Hospital Admissions
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2022 ◽  
Vol 16 (1) ◽  
Samiaa Hamdy Sadek ◽  
Maha Mohamed El-kholy ◽  
Fareda Ahmed Mohammed ◽  
Reham Mohammed El-Morshedy

Abstract Background Poorly controlled bronchial asthma limits patients’ quality of life (QOL), the condition which may potentiate the development of psychiatric disorders. The aim of this study was the assessment of anxiety and depression in bronchial asthma patients, and their interrelation with both level of asthma control and quality of life in our society. Results This study included 102 bronchial asthma patients, and 50 healthy control individuals. Patients had poorer QOL, and higher anxiety and depression scores compared to healthy control, moreover these scores were higher in uncontrolled asthma patients compared to controlled group. Poor QOL, frequent hospital admissions, and poor asthma control were the predictors for psychiatric disorders. Conclusion Depression and anxiety are frequently encountered in patients with bronchial asthma in our society; poor symptom control, poor QOL, and frequent hospital admissions are the main predictors for these psychiatric disorders.

2022 ◽  
Vol 23 (1) ◽  
Sarah Cooper ◽  
Elham Rahme ◽  
Sze Man Tse ◽  
Roland Grad ◽  
Marc Dorais ◽  

Abstract Background Having a primary care provider and a continuous relationship may be important for asthma outcomes. In this study, we sought to determine the association between 1) having a usual provider of primary care (UPC) and asthma-related emergency department (ED) visits and hospitalization in Québec children with asthma and 2) UPC continuity of care and asthma outcomes. Methods Population-based retrospective cohort study using Québec provincial health administrative data, including children 2-16 years old with asthma (N = 39, 341). Exposures and outcomes were measured from 2010-2011 and 2012-2013, respectively. Primary exposure was UPC stratified by the main primary care models in Quebec (team-based Family Medicine Groups, family physicians not in Family Medicine Groups, pediatricians, or no assigned UPC). For those with an assigned UPC the secondary exposure was continuity of care, measured by the UPC Index (high, medium, low). Four multivariate logistic regression models examined associations between exposures and outcomes (ED visits and hospitalizations). Results Overall, 17.4% of children had no assigned UPC. Compared to no assigned UPC, having a UPC was associated with decreased asthma-related ED visits (pediatrician Odds Ratio (OR): 0.80, 95% Confidence Interval (CI) [0.73, 0.88]; Family Medicine Groups OR: 0.84, 95% CI [0.75,0.93]; non-Family Medicine Groups OR: 0.92, 95% CI [0.83, 1.02]) and hospital admissions (pediatrician OR: 0.66, 95% CI [0.58, 0.75]; Family Medicine Groups OR: 0.82, 95% CI [0.72, 0.93]; non-Family Medicine Groups OR: 0.76, 95% CI [0.67, 0.87]). Children followed by a pediatrician were more likely to have high continuity of care. Continuity of care was not significantly associated with asthma-related ED visits. Compared to low continuity, medium and high continuity of care decreased asthma-related hospital admissions, but none of these associations were significant. Conclusion Having a UPC was associated with reduced asthma-related ED visits and hospital admissions. However, continuity of care was not significantly associated with outcomes. The current study provides ongoing evidence for the importance of primary care in children with asthma.

Gianmarco Lombardi ◽  
Giovanni Gambaro ◽  
Pietro Manuel Ferraro

Introduction Electrolytes disorders are common findings in kidney diseases and might represent a useful biomarker preceding kidney injury. Serum potassium [K+] imbalance is still poorly investigated for association with acute kidney injury (AKI) and most evidence come from intensive care units (ICU). The aim of our study was to comprehensively investigate this association in a large, unselected cohort of hospitalized patients. Methods: We performed a retrospective observational cohort study on the inpatient population admitted to Fondazione Policlinico Universitario A. Gemelli IRCCS between January 1, 2010 and December 31, 2014 with inclusion of adult patients with at least 2 [K+] and 3 serum creatinine (sCr) measurements who did not develop AKI during an initial 10-day window. The outcome of interest was in-hospital AKI. The exposures of interest were [K+] fluctuations and hypo (HoK) and hyperkalemia (HerK). [K+] variability was evaluated using the coefficient of variation (CV). Cox proportional hazards regression models were used to obtain hazard ratios (HRs) and 95% confidence intervals (CIs) of the association between the exposures of interest and development of AKI. Results: 21,830 hospital admissions from 18,836 patients were included in our study. During a median follow-up of 5 (interquartile range [IQR] 7) days, AKI was observed in 555 hospital admissions (2.9%); median time for AKI development was 5 (IQR 7) days. Higher [K+] variability was independently associated with increased risk of AKI with a statistically significant linear trend across groups (p-value = 0.012). A significantly higher incidence of AKI was documented in patients with HerK compared with normokalemia. No statistically significant difference was observed between HoK and HerK (p-value = 0.92). Conclusion: [K+] abnormalities including fluctuations even within the normal range are associated with development of AKI.

2022 ◽  
Vol 9 (1) ◽  
pp. 25
Sara Guillen-Aguinaga ◽  
Antonio Brugos-Larumbe ◽  
Laura Guillen-Aguinaga ◽  
Felipe Ortuño ◽  
Francisco Guillen-Grima ◽  

(1) Background: Patients with schizophrenia have higher mortality, with cardiovascular diseases being the first cause of mortality. This study aims to estimate the excess risk of hospital admission for cardiovascular events in schizophrenic patients, adjusting for comorbidity and risk factors. (2) Methods: The APNA study is a dynamic prospective cohort of all residents in Navarra, Spain. A total of 505,889 people over 18 years old were followed for five years. The endpoint was hospital admissions for a cardiovascular event. Direct Acyclic Graphs (DAG) and Cox regression were used. (3) Results: Schizophrenic patients had a Hazard Ratio (HR) of 1.414 (95% CI 1.031–1.938) of hospital admission for a cardiovascular event after adjusting for age, sex, hypertension, type 2 diabetes, dyslipidemia, smoking, low income, obesity, antecedents of cardiovascular disease, and smoking. In non-adherent to antipsychotic treatment schizophrenia patients, the HR was 2.232 (95% CI 1.267–3.933). (4) Conclusions: Patients with schizophrenia have a higher risk of hospital admission for cardiovascular events than persons with the same risk factors without schizophrenia. Primary care nursing interventions should monitor these patients and reduce cardiovascular risk factors.

Shane H Licheni ◽  
Latha Devaraja ◽  
Benjamin Watson ◽  
Marcelle Simeonovic ◽  
Daryl R Cheng ◽  

2022 ◽  
Vol 9 ◽  
Fredrik Methi ◽  
Ketil Størdal ◽  
Kjetil Telle ◽  
Vilde Bergstad Larsen ◽  
Karin Magnusson

Aim: To compare hospital admissions across common respiratory tract infections (RTI) in 2017-21, and project possible hospital admissions for the RTIs among children aged 0–12 months and 1-5 years in 2022 and 2023.Methods: In 644 885 children aged 0–12 months and 1–5 years, we plotted the observed monthly number of RTI admissions [upper- and lower RTI, influenza, respiratory syncytial virus (RSV), and COVID-19] from January 1st, 2017 until October 31st, 2021. We also plotted the number of RTI admissions with a need for respiratory support. We used the observed data to project four different scenarios of RTI admissions for the rest of 2021 until 2023, with different impacts on hospital wards: (1) “Business as usual,” (2) “Continuous lockdown,” (3) “Children's immunity debt,” and (4) “Maternal and child immunity debt.”Results: By October 31st, 2021, the number of simultaneous RTI admissions had exceeded the numbers usually observed at the typical season peak in January, i.e., ~900. Based on our observed data and assuming that children and their mothers (who transfer antibodies to the very youngest) have not been exposed to RTI over the last one and a half years, our scenarios suggest that hospitals should be prepared to handle two to three times as many RTI admissions, and two to three times as many RTI admissions requiring respiratory support among 0–5-year-olds as normal, from November 2021 to April 2022.Conclusion: Scenarios with immunity debt suggest that pediatric hospital wards and policy makers should plan for extended capacity.

2022 ◽  
pp. 0272989X2110699
Louise B. Russell ◽  
Qian Huang ◽  
Yuqing Lin ◽  
Laurie A. Norton ◽  
Jingsan Zhu ◽  

Introduction. Pragmatic clinical trials test interventions in patients representative of real-world medical practice and reduce data collection costs by using data recorded in the electronic health record (EHR) during usual care. We describe our experience using the EHR to measure the primary outcome of a pragmatic trial, hospital readmissions, and important clinical covariates. Methods. The trial enrolled patients recently discharged from the hospital for treatment of heart failure to test whether automated daily monitoring integrated into the EHR could reduce readmissions. The study team used data from the EHR and several data systems that drew on the EHR, supplemented by the hospital admissions files of three states. Results. Almost three-quarters of enrollees’ readmissions over the 12-mo trial period were captured by the EHRs of the study hospitals. State data, which took 7 mo to more than 2 y from first contact to receipt of first data, provided the remaining one-quarter. Considerable expertise was required to resolve differences between the 2 data sources. Common covariates used in trial analyses, such as weight and body mass index during the index hospital stay, were available for >97% of enrollees from the EHR. Ejection fraction, obtained from echocardiograms, was available for only 47.6% of enrollees within the 6-mo window that would likely be expected in a traditional trial. Discussion. In this trial, patient characteristics and outcomes were collected from existing EHR systems, but, as usual for EHRs, they could not be standardized for date or method of measurement and required substantial time and expertise to collect and curate. Hospital admissions, the primary trial outcome, required additional effort to locate and use supplementary sources of data. Highlights Electronic health records are not a single system but a series of overlapping and legacy systems that require time and expertise to use efficiently. Commonly measured patient characteristics such as weight and body mass index are relatively easy to locate for most trial enrollees but less common characteristics, like ejection fraction, are not. Acquiring essential supplementary data—in this trial, state data on hospital admission—can be a lengthy and difficult process.

BMJ ◽  
2022 ◽  
pp. e067519 ◽  
Seilesh Kadambari ◽  
Raphael Goldacre ◽  
Eva Morris ◽  
Michael J Goldacre ◽  
Andrew J Pollard

AbstractObjectiveTo assess the impact of the covid-19 pandemic on hospital admission rates and mortality outcomes for childhood respiratory infections, severe invasive infections, and vaccine preventable disease in England.DesignPopulation based observational study of 19 common childhood respiratory, severe invasive, and vaccine preventable infections, comparing hospital admission rates and mortality outcomes before and after the onset of the pandemic in England.SettingHospital admission data from every NHS hospital in England from 1 March 2017 to 30 June 2021 with record linkage to national mortality data.PopulationChildren aged 0-14 years admitted to an NHS hospital with a selected childhood infection from 1 March 2017 to 30 June 2021.Main outcome measuresFor each infection, numbers of hospital admissions every month from 1 March 2017 to 30 June 2021, percentage changes in the number of hospital admissions before and after 1 March 2020, and adjusted odds ratios to compare 60 day case fatality outcomes before and after 1 March 2020.ResultsAfter 1 March 2020, substantial and sustained reductions in hospital admissions were found for all but one of the 19 infective conditions studied. Among the respiratory infections, the greatest percentage reductions were for influenza (mean annual number admitted between 1 March 2017 and 29 February 2020 was 5379 and number of children admitted from 1 March 2020 to 28 February 2021 was 304, 94% reduction, 95% confidence interval 89% to 97%), and bronchiolitis (from 51 655 to 9423, 82% reduction, 95% confidence interval 79% to 84%). Among the severe invasive infections, the greatest reduction was for meningitis (50% reduction, 47% to 52%). For the vaccine preventable infections, reductions ranged from 53% (32% to 68%) for mumps to 90% (80% to 95%) for measles. Reductions were seen across all demographic subgroups and in children with underlying comorbidities. Corresponding decreases were also found for the absolute numbers of 60 day case fatalities, although the proportion of children admitted for pneumonia who died within 60 days increased (age-sex adjusted odds ratio 1.71, 95% confidence interval 1.43 to 2.05). More recent data indicate that some respiratory infections increased to higher levels than usual after May 2021.ConclusionsDuring the covid-19 pandemic, a range of behavioural changes (adoption of non-pharmacological interventions) and societal strategies (school closures, lockdowns, and restricted travel) were used to reduce transmission of SARS-CoV-2, which also reduced admissions for common and severe childhood infections. Continued monitoring of these infections is required as social restrictions evolve.

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