Search results

The purpose of this paper is to identify and analyse the readmission risk prediction tools reported in the literature and their benefits when it comes to healthcare organisations and management.

Readmission risk prediction is a growing topic of interest with the aim of identifying patients in particular those suffering from chronic diseases such as congestive heart failure, chronic obstructive pulmonary disease and diabetes, who are at risk of readmission. Several models have been developed with different levels of predictive ability. A structured and extensive literature search of several databases was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis strategy, and this yielded a total of 48,984 records.

Forty-three articles were selected for full-text and extensive review after following the screening process and according to the eligibility criteria. About 34 unique readmission risk prediction models were identified, in which their predictive ability ranged from poor to good (c statistic 0.5–0.86). Readmission rates ranged between 3.1 and 74.1% depending on the risk category. This review shows that readmission risk prediction is a complex process and is still relatively new as a concept and poorly understood. It confirms that readmission prediction models hold significant accuracy at identifying patients at higher risk for such an event within specific context.

Since most prediction models were developed for specific populations, conditions or hospital settings, the generalisability and transferability of the predictions across wider or other contexts may be difficult to achieve. Therefore, the value of prediction models remains limited to hospital management. Future research is indicated in this regard.

This review is the first to cover readmission risk prediction tools that have been published in the literature since 2011, thereby providing an assessment of the relevance of this crucial KPI to health organisations and managers.

The purpose of this paper is to identify published literature from a general hospital setting that may highlight variables implicated in the development of severe alcohol withdrawal syndrome (SAWS) in patients who have alcohol dependence syndrome (ADS).

A systematic literature review was carried out using the electronic databases: MEDLINE, Medline in Process, Cinahl, Embase and PsycINFO from 1989 to 2017. The focus of this search was on English language studies of individuals over 16 years admitted to general hospital with ADS, delirium tremens (DTs), alcohol-related seizure (ARS) or alcohol withdrawal syndrome (AWS).

Of the 205 studies screened, eight met the criteria for inclusion. Six studies were quantitative retrospective cohort and two were retrospective case-control. Six studies investigated risk factors associated with DTs, one examined SAWS and one alcohol kindling. Descriptive analysis was performed to summarise the empirical evidence from studies were 22 statistically significant risk factors were found; including the reason for admission to hospital, daily alcohol consumption, previous DTs and prior ARS. The last two factors mentioned appeared in two studies.

Further research should consider the quality and completeness of the alcohol history data and competence of staff generating the data in retrospective studies.

The paper suggests that the factors linked to SAWS development from the literature may not fully explain why some individuals who have ADS develop SAWS, and others do not.

The study aims to provide insights into the availability of common drugs with respect to disease load, regarding three common childhood diseases, acute respiratory infection (ARI), diarrhoea and malaria. The study flags an important issue regarding the level of expertise of the present system to address humanitarian logistics in case of emergency.

A mixed‐method approach using both qualitative and quantitative study techniques was used to collect data. Hospital level data were collected from randomly selected primary health centers and community health centers. a cohort of three community health centers and nine primary health centers were selected for the study. The data collected were both on disease load and availability of drugs during the study period (2009‐2012), using a retrospective cohort. Expert interviews were conducted of practising medical practitioners on classification of drugs into Vital, Essential and Desirable categories.

Results show that the month of September represents the highest morbidity (case loads of all three diseases taken together). Acute respiratory infection is most prevalent among the three diseases, with total case loads of 1,539 cases during the month of September (during 2009‐2012). However the Vital and Essential drugs availability for acute respiratory infection was found to be 7 per cent, 57 per cent for malaria and 98 per cent for diarrhoea. Drug supply was not only inadequate but also uneven and erratic, having weak correlation with the pattern of disease morbidity.

Cases who attended the government‐owned health centres were only considered for the study and it did not consider those who were attended by private practitioners. The study did highlight the capability of the system to manage ongoing health supplies and the extent of vulnerability it can pose in case of any humanitarian crisis but the latter remains outside the scope of the present study.

The study adds to the existing body of literature by demonstrating the gap that exists in availability of drugs against requirement, for common childhood illness. The study provides health policy makers with a useful guide to establish drugs requirement based on disease load, which holds policy implications across other low and middle income countries as well.

A literature review was carried out of the health impacts of incineration, landfill, composting, landspreading sewage sludge and sewage discharges. A protocol for making judgements about the strength and reliability of the evidence was applied using an algorithm with defined criteria. Possible judgements were “convincing”, “probable”, “possible” or “insufficient”. The review found that the evidence linking any adverse health outcomes with incineration, landfill or landspreading sewage sludge was “insufficient” to claim a causal association. The evidence is “insufficient” to link residence near a centralised composting facility with adverse health outcomes but it is “possible” that working at a centralised composting facility causes health problems. Working in sewage treatment plants “probably” causes gastrointestinal tract problems, headache, fatigue and airways symptoms. The only “convincing” evidence is that gastrointestinal symptoms result from bathing in sewage contaminated recreational waters.

Successive governments have called for greater “empowerment” of the patient, reflected in the chief medical officer's call for more patient‐related outcome measures (PROM). This paper aims to bring together three‐linked studies.

First study: in 1999, the neurosurgical patient was seen as “expert” to identify PROM outcomes, based upon a patient and carer‐designed self‐administered postal questionnaire in a regional two‐year retrospective survey of subarachnoid haemorrhage (SAH) patients with a 77 per cent response rate, designated treatment‐as‐usual (TAU) cohort (n=142).Second study: in the same region, following the implementing of the specialist neuro‐vascular nurse (SNVN), the SNVN recommendation was evaluated in a two‐year prospective study (n=184) that provided family‐specific psychosocial support and a continuity of care linking hospital and community; the response rate was 87 per cent. Third study: A re‐analysis of the national SAH study (n=2,380), by projecting the TAU and SNVN results onto clinically matched patients within the National cohort to estimate the potential “savings” if all 34 neurosurgical units had an SNVN type service.

First study: respondents identified many psychosocial and fiscal problems but recommended a SNVN to reduce these difficulties. Second study: the TAU and SNVN patient's were a close clinical match and using the TAU as a control group, it was found that there were major psychosocial and fiscal benefits for SNVN patients and carers, who more speedily re‐established their lives.Third study: it was estimated that this would have produced major financial benefits, e.g. 4,165 fewer bed occupancy days, saving £2.5million; reduced time‐off work for patients and carers, saving £8.1million; and, after deducting cost of a national SNVN service, a combined saving for the service and families of an estimated £9.83 million p.a. Thus, addressing PROM outcomes, through an integrated psychosocial service in neurosurgery was cost‐effective, benefited families, the service, and the wider economy and should be a factor when considering pressurised departmental budgets.

Overall, what the two regional studies and the re‐analysis of the national study showed was that there are benefits from treating the “patient as expert” and taking on board their agendas. There is a need for a more integrated approach to treatment and care that is of value to the service, patients, families and the wider economy.

This study was aimed to evaluate the implementation of an integrated antenatal care (ANC) scheme through a retrospective document study using a checklist for measuring the adequacy of the cohort ANC register documented by midwives in an urban area and to describe the barriers for the midwives during the ANC record process.

An exploratory descriptive study using a sequential mixed method was utilised where a quantitative method was employed by collecting secondary data of 150 entries of the cohort ANC register and followed by in-depth interviews among midwives and community health workers.

The results show that the cohort registry indicators for integrated care such as laboratory and management were poorly recorded. Several barriers were found and categorised during the implementation of the integrated ANC, namely (1) governance and strategy, (2) process of care, (3) organisation and management support.

The contribution of this present research is that it provides empirical data of the integrated ANC implementation in primary health care (PHC) which has the responsibility to deliver an integrated level of care for ANC using a cohort registry for pregnancy registration monitoring which facilitates the continuity and quality of care.

Practical implication of the finding is that functional integration such as the clinical information system to facilitate an efficient and effective approach during the implementation of integrated ANC in primary care should be considered to support the clinical, professional, organisational, system and normative integration.

Since only limited studies have been conducted to assess the quality of the cohort ANC registry and to investigate the barriers against integrated ANC implementation in Indonesia, the research findings are valuable information for the national and local governments to improve the ANC service in Indonesia.

The Adult Asperger Assessment (AAA), comprising the Autism Questionnaire, the Empathy Quiotient and the Relatives Questionnaire is a commonly used screening tool designed to identify adults who may benefit from a further clinical assessment for autism spectrum disorder. The purpose of this paper is to investigate the usefulness of this screening measure in a clinical setting.

This retrospective cohort study comprised of 192 service users referred for diagnostic assessment of Autism by a specialist service of the National Health Service. The authors evaluated the diagnostic accuracy of the AAA by investigating if the Autism Questionnaire, the Empathy Quiotient and the Relatives Questionnaire were able to predict the diagnostic outcome of Autism in a clinical setting.

Scores from the Relatives Questionnaire can accurately predict diagnostic outcome. No evidence of accuracy for the Autism Questionnaire or the Empathy Quotient was apparent. Based on the findings, the authors recommend clinicians are cautious when interpreting results of the AAA.

It should be acknowledged that the results may not be generalisable to whole populations. Also, the authors used the full item versions of the scales; therefore, the findings are most applicable to studies which did similar.

This study highlights the need for investigation into the lack of validation of commonly used screening measures in autistic populations.

The purpose of this paper is to develop an alcohol withdrawal syndrome risk stratification tool that could support the safe discharge of low risk patients from the emergency department.

A retrospective cohort study that included all patients referred to the acute addiction liaison nursing service over one calendar month (n=400, 1–30 April 2016) was undertaken. Bivariate and multivariate modelling identified the significant variables that supported the prediction of severe alcohol withdrawal syndrome (SAWS) in the cohort population.

The Glasgow Modified Alcohol Withdrawal Scale (GMAWS), hours since last drink, fast alcohol screening test (FAST) and systolic blood pressure correctly identified 89 per cent of patients who developed SAWS and 84 per cent of patients that did not. Increasing each component by a score of one is associated with an increase in the odds of SAWS by a factor of 2.76 (95% CI 2.21, 3.45), 1.31 (95% CI 1.24, 1.37), 1.30 (95% CI 1.08, 1.57) and 1.22 (95% CI 1.10, 1.34), respectively.

The research was conducted in a single healthcare system that had a high prevalence of alcohol dependence syndrome (ADS). Second, the developed risk stratification tool was unable to guarantee no risk and lastly, the FAST score previously aligned to severe ADS may have influenced the patients highest GMAWS score.

The tool could help redesign the care pathway for patients who attend the emergency department at risk of SAWS and link low risk patients with community alcohol services better equipped to deal with their physical and psychological needs short and long term supporting engagement, abstinence and prolongation of life.

The tool could help redesign the care pathway for emergency department patients at low risk of SAWS and link them with community alcohol services better equipped to deal with their physical and psychological needs, short and long term, supporting engagement, abstinence and prolongation of life.

Purpose – This study investigates the sociodemographics, late entry to antiretroviral therapy (ART), and clinical markers associated with AIDS-related mortality.

Methodology/Approach – Applying retrospective cohort design, 960 medical records of people who died of AIDS, from October 2006 to December 2014, were accessed from the ART center at tertiary health care center of Ranchi (India).

Findings – With useable data from 889 medical records revealed that the majority of people who died of AIDS consisted of married males in the age group of 19–40 years who were truck drivers, migrant laborers, and of rural origins. The median survival period was below 3 months following the ART. Males and people on the pre-ART group had a shorter survival period than their counterparts. Early mortality was associated with lower CD4+ T cell counts, the third or fourth clinical stage, ambulatory or bed-ridden functional status, and poor medication adherence.

Research limitations/implications – This study was limited to the analysis of AIDS deceased people only; it did not compare the survival duration with living people on ART. The lower CD4+ T cell counts and medication adherence, being strong predictors of mortality, can be addressed to attain higher survival rates of people who have AIDS.

Originality/Value of Paper – This is the first study conducted in the tribal-populated region, covering a large sample of 889 cases. Unique findings of this study update the existing data on AIDS-related mortality.

Very little is known about how weight gain during incarceration influences the health of people living in Canadian federal penitentiaries. To fill this knowledge gap, this study aims to determine how the observed weight gain influenced the development of obesity-related chronic diseases during incarceration.

This retrospective cohort study examined the association between weight gain and obesity-related chronic diseases for 1,420 participants incarcerated in federal penitentiaries in Ontario, New Brunswick and Nova Scotia. To participate, individuals had to be incarcerated for at least six months at the time of the study (2016–2017). Current anthropometric data were measured or taken from medical records, then compared to anthropometric data at the beginning of incarceration (mean follow-up of 5.0 years) to determine weight change (kg) and body mass index change (kg/m²) during incarceration. Then, information about obesity-related chronic diseases was drawn from the participants’ medical records.

Chi-square and nonparametric median comparison tests were performed to detect statistically significant changes in anthropometric data, to determine if a relationship was present. This study observed a significant association between weight gain and disease development for many types of obesity-related chronic diseases (e.g. cancer, type 2 diabetes, hypertension, dyslipidemia and sleep apnea). This confirmed an association between weight gain and chronic disease development in the prison population.

Participants who gained a significant amount of weight, during incarceration, were also more frequently diagnosed with obesity-related chronic diseases. These findings suggest that weight gain may contribute to the deterioration of peoples’ health during incarceration.