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Hospital Presentation (hospital + presentation)

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Medical Sciences100%

Selected Abstracts

The epidemiology of cannabis use and cannabis-related harm in Australia 1993,2007

ADDICTION, Issue 6 2010
Amanda Roxburgh
ABSTRACT Aims To examine trends in patterns of cannabis use and related harm in the Australian population between 1993 and 2007. Design Analysis of prospectively collected data from: (1) the National Drug Strategy Household Survey (NDSHS) and Australian Secondary Student Alcohol and Drug Survey (ASSADS); (2) the National Hospital Morbidity Database (NHMD); and (3) the Alcohol and Other Drug Treatment Services National Minimum Dataset (AODTS-NMDS). Participants Australians aged 14 years and over from the general population; students aged 12,17 years; public and private hospital in-patients; public and private in-patients and out-patients attending for drug treatment. Measurement Prevalence of 12-month cannabis use among the general population and secondary students. Proportions in the general population by age group reporting: daily cannabis use; difficulties in controlling cannabis use; and heavy cannabis use on each occasion. Number of hospital and treatment presentations for cannabis-related problems. Findings Prevalence of past-year cannabis use has declined in the Australian population since the late 1990s. Among those reporting past-year use, daily use is prevalent among 40,49-year-olds, while heavy patterns of use are prevalent among 14,19-year-olds. Hospital presentations for cannabis-related problems reflect similar trends. Past-year cannabis use has decreased among the 10,19-year age group, but those who are daily users in this age group report using large quantities of cannabis. Conclusions Despite declines in the prevalence of cannabis use, continued public health campaigns warning of the harms associated with cannabis use are essential, aimed particularly at users who are already experiencing problems. The increasing demand for treatment for cannabis problems in Australia suggests the need for more accessible and more effective interventions for cannabis use disorders. [source]

Pathophysiology of ketoacidosis in Type 2 diabetes mellitus

DIABETIC MEDICINE, Issue 10 2005
P. Linfoot
Abstract Aims Despite an increasing number of reports of ketoacidosis in populations with Type 2 diabetes mellitus, the pathophysiology of the ketoacidosis in these patients is unclear. We therefore tested the roles of three possible mechanisms: elevated stress hormones, increased free fatty acids (FFA), and suppressed insulin secretion. Methods Forty-six patients who presented to the Emergency Department with decompensated diabetes (serum glucose > 22.2 mmol/l and/or ketoacid concentrations , 5 mmol/l), had blood sampled prior to insulin therapy. Three groups of subjects were studied: ketosis-prone Type 2 diabetes (KPDM2, n = 13) with ketoacidosis, non-ketosis-prone subjects with Type 2 diabetes (DM2, n = 15), and ketotic Type 1 diabetes (n = 18). Results All three groups had similar mean plasma glucose concentrations. The degree of ketoacidosis (plasma ketoacids, bicarbonate and anion gap) in Type 1 and 2 subjects was similar. Mean levels of counterregulatory hormones (glucagon, growth hormone, cortisol, epinephrine, norepinephrine), and FFA were not significantly different in DM2 and KPDM2 patients. In contrast, plasma C-peptide concentrations were approximately three-fold lower in KPDM2 vs. non-ketotic DM2 subjects (P = 0.0001). Type 1 ketotic subjects had significantly higher growth hormone (P = 0.024) and FFA (P < 0.002) and lower glucagon levels (P < 0.02) than DM2. Conclusions At the time of hospital presentation, the predominant mechanism for ketosis in KPDM2 is likely to be greater insulinopenia. [source]

Adolescent emergency department presentations with alcohol- or other drug-related problems in Perth, Western Australia

ADDICTION, Issue 7 2001
Gary K. Hulse
Aims. To identify the morbidity, type of substance used and the pattern of presentation by adolescents with problems related to alcohol or other drug (AOD) use. Design. A 4-week retrospective review of hospital records. Setting. Four metropolitan hospitals in Perth, Australia. Participants. There were 1064 presentations by people aged 12-19 years of which 160 (15%) were related to AOD use. The median age of the AOD cases was 17 (interquartile range 16-19) of whom 97 (61%) were male and 19 (12%) were Indigenous Australians. Findings. Alcohol was the most frequent precursor to presentation (66, 41%) followed by heroin (24, 15%) and prescription/over-the-counter drugs (24, 15%). Injury was the most common diagnosis at presentation (50, 31%), followed by overdose/drug use (47, 29%). A diagnosis of injury was significantly more likely following the use of alcohol than other categories of substances (,2 = 42.07, df = 3, p < 0.001). Deliberate self-harm (DSH) occurred in more female than male cases (,2 = 7.4, df = 1, p < 0.01). Presentations were more frequent over the weekend (102, 64%) than on weekdays, and the length of stay was significantly shorter for weekend cases (Mann-Whitney U 2132, p < 0.05). Conclusions. Given the small window of opportunity to provide AOD treatment to youth following hospital presentation, a number of suggestions are made. From a harm-minimization perspective the focus of interventions should be on alcohol use by male youth and DSH associated with prescription/over-the-counter drug use by female adolescents. In addition, Indigenous youth are over-represented in hospital presentations, but there is currently a lack of evaluated interventions designed for them. [source]

Healthcare-associated candidemia,A distinct entity?,

JOURNAL OF HOSPITAL MEDICINE, Issue 5 2010
Joyti Gulia MD
Abstract BACKGROUND: The concept of health care-associated infection (HCAI) was developed to address the fact that select patients now present to the hospital with infections due to traditionally nosocomial pathogens. Although epidemiologic studies document the clear existence of health care-associated pneumonia, little is known about fungal pathogens and their role in HCAIs. OBJECTIVE: To describe the epidemiology of health care-associated bloodstream infections (BSIs) due to candida species and to compare patients with HCA candidemia to nosocomial candidemia. DESIGN: Retrospective case series. SETTING: Academic, tertiary care hospital. MEASUREMENTS: We measured the proportion of cases of candidal BSI classified as health care-associated along with the microbiology of these infections. We compared health care-associated and nosocomial cases of candidemia with respect to demographics, severity of illness, and fluconazole susceptibility. RESULTS: We noted 233 cases of candidal BSI over a 3-year period. Nearly one-quarter represented an HCAI that presented to the hospital, as opposed to a nosocomial process. Although patients with HCA candidemia were similar to subjects with nosocomial infection in terms of underlying comorbidities and severity of illness, those with HCA yeast BSI were more likely to be immunosuppressed and to have their infection caused by a fluconazole-resistant organism. C. glabrata was seen more often in patients presenting to the hospital with an HCA case of candidemia. CONCLUSIONS: Clinicians must recognize the potential for candida species to cause HCA infections and to be present at time of hospital presentation. Physicians need to consider this and the distribution of species of yeast causing BSI in their institution when considering initial therapy for patients with a suspected BSI. Journal of Hospital Medicine 2010;5:298,301. © 2010 Society of Hospital Medicine. [source]

Hospitalized patients with acute decompensated heart failure: Recognition, risk stratification, and treatment review

JOURNAL OF HOSPITAL MEDICINE, Issue S6 2008
Alpesh Amin MD
Abstract Acute decompensated heart failure (ADHF) has emerged as a major healthcare problem. It causes approximately 3% of all hospitalizations in the United States, with the direct medical cost of these hospitalizations estimated at $18.8 billion per year. Early recognition, risk stratification, and evidence-based treatment are crucial in reducing the morbidity, mortality, and costs associated with this disorder. Classic signs and symptoms of ADHF, such as rales, dyspnea, and peripheral edema, may be absent at hospital presentation and, even when present, are not specific to this disorder. As a result, serum B,type natriuretic peptide level is now used to rapidly and accurately detect ADHF. Multivariate analyses have identified renal dysfunction, hypotension, advanced age, hyponatremia, and comorbidities as significant and independent mortality risk factors. Based on these factors, mortality risk can be stratified from very low to very high using published algorithms that have been validated in independent populations. Evidence-based guidelines for the treatment of ADHF are available from both the European Society of Cardiology and the Heart Failure Society of America. In general, an intravenous loop diuretic, either alone or in combination with a vasodilator, is recommended as initial therapy in patients with volume overload, depending on the patient's clinical status. Use of inotropic agents should be limited to the small subset of patients with low-output syndrome and significant hypotension. In any event, frequent monitoring of clinical response is essential, with subsequent therapy determined by this response. Finally, focused patient education during hospitalization may help reduce readmissions for ADHF. Journal of Hospital Medicine 2008;3(Suppl 6):S16,S24. © 2008 Society of Hospital Medicine. [source]

Adolescent emergency department presentations with alcohol- or other drug-related problems in Perth, Western Australia

ADDICTION, Issue 7 2001
Gary K. Hulse
Aims. To identify the morbidity, type of substance used and the pattern of presentation by adolescents with problems related to alcohol or other drug (AOD) use. Design. A 4-week retrospective review of hospital records. Setting. Four metropolitan hospitals in Perth, Australia. Participants. There were 1064 presentations by people aged 12-19 years of which 160 (15%) were related to AOD use. The median age of the AOD cases was 17 (interquartile range 16-19) of whom 97 (61%) were male and 19 (12%) were Indigenous Australians. Findings. Alcohol was the most frequent precursor to presentation (66, 41%) followed by heroin (24, 15%) and prescription/over-the-counter drugs (24, 15%). Injury was the most common diagnosis at presentation (50, 31%), followed by overdose/drug use (47, 29%). A diagnosis of injury was significantly more likely following the use of alcohol than other categories of substances (,2 = 42.07, df = 3, p < 0.001). Deliberate self-harm (DSH) occurred in more female than male cases (,2 = 7.4, df = 1, p < 0.01). Presentations were more frequent over the weekend (102, 64%) than on weekdays, and the length of stay was significantly shorter for weekend cases (Mann-Whitney U 2132, p < 0.05). Conclusions. Given the small window of opportunity to provide AOD treatment to youth following hospital presentation, a number of suggestions are made. From a harm-minimization perspective the focus of interventions should be on alcohol use by male youth and DSH associated with prescription/over-the-counter drug use by female adolescents. In addition, Indigenous youth are over-represented in hospital presentations, but there is currently a lack of evaluated interventions designed for them. [source]

Trends in paediatric injury rates using emergency department based injury surveillance

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2010
Michael Shepherd
Abstract Objective: The primary aim of this study was to develop a method of calculating paediatric injury rate from Emergency Department injury surveillance data and use this to describe trends in paediatric injury. This study also aimed to establish whether triage category could be used as an indicator of severity. Methods: Prospective observational study of paediatric injury in Brisbane, Australia from 1998 to 2005 using Emergency Department injury surveillance data. Injury incidence was calculated using postcode restriction, census data and analysis of injury surveillance data quality and alternative hospital presentations. Results: The incidence of Emergency Department injury presentation increased by 56% between 1998 and 2005. The incidence of injury (adjusted for ascertainment and other hospital presentations) increased from 5,323/100,000/year to 8,316/100,000/year (p<0.01). The overall incidence of admission increased from 1,066/100,000/year to 1,238/100,000/year (p<0.01). The incidence of injury presentations triaged as urgent or above increased by 16% over the study period (2,348/100,000/year to 2,723/100,000/year, p<0.01). Conclusion: Injury incidence can be determined using Emergency Department injury surveillance data and triage category is a useful indicator of injury severity. Paediatric emergency department injury presentations, including serious injury, increased significantly between 1998 and 2005. Implications: The methodology used in this study is easily repeatable and could be used to evaluate injury prevention interventions. The prevention and management of injury should be directed by accurate injury incidence data. [source]