850Description of total population hospital admissions for Craniosynostosis in Australia

Background Craniosysnostosis (CS) is a condition ensuing from premature fusion of cranial sutures, resulting in altered craniofacial morphology, requiring early neurosurgical interventions to improve prognosis and outcomes. This study aimed to describe total population hospital admissions related to craniosynostosis in Australia over a 22-year period. Methods Population summary data for admissions to public and private hospitals were obtained from the Australian Institute of Health and Welfare National Hospital Morbidity Database (July 1996 to June 2018). The primary outcome variable was a hospital separation with the principal diagnosis of craniosynostosis, craniodysostosis or acrocephalosyndactyly (ICD9CM diagnosis codes 756.00 and 756.01 between July 1996– June 1998 and ICD10AM diagnosis codes Q75.0, Q75.1 and Q87.02 for July 1998 onwards). Trends in rates of hospital admission and length of stay by age, gender and type of craniosynostosis were investigated by negative binomial regression. Results A total of 8,115 admissions were identified between July 1996 to June 2018. Marginal decrease in hospital admission rates [-0.02 (95%CI 0.03, 0.001)] has been observed over a duration of 22 years. Admissions were higher for males, infants (<1 year) and nonsyndromic cases of disease. Average length of stay at hospitals for CS was calculated to be 5.3 ± 1.3 days per year which were even lengthier with syndromic conditions. Conclusion This study has identified population level trends in hospital separation for craniosynostosis in Australia. Key Message Population administrative data, despite limitations provides useful information to inform research and practice.

A Brief history of the Care of Children in Hospital

Children are unique human beings who need attention from an adult including their parents in order to assist him/her to deal with problems in their childhood period. An unhealthy child needs more attention from adult person including a nurse in order to assist him/her to deal with experiences during his/her period. Children’s hospital was not always as a convenient place for unhealthy children. They were thought as places which could detach children from their parents. However, considering the history of development of children’s hospitals is important for those who are involved in nursing care for children. This article discuss about a history of children’s hospitals and focuses on how important to prepare unhealthy child to face a separation process. The article also discusses about stages through which children who are separated from their parents go.Keywords: Children, hospital, separation, health care delivery system. Abstrak Anak-anak adalah makhluk unik yang membutuhkan perhatian dari orang dewasa termasuk orang tua dalam rangka membimbing menghadapi masalah-masalah selama masa anak-anak. Seorang anak yang sakit membutuhkan lebih banyak perhatian dari orang-orang dewasa termasuk perawat dalam rangka membantunya menghadapi pengalaman selama sakit. Di masa lalu, rumah sakit anak tidak dilihat sebagai tempat yang nyaman untuk anak-anak yang sedang sakit. Rumah sakit ini telah dianggap sebaga tempat pemisah antara anak-anak dan orang tuanya. Beberapa tahun terakhir, rumah sakit di negara-negara yang sedang berkembang telah berubah citranya dari “sebuah tempat untuk: naughty boy” menjadi sebuah tempat dimana seorang anak dapat melanjutkan kegiatan hariannya dengan atau tanpa orang tua. Mempertimbangkan sejarah perkembangan rumah sakit-rumah sakit anak amat penting bagi mereka yang terlibat dalam pelayanan/asuhan keperawatan pada anak-anak. Artikel ini mendiskusikan tentang rumah sakit anak, dan berfokus pada betapa pentingnya mempersiapkan anak-anak yang sakit untuk menghadapi proses perpisahan. Artikel ini juga membahas tentang fase-fase yang harus dilalui oleh anak-anak yang dipisahkan dari orang tua selama sakit.Kata kunci: Anak-anak, rumah sakit, perpisahan, sistem pemberian asuhan keperawatan.

Validation of Jarman’s method of calculation of hospital standardised mortality ratios

Objective. To compare Jarman-derived hospital standardised mortality ratios (HSMR) and Linkage-derived cumulative mortality ratios (CMR). Methods. HSMR and CMR values for four groups of hospitals were derived from four single-year cohorts of linked patient admissions and deaths, and compared; differences were explored and reasons for non-matching and discordance were suggested. Results. For the group of metropolitan teaching hospitals the Jarman-derived HSMR value of 0.95 (95% CI 0.93–0.97) was significantly lower than the Linkage-derived CMR value of 0.99 (95% CI 0.97–1.01). The opposite result was seen for the group of metropolitan non-teaching public hospitals: the Linkage-derived CMR of 0.81 (0.77–0.85) was significantly lower than the Jarman method HSMR of 1.03 (0.98–1.07). Unmatched deaths in the study resulted from a condition unique to the Jarman method. Besides there being fewer deaths based only on the hospital separation records, 593 of these records suggested wrongly diagnosed deaths, possibly due to erroneous coding. Also, 467 hospital separation records deemed not to have involved transfer in the Jarman method database were detected by the Linkage method. However, excluding these unmatched deaths did not result in total concordance for two-method hospital-related deaths. Conclusions. Incorrect deaths in the Jarman method can be overcome by using the Linked method. The Jarman method, unable to adjust for the contiguous transfers related to the death, apportioned excess deaths unfairly to the teaching hospitals group. What is known about the topic? HSMR based on hospital separation record information can reflect hospital performance if monitored over a regular period. Despite considerable variability, inter-hospital comparison league tables of hospitals based on such ratios have been published. What does this paper add? This study demonstrated that the Linkage-derived CMR, utilising valid details from the state death registry, more accurately ascertains number of deaths than does the Jarman method-derived HSMR. What are the implications for practitioners? Where data linkages are possible, dual death derivations by the Jarman method and the Linked method can identify any unmatched or discordant deaths. Detailed exploration may help identify any differing hospital discharge practices.

Time Spent in Hospital in the Last Six Months of Life in Patients Who Died of Cancer in Ontario

PURPOSE: To describe hospital bed utilization in the final 6 months of life in patients dying of cancer in Ontario, Canada. PATIENTS AND METHODS: Hospital separation records were linked to a population-based cancer registry to identify factors associated with hospitalization in the 203,713 patients who died of cancer in Ontario between 1986 and 1998. RESULTS: Between 1986 and 1998, 5.3% of all acute care beds in Ontario were devoted to the care of cancer patients in the last 6 months of life. The mean time spent in hospital in the last 6 months of life decreased from 34.3 days in 1986 to 22.7 days in 1998. Hospitalization rates increased exponentially during the last month of life. Patients younger than 50 years of age, women, and residents of poorer communities spent significantly longer in hospital than others. Hospitalization rates differed very little among the common solid tumors, but patients with CNS malignancies, the lymphomas, and the leukemias spent significantly longer in hospital than the other groups. There was significant interregional variations in hospitalization that were not explained by differences in case mix. There was a statistically significant inverse correlation between the rate of use of palliative radiotherapy and the hospital bed use in the county in which the patient resided. CONCLUSION: The total time spent in hospital in the last 6 months of life has decreased over the last decade, but acute care hospitals continue to play a large role in the care of patients who are dying of cancer.