Gastrointestinal Bleeding in Patients with Hereditary Hemorrhagic Telangiectasia: Risk Factors and Endoscopic Findings

Background: We aimed to describe risk factors for gastrointestinal (GI) bleeding and endoscopic findings in patients with hereditary hemorrhagic telangiectasia (HHT). Methods: This is a prospective study from a referral HHT unit. Endoscopic tests were performed when there was suspicion of GI bleeding, and patients were divided as follows: with, without, and with unsuspected GI involvement. Results: 67 (27.9%) patients with, 28 (11.7%) patients without, and 145 (60.4%) with unsuspected GI involvement were included. Age, tobacco use, endoglin (ENG) mutation, and hemoglobin were associated with GI involvement. Telangiectases were mostly in the stomach and duodenum, but 18.5% of patients with normal esophagogastroduodenoscopy (EGD) had GI involvement in video capsule endoscopy (VCE). Telangiectases ≤ 3 mm and ≤10 per location were most common. Among patients with GI disease, those with hemoglobin < 8 g/dL or transfusion requirements (65.7%) were older and had higher epistaxis severity score (ESS) and larger telangiectases (>3 mm). After a mean follow-up of 34.2 months, patients with GI involvement required more transfusions and more emergency department and hospital admissions, with no differences in mortality. Conclusions: Risk factors for GI involvement have been identified. Patients with GI involvement and severe anemia had larger telangiectases and higher ESS. VCE should be considered in patients with suspicion of GI bleeding, even if EGD is normal.

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A preliminary study of the relationship between general practice care and hospitalisation using a diabetes register, CARDIAB

Australian Health Review ◽

10.1071/ah12175 ◽

2013 ◽

Vol 37 (2) ◽

pp. 210 ◽

Cited By ~ 7

Author(s):

Elizabeth J. Comino ◽

Duong Thuy Tran ◽

Jane R. Taggart ◽

Siaw-Teng Liaw ◽

Warwick Ruscoe ◽

...

Keyword(s):

Risk Factors ◽

Primary Care ◽

Emergency Department ◽

General Practice ◽

Data Collection ◽

Hospital Admissions ◽

Processes Of Care ◽

Control Of Diabetes ◽

Diabetes Register

Background. Diabetes can be effectively managed in general practice (GP). This study used record linkage to explore associations between diabetes care in GP and hospitalisation. Methods. Data on patients with type 2 diabetes were extracted from a Division of GP diabetes register (CARDIAB) for 2002–05 and were linked to the New South Wales Admitted Patient and Emergency Department (ED) Data Collection to create a unit record data collection containing demographic, clinical and health service records. Rates of admission and ED presentation per patient-year of follow up were calculated for the year following CARDIAB record. Results. The study included 1178 diabetic patients with 2959 patient-years of follow up. Their mean age was 65.7 years and duration of diabetes was 5.9 years. All-cause admission and ED presentation rates were 0.7 and 0.2 per patient-year of follow up respectively and length of admission 3.2 days (s.d. 11.7 days). Admission was associated with age, duration of diabetes and prior admission. The number of processes of care recorded for each patient-year was associated with admission. Admission and length of stay were not associated with achievement of clinical targets. Conclusions. These data suggest that receipt of processes of care, rather than clinical targets, will prevent admission. One explanation may be that continuity of care in GP provides opportunity for early intervention and treatment. What is known about the topic? Diabetes is a serious public health problem that is largely managed in primary care. Health care planners use health service use (hospital admissions) for diabetes as an indicator of primary care. Guidelines for diabetes care are known to be effective in reducing diabetes-related complications. What does this paper add? This paper created a linked data collection comprising demographic and clinical data from general practice and administrative health records of hospital admissions and emergency department presentations. The paper explores the associations between processes of primary care and control of diabetes and cardiovascular risk factors, and use of health services for a general practice population with diabetes. What are the implications for practitioners? The study suggests that processes of care and not technical control of diabetes and cardiovascular risk factors are important in preventing hospital admission. Continuity of care in general practice that ensures implementation of processes of care provides opportunity for early intervention and treatment.

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Risk factors of hospital admissions and recurrent emergency department visits among pediatric asthma patients

International Journal of Medicine in Developing Countries ◽

10.24911/ijmdc.51-1586725862 ◽

2020 ◽

pp. 1011-1015

Author(s):

Abdullah Aldamigh ◽

Afaf Alnefisah ◽

Abdulrahman Almutairi ◽

Fatima Alturki ◽

Suhailah Alhtlany ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Hospital Admissions ◽

Pediatric Asthma ◽

Emergency Department Visits ◽

Asthma Patients

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81 Integrating A Front Door Frailty Service in the Emergency Department: Results of A Pilot Study

Age and Ageing ◽

10.1093/ageing/afab030.42 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

L Dunnell ◽

A Shrestha ◽

E Li ◽

Z Khan ◽

N Hashemi

Keyword(s):

Emergency Department ◽

Hospital Admissions ◽

Admission Rate ◽

Community Services ◽

Service Improvement ◽

Specialist Nurse ◽

Front Door ◽

Medication Changes ◽

Health Service Improvement

Abstract Introduction Increasing old age and frailty is putting pressure on health services with 5–10% of patients attending the emergency department (ED) and 30% of patients in acute medical units classified as older and frail. National Health Service improvement mandates that by 2020 hospital trusts with type one EDs provide at least 70 hours of acute frailty service each week. Methodology A two-week pilot (Monday–Friday 8 am-5 pm) was undertaken, with a “Front Door Frailty Team” comprising a consultant, junior doctor, specialist nurse and pharmacist, with therapy input from the existing ED team. They were based in the ED seeing patients on arrival, referrals from the ED team and patients in the ED observation ward—opposed to the usual pathway of referral from the ED team to medical team. Data was captured using “Cerner” electronic healthcare records. A plan, do, study, act methodology was used throughout with daily debrief and huddle sessions. Results 95 patients were seen over two weeks. In the over 65 s, average time to be seen was 50 minutes quicker than the ED team over the same period, with reduced admission rate (25.7% vs 46.5%). The wait between decision to admit and departure was shortened by 119 minutes. Overall, this led to patients spending on average 133 minutes less in the ED. 64 patients were discharged, of which 44 had community follow-up (including 37.5% of 64 referred to acute elderly clinic and 25% to rapid response). 47 medications were stopped across 25 patients. Conclusion The pilot shows that introduction of an early comprehensive geriatric assessment in the ED can lead to patients being seen sooner, with more timely decisions over their care and reduction in hospital admissions. It allowed for greater provision of acute clinics and community services as well as prompt medication review and real time medication changes.

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Predictors of mortality in patients with hereditary hemorrhagic telangiectasia

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-020-01579-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

K. P. Thompson ◽

◽

J. Nelson ◽

H. Kim ◽

L. Pawlikowska ◽

...

Keyword(s):

Hereditary Hemorrhagic Telangiectasia ◽

Cox Regression ◽

Clinical Symptoms ◽

Vascular Malformations ◽

Smoking Status ◽

Treatment Options ◽

Gi Bleeding ◽

Cox Regression Analysis ◽

Predictors Of Mortality

Abstract Background Retrospective questionnaire and healthcare administrative data suggest reduced life expectancy in untreated hereditary hemorrhagic telangiectasia (HHT). Prospective data suggests similar mortality, to the general population, in Denmark’s centre-treated HHT patients. However, clinical phenotypes vary widely in HHT, likely affecting mortality. We aimed to measure predictors of mortality among centre-treated HHT patients. HHT patients were recruited at 14 HHT centres of the Brain Vascular Malformation Consortium (BVMC) since 2010 and followed annually. Vital status, organ vascular malformations (VMs) and clinical symptoms data were collected at baseline and during follow-up (N = 1286). We tested whether organ VMs, HHT symptoms and HHT genes were associated with increased mortality using Cox regression analysis, adjusting for patient age, sex, and smoking status. Results 59 deaths occurred over average follow-up time of 3.4 years (max 8.6 years). A history of anemia was associated with increased mortality (HR = 2.93, 95% CI 1.37–6.26, p = 0.006), as were gastro-intestinal (GI) bleeding (HR = 2.63, 95% CI 1.46–4.74, p = 0.001), and symptomatic liver VMs (HR = 2.10, 95% CI 1.15–3.84, p = 0.015). Brain VMs and pulmonary arteriovenous malformations (AVMs) were not associated with mortality (p > 0.05). Patients with SMAD4 mutation had significantly higher mortality (HR = 18.36, 95% CI 5.60–60.20, p < 0.001) compared to patients with ACVRL1 or ENG mutation, but this estimate is imprecise given the rarity of SMAD4 patients (n = 33, 4 deaths). Conclusions Chronic GI bleeding, anemia and symptomatic liver VMs are associated with increased mortality in HHT patients, independent of age, and in keeping with the limited treatment options for these aspects of HHT. Conversely, mortality does not appear to be associated with pulmonary AVMs or brain VMs, for which patients are routinely screened and treated preventatively at HHT Centres. This demonstrates the need for development of new therapies to treat chronic anemia, GI bleeding, and symptomatic liver VMs in order to reduce mortality among HHT patients.

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THU0417 READMISSION RISK AND QUALITY OF CARE IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH GOUT FLARES

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3302 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 446.2-446

Author(s):

L. Brunetti ◽

J. Vekaria ◽

P. Lipsky ◽

N. Schlesinger

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Economic Burden ◽

Hospital Admissions ◽

Medical Center ◽

Research Support ◽

Increased Risk ◽

Comorbidity Index ◽

Anti Inflammatory ◽

Gout Flares

Background:Gout is the most common form of inflammatory arthritis and its economic burden is substantial, with estimates for the overall cost exceeding $20 billion (US) annually. Contributing to the economic burden are hospital admissions and iatrogenic events associated with pharmacotherapy. Identification of modifiable risk factors would be an important contribution to clinical practice.Objectives:The aim of this study was to identify opportunities for enhancing gout care in patients presenting to the Emergency Department (ED) with gout flares.Methods:This retrospective cohort study used data from electronic medical records (EMR) at a large community hospital. All consecutive patients visiting the medical center ED with a primary diagnosis of gout from 1/1/2016 to 7/1/2019 were included. Patients were then followed for 90 days to determine whether they were readmitted to the ED for any reason. A chart review identified whether they were on appropriate medications in terms of gout flare management. All data were summarized using descriptive statistics. A multiple logistic regression was constructed to identify risk factors for ED utilization within 90 days of the index visit.Results:A total of 214 patients were included in the analysis. Most patients were male (79%), mean age was 59.4 ± 15.6 years, and mean Charlson comorbidity index was 0.5 ± 1.14. The most common medications prescribed during the ED visit included NSAIDs (41.6%), opioids (28%), corticosteroids (26.6%), and colchicine (21%). Allopurinol and febuxostat were initiated in the ED in 4.7% and 0.9%, respectively. Discharge medications for the management of gout included NSAIDs (37%), corticosteroids (34.6%), opioids (23.8%), colchicine (14%), febuxostat (7%), and allopurinol (6.5%). Of the patients sent home with an opioid, 40% were newly prescribed. An anti-inflammatory medication was not prescribed in 29.6% of patients discharged from the ED. Readmission within 90 days was recorded in 16.8% of patients. Of these readmissions, 33.3% were gout-related and 11.1% were cardiac related.After adjusting for age and comorbidity index, patients receiving colchicine were 2.8 times more likely (OR, 2.81; 95% CI, 1.12 to 7.02; p=0.027) to return to the ED within 90 days. The most common cause of readmission in this subset was gout-related (54.5%).Conclusion:Nearly 30% of patients were discharged from the ED without an anti-inflammatory medication, whereas initiation of urate lowering therapy was rare. Opiates were used frequently, but the indication was uncertain. Only 5.6% of subjects revisited the ED for gout-related diagnoses in the subsequent 3 months. Colchicine prescription was associated with an increased risk of gout-related ED utilization within 90 days. Treatment of gout in the ED is sub-optimal and often does not follow established guidelines.Disclosure of Interests: :Luigi Brunetti Grant/research support from: Astellas Pharma, CSL Behring, Consultant of: Horizon Foundation of New Jersey, Janaki Vekaria: None declared, Peter Lipsky Consultant of: Horizon Therapeutics, Naomi Schlesinger Grant/research support from: Pfizer, AMGEN, Consultant of: Novartis, Horizon Pharma, Selecta Biosciences, Olatec, IFM Therapeutics, Mallinckrodt Pharmaceuticals, Speakers bureau: Takeda, Horizon

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Infeções do Trato Urinário numa Coorte de Transplantados Renais

Acta Médica Portuguesa ◽

10.20344/amp.4959 ◽

2014 ◽

Vol 27 (3) ◽

pp. 364 ◽

Cited By ~ 2

Author(s):

Ana Bispo ◽

Milene Fernandes ◽

Cristina Toscano ◽

Teresa Marques ◽

Domingos Machado ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Urinary Tract Infections ◽

Hospital Admissions ◽

Female Gender ◽

Tract Infections

Introduction: Urinary tract infection is the most common infectious complication following renal transplantation and its frequency is insufficiently studied in Portugal. The aim of this study was to characterize the incidence of urinary tract infections and recurrent urinary tract infections in renal transplant recipients. Material and Methods: This was a retrospective cohort observational study, obtained from clinical files of all patients who received a renal transplant at the Hospital of Santa Cruz, from January 2004 to December 2005, with a mean follow-up period of five years or until date of graft loss, death or loss of follow-up. After a descriptive analysis of the population, we used bivariate tests to identify risk factors for urinary tract infections. Results: A total of 127 patients were included, with a 593 patients.year follow-up. We detected 53 patients (41.7%) presenting with at least one episode of urinary tract infection; 21 patients (16.5%) had recurrent urinary tract infection. Female gender was the only risk factor associated with the occurrence of urinary tract infections (p < 0.001, OR = 7.08, RR = 2.95) and recurrent urinary tract infections (p < 0.001, OR = 4.66, RR = 2.83). Escherichia coli (51.6%), Klebsiella pneumoniae (15.5%) and Enterobacter spp (9.9%) were the most frequently identified pathogens. Patients did not reveal an increased mortality or allograft loss. However, urinary tract infections were the most important cause of hospital admissions. Discussion: Female gender was the only risk factor for urinary tract infections in this population. Escherichia coli was the most frequent agent isolated. Conclusion: Despite preventive measures, urinary tract infections remain an important cause of morbidity and hospital admissions. Keywords: Urinary Tract Infections; Postoperative Complications; Risk Factors; Kidney Transplantation; Portugal.

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A study of clinical/biological markers of exacerbation/progression in a cohort of patients admitted with acute excerbation of COPD

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20175539 ◽

2018 ◽

Vol 5 (1) ◽

pp. 32

Author(s):

Shivraj A. L. ◽

Prakash B.

Keyword(s):

Hospital Admissions ◽

Chronic Obstructive ◽

Clinical Markers ◽

Significant Drop ◽

Obstructive Pulmonary Disease ◽

Protein Levels ◽

Related Quality ◽

Frequent Exacerbation ◽

A Prospective Study

Background:Exacerbations of chronic obstructive pulmonary disease increases the morbidity, hospital admissions, mortality, and strongly influence health-related quality of life. The aims of this study to know the Clinical profile of COPD and acute exacerbation, Role of clinical markers in diagnosis and follow up of exacerbation.Methods: A prospective study of a cohort of 60 patients hospitalized for AECOPD was undertaken to identify markers for frequent exacerbation and progression of disease. Advised to fill the SGRQ questionnaire, At the time of discharge 6MWT done and analyzed. C Reactive protein levels at the time of admission done and analyzed. Sputum grams stain culture, total counts and differential counts done and analyzed. At the time of discharge spirometry done both pre and post bronchodilators by using asthalin inhaler with or without spacer, results were analyzed.Results:There was statistically significant drop in the SPO2 levels in frequent exacerbators over 6 months follow up time. There was statistically significant elevation of sputum Neutrophil counts in frequent exacerbators and Eosinophil counts in infrequent exacerbators, there was a drop in the CRP levels of from the time of initial exacerbation to 6 months follow up time. There was statistically significant drop in FEV1 in frequent exacerbators over 6 months follow up study. The drop of 6MWT was more in patients, who had frequent exacerbations.Conclusions:Patients with more frequent exacerbation have more symptoms, drop in the saturation level and have more sputum neutrophil counts. Patients with more frequent exacerbations will have more deterioration of lung functions (FEV1.6MWT).

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A Prospective Study on Risk Factors for Olfactory Dysfunction in Aging

The Journals of Gerontology Series A ◽

10.1093/gerona/glz265 ◽

2019 ◽

Vol 75 (3) ◽

pp. 603-610 ◽

Cited By ~ 2

Author(s):

Eva Palmquist ◽

Maria Larsson ◽

Jonas K Olofsson ◽

Janina Seubert ◽

Lars Bäckman ◽

...

Keyword(s):

Risk Factors ◽

Healthy Lifestyle ◽

Total Sample ◽

Olfactory Dysfunction ◽

National Study ◽

Current Smoking ◽

Ε4 Allele ◽

A Prospective Study

Abstract Background Olfactory dysfunction (OD) refers to a reduced or absent ability to smell. OD negatively impacts health and quality of life and its prevalence increases with advancing age. Since OD may be an early marker of dementia and impending death, more knowledge regarding risk factors of OD in aging is warranted. The objective was therefore to explore longitudinally which demographic, genetic, clinical, lifestyle, and cognitive factors predict the development of OD. Methods The study included participants aged 60–90 years from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), who did not have OD at baseline and were reassessed with an odor identification task at a 6-year follow-up (n = 1,004). Risk factors of OD were assessed with multivariable logistic regression analyses. Results The percentage of incident OD cases was 14.2% over 6 years in the total sample and this number increased monotonically with age. Increasing age, carrying the ε4 allele of the APOE gene, atrial fibrillation, cerebrovascular disease, and current smoking were found to be risk factors for the development of OD, whereas better olfactory identification and verbal episodic memory proficiency at baseline were identified as protective factors. Conclusions In addition to nonmodifiable factors (age and genetic risk), several modifiable risk factors of OD were identified. This suggests that it might be possible to reduce OD incidence through the management of vascular risk factors and maintenance of a healthy lifestyle.

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Recurrent Emergency Department Users: Two Categories with Different Risk Profiles

Journal of Clinical Medicine ◽

10.3390/jcm8030333 ◽

2019 ◽

Vol 8 (3) ◽

pp. 333 ◽

Cited By ~ 4

Author(s):

Ksenija Slankamenac ◽

Meret Zehnder ◽

Tim Langner ◽

Kathrin Krähenmann ◽

Dagmar Keller

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Emergency Services ◽

Hospital Admissions ◽

Tertiary Care ◽

Chronic Obstructive ◽

Care Hospital ◽

Co Morbidity ◽

Ed Visits ◽

Morbidity Index

Recurrent emergency department (ED) visits are responsible for an increasing proportion of overcrowding. Therefore, our aim was to investigate the characteristics and prevalence of recurrent ED visitors as well as to determine risk factors associated with multiple ED visits. ED patients visiting the ED of a tertiary care hospital at least four times consecutively in 2015 were enrolled. Of 33,335 primary ED visits, 1921 ED visits (5.8%) were performed by 372 ED patients who presented in the ED at least four times within the one-year period. Two different categories of recurrent ED patients were identified: repeated ED users presenting always with the same symptoms and frequent ED visitors who were suffering from different symptoms on each ED visit. Repeated ED users had more ED visits (p < 0.001) and needed more hospital admissions (p < 0.010) compared to frequent ED users. Repeated ED users visited the ED more likely due to symptoms from chronic obstructive pulmonary diseases (p < 0.001) and mental disorders (p < 0.001). In contrast, frequent ED patients showed to be at risk for multiple ED visits when being disabled (p = 0.001), had an increased Charlson co-morbidity index (p = 0.004) or suffering from rheumatic diseases (p < 0.001). A small number of recurrent ED visitors determines a relevant number of ED visits with a relevance for and impact on patient centred care and emergency services. There are two categories of recurrent ED users with different risk factors for multiple ED visits: repeated and frequent. Therefore, multi-professional follow-up care models for recurrent ED patients are needed to improve patients’ needs, quality of life as well as emergency services.

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Predictors of ICU admission and long-term outcomes in overdose presentations to Emergency Department

Australasian Psychiatry ◽

10.1177/1039856219889317 ◽

2020 ◽

Vol 28 (1) ◽

pp. 75-79

Author(s):

Mark Savage ◽

Ross Kung ◽

Cameron Green ◽

Brandon Thia ◽

Dinushka Perera ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Emergency Department ◽

Psychiatric Illness ◽

Atypical Antipsychotics ◽

Long Term Outcomes ◽

Icu Admission ◽

History Of

Objective: To describe the characteristics of patients presenting to an Emergency Department (ED) following overdoses; to identify risk factors for intensive care unit (ICU) admission among these patients; and to identify the rate of mortality and repeat overdose presentations over four years. Methods: Adult patients presenting to ED following drug overdose during 2014 were included. Data were collected from medical notes and hospital databases. Results: During the study period, 654 patients presented to ED 800 times following overdose. Seventy-eight (9.8%) resulted in ICU admission, and 59 (7.4%) required intubation; 57.2% had no history of overdose presentations, and 72.9% involved patients with known psychiatric illness. Overdose of atypical antipsychotics (AAP), age and history of prior overdose independently predicted ICU admission. A third of patients ( n = 196, 30%) had subsequent presentations to ED following overdose, in the four years from their index presentation, with an all-cause four-year mortality of 3.4% ( n = 22). Conclusion: A history of overdose, use of AAP and older age were risk factors for ICU admission following ED presentations. Over a third of patients had repeat overdose presentation in the four-year follow-up with a mortality of 3.4%.

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