Division of Respiratory Medicine, Center for Medicine and Clinical Research, Kuopio University Hospital, Kuopio, Finland. Electronic address: Margit.Pelkonen@kuh.fi.
The present study examines how trends in the prevalence of asthma during the past three decades associate with hospitalization and mortality during the same period.
Altogether 54?320 subjects aged 25-74 years were examined in seven independent cross-sectional population surveys repeated every five years between 1982 and 2012 in Finland. The study protocol included a standardized questionnaire on self-reported asthma, smoking habits and other risk factors, and clinical measurements at the study site. Data on hospitalizations were obtained from the Care Register for Health Care, and data on mortality from the National Causes of Death register.
During the study, the prevalence of asthma increased - especially in women. In asthmatic compared with non-asthmatic subjects, hospitalization was significantly higher for all causes, respiratory causes, cardiovascular causes and lung cancer. In addition, particularly in asthmatic subjects, mean yearly hospital days in the 5-year periods after each survey diminished. In asthmatic subjects, the decrease in yearly all-cause hospital days was from 4.45 (between 1982 and 1987) to 1.11 (between 2012 and 2015) and in subjects without asthma the corresponding decrease was from 1.77 to 0.60 (p?
INTRODUCTION: A multimodal approach to minimise the effect of the surgical stress response can reduce complications and hospital stay after abdominal surgery and hip arthroplasty. The aim of the study was to assess the results of a well-defined rehabilitation programme after hip fracture. MATERIAL AND METHODS: In an open intervention study, we entered 200 consecutive patients with hip fracture allowing full weight-bearing after operative treatment. The effect of a revised, optimised perioperative care programme with continuous epidural analgesia, early oral nutrition, oxygen supplementation, restricted volume and transfusion therapy, and intensive physiotherapy and mobilisation was assessed (n = 100) and compared with the conventional perioperative treatment programme before the intervention (n = 100). The median age was 82 (56-96) years in the control group and 82 (63-101) years in the accelerated multimodal perioperative treatment group. RESULTS: The median hospital stay was reduced from 21 (range 1-162, mean 32) to 11 (range 1-100, mean 17) days. The total use of days in hospital was reduced from 3211 to 1667. There were fewer complications, whereas the need for home care after discharge was unchanged. CONCLUSION: An accelerated clinical pathway with focus on pain relief, oral nutrition, and rehabilitation may reduce hospital stay and improve recovery after hip fracture.
INTRODUCTION: The goal of this study was to evaluate patient satisfaction with the hospital stay in relation to the length of stay for patients operated on with primary total hip- and knee-arthroplasty (THA and TKA). MATERIALS AND METHODS: According to the National Register on Patients, the three departments with the shortest and the three departments with the longest postoperative hospital stay at the end of 2003 were chosen for evaluation. The patients, operated on with THA or TKA from September 2004 to April 2005, from the selected departments answered a questionnaire regarding satisfaction with elected parts of their stay, co-morbidity, sex and age. RESULTS: The patients from the departments with the shortest stay were not younger nor had they less co-morbidities than patients from departments with longer stays. Apart from staying a significantly shorter time, they were either as satisfied--or sometimes more satisfied--with all parts of their stay compared to patients from the departments with longer hospital stay. CONCLUSION: Patients in accelerated stays are not less satisfied with their hospital stay (or any part of it) compared to patients with longer and more conventional hospital stays. These results support the implementation of fast-track total hip- and knee arthroplasty.
Exceptional amount of snow led to snow removal attempts from the rooftops resulting in a relative unique and extraordinary epidemic of accidental falls in winter of 2010.
The injury pattern, hospital care, surgical operations, and the total costs of the primary hospital stay of accidentally fallen patients treated in Helsinki University Hospital trauma unit were analyzed.
Forty-six patients were admitted to hospital during the study period of three months. Majority of the patients were males (N?=?43, 93%) with the average age of 52.9 years. Seven patients were admitted to ICU. The average length of primary hospital stay was 4.7 days with 0% mortality. Total amount of fractures was 65 (63%) of all 97 injuries. The most common injuries were fractures of upper and lower extremity, and spinal column.
Preventing similar unnecessary epidemics of accidental falls in the future it is important to have professional opinion of the need of snow removal along with understanding of the risk of injury. Wearing appropriate safety equipments, and use professional help when necessary is advisable.
For Canadians under 45, accidents are the leading cause of both death and hospitalization. For the Canadian population as a whole, accidents rank fourth as a cause of death, after cardiovascular disease (CVD), cancer and respiratory disease. This article analyzes accident mortality and hospitalization in Canada using age-specific rates, age-standardized mortality rates (ASMR), and potential years of life lost (PYLL). The six major causes of accidental death for men are motor vehicle traffic accidents (MVTA), falls, drowning, fires, suffocation and poisoning. For women, the order is slightly different: MVTA, falls, fires, suffocation, poisoning and drowning. From 1971 to 1986, age-standardized mortality rates (ASMR) for accidents decreased by 44% for men and 39% for women. The largest decrease occurred in the under 15 age group. Accidents accounted for 11.5% of total hospital days in 1985, and 8% of hospital discharges. Because young people have the highest rates of accidental death, potential years of life lost (PYLL) are almost as high for accidents as for cardiovascular disease, although CVD deaths outnumbered accidental deaths by almost five to one in 1985.
The knowledge of the impact of coercion on psychiatric treatment outcome is limited. Multiple measures of coercion have been recommended. The aim of the study was to examine the impact of accumulated coercive incidents on short-term outcome of inpatient psychiatric care
233 involuntarily and voluntarily admitted patients were interviewed within five days of admission and at discharge or after maximum three weeks of care. Coercion was measured as number of coercive incidents, i.e. subjectively reported and in the medical files recorded coercive incidents, including legal status and perceived coercion at admission, and recorded and reported coercive measures during treatment. Outcome was measured both as subjective improvement of mental health and as improvement in professionally assessed functioning according to GAF. Logistic regression analyses were performed with patient characteristics and coercive incidents as independent and the two outcome measures as dependent variables
Number of coercive incidents did not predict subjective or assessed improvement. Patients having other diagnoses than psychoses or mood disorders were less likely to be subjectively improved, while a low GAF at admission predicted an improvement in GAF scores
The results indicate that subjectively and professionally assessed mental health short-term outcome of acute psychiatric hospitalisation are not predicted by the amount of subjectively and recorded coercive incidents. Further studies are needed to examine the short- and long-term effects of coercive interventions in psychiatric care.
Notes
Cites: Int J Law Psychiatry. 1997 Spring;20(2):227-419178064
Cites: Int J Law Psychiatry. 1996 Spring;19(2):201-178725657
Pharmacoepidemiology and Pharmacoeconomics Research Unit, Centre de Recherche, Campus Hôtel-Dieu, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
In Quebec, MED-ECHO database can be used to estimate inhospital length of stay (LOS) and number of hospitalizations (NOH) both accurately and reliably. However, access to MED-ECHO database is time-consuming. Quebec medical claims database (RAMQ) can be used as an alternative source to estimate these measures. Considering MED-ECHO as the 'gold standard,' this study examined the validity of using RAMQ medical claims to estimate LOS and NOH.
We used a cohort of 3768 elderly patients with chronic obstructive pulmonary disease (COPD) between 1990 and 1996 and identified those with inhospital claims. Inhospital LOS was defined as the total number of days with inhospital claims. Various grace periods (1-15 days) between consecutive claims were considered for the estimation of LOS and NOH. RAMQ and MED-ECHO databases were linked using unique patient identifiers. Estimates obtained from RAMQ data were compared to those from MED-ECHO using various measures of central tendency and predictive error estimates.
Overall, 32.7% of patients were hospitalized at least once during the study period based on RAMQ claims, as compared to 32.0% in MED-ECHO ( p-value = 0.51). The best estimates [mean (p-value)] were found to be those obtained when using a 7-day grace period. RAMQ versus MED-ECHO estimates were: 12.2 versus 13.5 days (
A prerequisite for using administrative data to study the care of critically ill patients in intensive care units (ICUs) is that it accurately identifies such care. Only limited data exist on this subject.
To assess the accuracy of administrative data in the Canadian province of Manitoba for identifying the existence, number, and timing of admissions to adult ICUs.
For the period 1999 to 2008, we compared information about ICU care from Manitoba hospital abstracts, with the criterion standard of a clinical ICU database that includes all admissions to adult ICUs in its largest city of Winnipeg. Comparisons were made before and after a national change in administrative data requirements that mandated specific data elements identifying the existence and timing of ICU care.
In both time intervals, hospital abstracts were extremely accurate in identifying the presence of ICU care, with positive predictive values exceeding 98% and negative predictive values exceeding 99%. Administrative data correctly identified the number of separate ICU admissions for 93% of ICU-containing hospitalizations; inaccuracy increased with more ICU stays per hospitalization. Hospital abstracts were highly accurate for identifying the timing of ICU care, but only for hospitalizations containing a single ICU admission.
Under current national-reporting requirements, hospital administrative data in Canada can be used to accurately identify and quantify ICU care. The high accuracy of Manitoba administrative data under the previous reporting standards, which lacked standardized coding elements specific to ICU care, may not be generalizable to other Canadian jurisdictions.
Population-based incidence rates and trends of acute Achilles tendon ruptures are not known. It is also not known whether recent high-quality randomized controlled trials not favoring surgery have had an effect on treatment protocols.
To assess the incidence of acute Achilles tendon ruptures in Sweden and to examine the trends in surgical treatment.
Descriptive epidemiology study.
We conducted a nationwide registry-based study including all adult (=18 years of age) inpatient and outpatient hospital visits because of an acute Achilles tendon rupture in Sweden between 2001 and 2012.
We identified a total of 27,702 patients (21,979 men, 79%) with acute Achilles tendon ruptures between 2001 and 2012. In 2001, the sex-specific incidence of acute Achilles tendon ruptures was 47.0 (per 100,000 person-years) in men and 12.0 in women. In 2012, the corresponding values were 55.2 in men and 14.7 in women, with an increase of 17% in men and 22% in women. The proportion of surgically treated patients declined from 43% in 2001 to 28% in 2012 in men and from 34% in 2001 to 22% in 2012 in women.
The incidence of acute Achilles tendon ruptures in Sweden is increasing. The most probable reason for this increase is the rise in the number of older adults participating in high-demand sports. The proportion of surgically treated patients is decreasing most likely because of recent high-quality randomized controlled trials and their meta-analyses supporting similar results between surgical and nonsurgical approaches.
Department of Hallingdal sjukestugu, Medical Clinic of Ringerike General Hospital, Vestre Viken Hospital Trust, Norway and Hallingforsk, Ål Municipality, Ål, Norway. oystein.lappegard@vestreviken.no
Acute admissions to anywhere other than general hospitals are uncommon in Norway, but at Hallingdal sjukestugu, a community hospital in a rural district, this has been practiced for years. This article presents experiences from this practice. Materials and
Hallingdal sjukestugu is a decentralized, specialist healthcare service, under the administration and funding of Ringerike sykehus, the nearest general hospital, which is 170 km away. General practitioners under telephone supervision of the hospital specialists run the inpatient department. Six municipalities with 20,000 inhabitants make use of the community hospital. Statistics were obtained from the patient administration systems and from manual statistics continuously registered in 2009-10.
In 2009-10 the inpatient department, an intermediate care unit with 14 beds, had an average of 605 admissions a year, with a mean length of stay of 6.3 days. There were 455 acute admissions to Hallingdal sjukestugu. Forty per cent of these patients were younger than 67 and 36% were older than 80 years of age. Half were admitted for observation and half for treatment. The main diagnostic groups were infections, injuries and palliative care. Seventeen per cent of the acute admitted patients were later transferred to the general hospital for further work-up or treatment; 70% were discharged to their homes.
The experiences from Hallingdal sjukestugu indicate that it is feasible to give a selected group of patients an alternative to acute admissions to a general hospital.
