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Hospital Population (hospital + population)
Selected AbstractsOutcome Analysis of Patients with Squamous Cell Carcinoma of the Head and Neck and Hepatitis C Virus,THE LARYNGOSCOPE, Issue 10 2005Jason Hunt MD Abstract Objective/Hypothesis: Infection with the hepatitis C virus (HCV) is a global problem with over 170 million people infected. Recently, we have noticed that a large number of patients diagnosed with squamous cell carcinoma of the head and neck (SCCHN) have also been diagnosed with HCV. A review of the literature reveals little information concerning this patient population. The objective of this study was to compare the outcome of SCCHN patients who have been exposed to HCV with naïve SCCHN patients. Study Design: Retrospective chart review. Methods: A retrospective chart review from June 1991 through December 2002 was performed to identify patients diagnosed with SCCHN who were screened for HCV. Patients were stratified into two groups (HCV positive and HCV negative). Data were recorded on patients for status of disease at last clinic visit, pretreatment serum albumin and hematocrit levels, and RNA quantities of HCV. Statistical analysis was performed using paired t test to compare serum albumin and hematocrit levels. Kaplan-Meier survival curves were used to compare outcomes. The log-rank test was used to determine significance. Cox regression was used to examine the association of prognostic predictor variables with overall survival and disease-free survival. Results: There was no difference noted in 5 year survival between hepatitis C positive and hepatitis C negative groups in overall outcomes (66.7% vs. 67.9%, P = 1.000) or 5 year disease-free survival (90.5% vs. 80.8%, P = .514). The two groups, HCV positive versus HCV negative, also had similar serum albumin levels (3.62 g/dL vs. 3.72 g/dL, P = .37) as well as serum hematocrit levels (42.9% vs. 41.0%, P = .12). Serum levels of hepatitis C RNA were obtained in seven patients, with only one being undetectable. The only prognostic predictor variable that was significantly associated with overall survival was age. None of the predictor variables were significantly associated with disease-free survival. Conclusion: Co-infection with HCV, although prevalent in the Veterans Administration Hospital population, did not affect patient outcome as defined by disease-free survival. Patients who were seropositive for HCV had comparable serum albumin levels as well as serum hematocrit when compared with HCV negative patients. [source] Psychosis and offending in British Columbia: characteristics of a secure hospital populationCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 3 2001Nicola Hodelet Specialist Registrar Introduction There is an increased likelihood of violence in the mentally ill although the risk is small. Aims The study aimed to ascertain the features in a secure hospital population that linked offending and mental illness. Method A survey of patients in the high security hospital serving the province of British Columbia in Canada was carried out. Information on 175 mentally disordered offenders was extracted and included demographic data and specific characteristics of their offences, diagnoses and psychotic symptoms. Results The most prevalent offences were crimes of violence, but 39% of patients were not primarily violent offenders. Almost two-thirds (61%) had two or more diagnoses. A large majority of the patients were psychotic, schizophrenia being the most common diagnosis. There was a highly significant association between psychosis and violence, but the strength of the association was not increased by the presence of imperative hallucinations or delusions. The sample comprised various ethnic groups, one of which, Native Americans, was over-represented. However, no association was found between violent offending and ethnicity, or age or years of illness. Discussion The study replicates previous findings of the link between violent offending and psychosis, but not a specific link between violent offending and psychotic drive. A surprising finding was a lack of association between violent offences and substance misuse. Copyright © 2001 Whurr Publishers Ltd. [source] Casenote assessment of psychopathy in a high security hospitalCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2001Dr David Reiss Introduction There is now a large amount of data demonstrating the internal reliability and construct validity of the Hare Psychopathy Checklist (PCL/PCL-R) when used in the assessment of psychopathy in male forensic populations. It has well-established psychometric properties when scored following a review of collateral information and a subsequent interview. However, its internal reliability and factor structure, when casenote information alone has been used, have not been examined outside North America. Method A sample of 89 patients from a British high security hospital, with the legal classification of psychopathic disorder, was scored retrospectively on the PCL-R from their medical files only. The psychometric properties of the PCL-R were analysed. Results The PCL-R ratings showed a high level of internal reliability. The factor structure was very similar to that found in Hare's North American sample of forensic psychiatric patients. Discussion The findings support the application of the PCL-R, when scored using existing file data alone, to a British high security hospital population. Copyright © 2001 Whurr Publishers Ltd. [source] Dynamic pharyngeal collapse in racehorsesEQUINE VETERINARY JOURNAL, Issue S36 2006A. G. BOYLE Summary Reason for performing study: Dynamic pharyngeal collapse (PC) is a condition seen in racehorses that can be career-ending. Objectives: To characterise and grade PC and describe the effects of PC on athletic performance. Methods: Medical records were reviewed for 828 horses, of which 49 (6%) records were identified as horses with a primary diagnosis of PC. Tapes of video-endoscopy of the pharynx during exercise were reviewed. Each video recording was assigned a grade (0,4) reflecting the degree of PC and a classification for severity of upper airway obstruction. Earnings per race prior to diagnosis of PC were compared to earnings per race after diagnosis of PC for all horses, as well as performance index (PI). Available exercising arterial blood gases were reviewed for horses with PC. Results: There were 35 (80%) Thoroughbreds (TB), and 9 (20%) Standardbreds (STD). 32 (73%) had a history of making an upper respiratory noise. 4 (9%) grade 1 PC, 8 (18%) grade 2 PC, 26 (59%) grade 3 PC, and 6 (14%) grade 4 PC. Seven (16%) horses were classified as mild PC, 18 (41%) as low-moderate PC, 14 (32%) as high-moderate PC, and 5 (11%) as severe PC. Of 30 horses 11 had abnormally decreased PaO2 and 8 horses had abnormally elevated PaCO2. A significant decrease was found in earnings per race prediagnosis when compared to post diagnosis earnings per race in horses ?4 years of age (P = 0.003). A significant decrease was also observed for earnings per race prediagnosis when compared to post diagnosis earnings per race in horses with grade 3 PC (P = 0.03) No significant differences were observed in PI before or after diagnosis of PC. Conclusions: There was a trend for PC to be observed in more TB than STD, and more males than females compared to the general hospital population. Horses with PC significant had decreases in arterial oxygenation. Racing records after a diagnosis of PC in all horses ?4 years of age suggesting that older horses have a guarded prognosis for continued success. Potential relevance: This study provides a classification system for dynamic pharyngeal collapse and suggests that older racehorses (?4 years of age) diagnosed with PC and all horses with grade 3 PC have a poor prognosis for return to previous level of performance. [source] The cost effectiveness of specialised facilities for service users with persistent challenging behavioursHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2001Angela Hallam MSc Abstract Little systematic research relates specifically to the last people to leave a psychiatric hospital at the end of a closure programme. The long-running evaluation of the reprovision of services from Friern Hospital in North London allowed a special study to be made of such a group (67 people in all), whose range of problem behaviours made placement in community settings most difficult. The patients were relatively young, with a shorter length of stay than the remainder of the former long-stay hospital population. They were assessed three times: before leaving Friern, and one and 5 years after relocation. The social and clinical characteristics of each person were measured, and the full costs of their care calculated. The ,difficult-to-place' patients moved to four highly staffed rehabilitation facilities, where the total cost of their care was, on average, £1230 per week. There was no overall change in their psychiatric state over the 5 years after they left Friern Hospital although, in the longer-term, they gained skills in several areas of daily functioning. Most importantly, there was a fall of almost 50% in the number of challenging behaviours exhibited by the study group. At the five-year follow-up point, the cost of care had fallen, on average, by £170 per week, and 24 people had been able to move to more independent accommodation arrangements. Study participants had gained a new network of community service contacts, and used services provided by a greater variety of agencies. The indicators suggest that high expenditure on alternative care was justified retrospectively by overall long-term outcomes. An important policy lesson from the Friern Hospital reprovision study is that adequate funds should be reserved until the end of the closure programme to allow the investment of resources in provision for patients with the most severe problem behaviours. [source] Predicting pressure ulcer risk: a multifactorial approach to assess risk factors in a large university hospital populationJOURNAL OF CLINICAL NURSING, Issue 1 2009Michael Nonnemacher Aims., The purpose of this study was: (1) to determine the combination of risk factors which best predicts the risk of developing pressure ulcers among inpatients in an acute care university hospital; (2) to determine the appropriate weight for each risk factor; and (3) to derive a concise and easy-to-use risk assessment tool for daily use by nursing staff. Background., Efficient application of preventive measures against pressure ulcers requires the identification of patients at risk. Adequate risk assessment tools are still needed because the predictive value of existing tools is sometimes unsatisfactory. Design., Survey. Methods., A sample of 34,238 cases admitted to Essen University Clinics from April 2003 and discharged up to and including March 2004, was enrolled into the study. Nursing staff recorded data on pressure ulcer status and potential risk factors on admission. Predictors were identified and weighted by multivariate logistic regression. We derived a risk assessment scale from the final logistic regression model by assigning point values to each predictor according to its individual weight. Results., The period prevalence rate of pressure ulcers was 1·8% (625 cases). The analysis identified 12 predictors for developing pressure ulcers. With the optimum cut-off point sensitivity and specificity were 83·4 and 83·1%, respectively, with a positive predictive value of 8·4% and a negative predictive value of 99·6%. The diagnostic probabilities of the derived scale were similar to those of the original regression model. Conclusions., The predictors mostly correspond to those used in established scales, although the use of weighted factors is a partly novel approach. Both the final regression model and the derived scale show good prognostic validity. Relevance to clinical practice., The derived risk assessment scale is an easy-to-understand, easy-to-use tool with good prognostic validity and can assist in effective application of preventive measures against pressure ulcer. [source] Congenital Cardiac Defects in Neonatal Foals: 18 Cases (1992,2007)JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2010T.L. Hall Background: Literature available regarding congenital cardiac defects in foals is limited to reports of individual cases or small case series. Objective: To describe the clinical, echocardiographic, and necropsy findings and breed predilection of congenital cardiac defects in neonatal foals. Animals: Eighteen foals <15 days of age with 1 or more congenital cardiac defects. Methods: Medical records of foals diagnosed with congenital cardiac defects at the William R. Pritchard Veterinary Medical Teaching Hospital were reviewed. Data collected included history, signalment, clinical signs, laboratory data, diagnostic and necropsy results, and outcome. Results: Arabian foals represented 39% of cases with congenital cardiac defects and were significantly (P= .004) overrepresented (OR = 4.7 [CI: 1.8,12.4]) compared with the general hospital population. Ventricular septal defect (VSD) (14/18), tetralogy of Fallot (5/18), and tricuspid valve atresia (4/18) were the most common defects identified. A ,3/6 heart murmur (14/14) accompanied by tachycardia (14/17), tachypnea (17/17), and cyanosis of mucous membranes (7/16) were the most common clinical signs. Concurrent congenital defects were common (9/18). Two foals, both with VSD, survived for , 8 years after diagnosis and 1 was a successful performance horse. Conclusions and Clinical Relevance: Arabian horses appear to have a predisposition for cardiac defects. The presence of a loud murmur (, 3/6), cyanotic membranes, and tachycardia or tachypnea in a neonatal foal should warrant thorough evaluation of the heart for congenital defects. Foals with cardiac defects should be closely evaluated for concurrent congenital defects in other body systems. [source] Unplanned anesthesia-related admissions to pediatric intensive care , a 6-year auditPEDIATRIC ANESTHESIA, Issue 6 2007IRINA KUROWSKI MBBS FANZCA Summary Background:, Unplanned admissions to the intensive care unit may result from unexpected events related to anesthesia, and are recommended by some healthcare organizations as a clinical indicator. The rate of anesthesia-related unplanned admissions in adults ranges between 0.04% and 0.45% of procedures. However, there is a paucity of data relating to the rate in children. Methods:, Admissions to the pediatric intensive care unit (PICU) occurring within 24 h of anesthesia were identified through retrospective chart review. Only those admissions from a complication of anesthesia were included and not those from communication errors or surgical problems. The aim was to determine the rate of unplanned admissions, as well as the causes and management of this group of unplanned admissions. Results:, Seventy-six children requiring admission to the PICU were identified from 55196 procedures during the 6-year study period. The rate of unplanned admission was 0.14% of procedures. A total of 47% of these admissions were related to airway problems and 68% of children requiring admission were aged less than 5 years. Most children required only observation after their admission. Conclusions:, We found the unplanned admission rate to the PICU in our hospital population to be similar to that reported for adults, and is a relatively rare event in pediatric anesthesia. Most admissions were for children aged less than 5 years and were as a result of airway problems. Most cases were deemed potentially predictable. [source] Hepatitis C virus infection rates and risk factors in an Australian hospital endoscopy cohortAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 5 2009Karen Vickery Abstract Objective: To determine the reservoir and risk factors of HCV infection in a hospital population. Methods: The presence of anti-HCV in 2,119 endoscopy patients was related to putative risk factors for exposure using the SAS statistical package. Results: Most of the 4.7% of anti-HCV positive patients had multiple risk factors for HCV exposure. The risk was significantly increased in patients; with a previous history of hepatitis (36.4 fold), past history of injecting drugs (IDU) (32.1 fold), those born in North Africa, Middle East and Mediterranean countries (4.3 fold), had been tattooed before 1980s (3.3 fold), from 1980s-1990s (5.9 fold), had acupuncture before 1980s (3.8 fold), had a blood transfusion (3.6 fold), had clotting factors or growth hormone (4 fold), had contact with someone diagnosed with hepatitis in 1990s (4.1 fold). Of the anti-HCV patients 38 had a history of IDU, 43 were migrants and 10 were both. Conclusion: Anti-HCV prevalence was five times higher than predicted by the passive surveillance scheme and 20% of patients were unaware of their infection. Only one of these patients reported IDU. The evidence of HCV intersecting epidemics between developing and developed countries in Australia was strongly supported. Implications: The study provides a rational basis for targeted programs to identify asymptomatic HCV carriers who might benefit from the new antiviral treatment. [source] The Financial Impact of Ambulance Diversion on Inpatient Hospital Revenues and ProfitsACADEMIC EMERGENCY MEDICINE, Issue 1 2009Daniel A. Handel MD Abstract Objectives:, The objective was to study the association between ambulance diversion and weekly inpatient hospital revenues and profits. Methods:, This was a retrospective review of administrative data from one academic medical center from July 1, 2003, to December 31, 2006. Given the high amount of daily variability, inpatient hospital revenues and profits were collapsed by week and evaluated in four categories: no diversion, mild diversion (from >0 and <10 hours), moderate diversion (>10 and <20 hours), and high diversion (>20 hours). Revenues and profits for two categories of patients admitted to the hospital were calculated: 1) patients admitted from the emergency department (ED; i.e., those arriving by ambulance and by other means) and 2) electively admitted patients. Results:, A total of 166,460 ED patients were included in the analysis. Inpatient hospital revenues were included from 85,111 patients, 28,665 of which were admissions from the ED (33.7%). For patients admitted from the ED, the average weekly revenues during periods of high diversion were $265K higher than periods of no diversion. For patients admitted on an elective basis, revenues were significantly higher when comparing periods of mild divert to high diversion (an additional $415K weekly). The overall increase in profitability was significant for periods of severe divert compared to no divert ($119K per week). Conclusions:, Periods of greater diversion are associated with higher inpatient revenues and profits for ED, electively admitted patients, and the overall inpatient hospital population. Therefore, no financial disincentive exists from an inpatient perspective for the boarding of admitted patients in the ED and increasing periods of diversion. Efforts to decrease ambulance diversion must therefore be based on other rationales, like patient safety, quality of care, and improving access to care, or new models of reimbursement that reward hospitals for reducing ambulance diversion. [source] Validation of a six-graded faces scale for evaluation of postoperative pain in childrenPEDIATRIC ANESTHESIA, Issue 8 2003A. Bosenberg MBChB Summary Background: The faces pain scales are often used for self-report assessment of paediatric pain. The aim of this study was to evaluate the validity of a six-graded faces pain scale after surgery by comparing the level of agreement between the children's report of faces pain scores and experienced nurses' assessment of pain by observation of behaviour. The faces pain scores before, at and after administration of analgesics were analysed. The study was performed in two South African hospitals, one with a mainly rural population and the other with an urban population. Methods: A total of 110 children aged 4,12 years, scheduled for inguinal surgery in the two South African hospitals, were included in the study. The anaesthetic technique was standardized. All patients received a caudal block preoperatively. Postoperative pain assessments were made every hour for 8 h after the caudal block was performed. A designated nurse assessed pain by using a four-graded descriptive scale (no, mild, moderate or severe pain) and thereafter the child reported pain by using the six-graded faces pain scale. Results: A high correlation was found between the two methods of assessment (, = 0.76, P < 0.0001). The correlation between methods was high in both hospital populations and in all age groups. The weakest correlation was found in children aged 8,12 years (, = 0.56, P < 0.01). Significantly lower faces pain scores were found after administration of analgesics compared with pain rating before analgesics (P < 0.0001). The proportion of patients with pain scores above 2 decreased from 86% to 31% (P < 0.001). Conclusions: The findings support this six-graded faces pain scale as a useful and valid instrument for measuring pain in the postoperative period in children aged 4,12 years. [source] | ||||||||||