guidelines in the very old hospitalised patient.

The evidence for introducing case-finding for delirium and dementia in older medical inpatients in a New Zealand hospital

2022 ◽  
pp. 103985622110624
Author(s):  
Sarah Cullum ◽  
Yezen Kubba ◽  
Chris Varghese ◽  
Christin Coomarasamy ◽  
John Hopkins
Keyword(s):  
Cognitive Impairment ◽  
New Zealand ◽  
Length Of Stay ◽  
Assessment Tool ◽  
Hospital Costs ◽  
Case Finding ◽  
Risk Of Death ◽  
Lengths Of Stay ◽  
Medical Wards ◽  
Hospital Inpatients

Objective The aim of this project was to make the case to the managers of a large urban teaching hospital in New Zealand for the introduction of systematic case-finding for pre-existing cognitive impairment/dementia in older hospital inpatients that screen positive for delirium. Method Two hundred consecutive acute admissions aged 75+ in four medical wards were assessed using the 4AT assessment tool for delirium and the Alzheimer Questionnaire (AQ) for pre-existing cognitive impairment/dementia. Length of stay and mortality at 1 year were also collected. Results Over a third of the sample screened positive for delirium and nearly two-thirds of these also screened positive for dementia. The median length of stay was 5 days for delirium without dementia and 7 days for delirium with dementia, compared to 3 days for those who screened negative for both. After adjustment for age, gender and ethnic group, people who screened positive for delirium (with or without dementia) had 50% longer length of stay ( p < 0.05) and at least double the risk of death ( p < 0.05). Conclusion Older hospital inpatients that screen positive for delirium and dementia using 4AT and AQ have longer lengths of stay and higher mortality. Identification may lead to more timely interventions that help to improve health outcomes and reduce hospital costs.

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