Geographic distribution of asthma and chronic obstructive pulmonary disease hospitalisations in Australia: 2007-08 to 2009-10

This report shows how asthma and chronic obstructive pulmonary disease (COPD) hospitalisations vary across Australia. It also examines the association between these hospitalisation rates and socioeconomic status (SES), remoteness and the proportion of Indigenous Australians in different locations across Australia. Maps presented in this report show higher hospitalisation rates for both asthma and COPD in inland Australia and rural areas. Asthma hospitalisation rates are also higher in certain coastal areas in Queensland, in south-east South Australia and in south Western Australia. In comparison, COPD hospitalisation rates are higher in much of the Northern Territory and north-west Western Australia. Further investigation found that SES, remoteness and the proportion of the population that identifies as Indigenous all had a significant association with the hospitalisation rates for asthma and COPD by area. There may be further reasons for the variation in hospitalisation rates for asthma and COPD, such as: location specific factors, such as air pollution and allergic triggersaccess to hospital and primary care servicesvariation in smoking rates. These issues could be explored in further studies

Visualising linked health data to explore health events around preventable hospitalisations in NSW Australia

Objective: To explore patterns of health service use in the lead-up to, and following, admission for a ‘preventable’ hospitalisation. Setting: 266 950 participants in the 45 and Up Study, New South Wales (NSW) Australia Methods: Linked data on hospital admissions, general practitioner (GP) visits and other health events were used to create visual representations of health service use. For each participant, health events were plotted against time, with different events juxtaposed using different markers and panels of data. Various visualisations were explored by patient characteristics, and compared with a cohort of non-admitted participants matched on sociodemographic and health characteristics. Health events were displayed over calendar year and in the 90 days surrounding first preventable hospitalisation. Results: The visualisations revealed patterns of clustering of GP consultations in the lead-up to, and following, preventable hospitalisation, with 14% of patients having a consultation on the day of admission and 27% in the prior week. There was a clustering of deaths and other hospitalisations following discharge, particularly for patients with a long length of stay, suggesting patients may have been in a state of health deterioration. Specialist consultations were primarily clustered during the period of hospitalisation. Rates of all health events were higher in patients admitted for a preventable hospitalisation than the matched non-admitted cohort. Conclusions: We did not find evidence of limited use of primary care services in the lead-up to a preventable hospitalisation, rather people with preventable hospitalisations tended to have high levels of engagement with multiple elements of the healthcare system. As such, preventable hospitalisations might be better used as a tool for identifying sicker patients for managed care programmes. Visualising longitudinal health data was found to be a powerful strategy for uncovering patterns of health service use, and such visualisations have potential to be more widely adopted in health services research

Predicting risk of hospitalisation: a retrospective population-based analysis in a paediatric population in Emilia-Romagna, Italy.

OBJECTIVES: Develop predictive models for a paediatric population that provide information for paediatricians and health authorities to identify children at risk of hospitalisation for conditions that may be impacted through improved patient care. DESIGN: Retrospective healthcare utilisation analysis with multivariable logistic regression models. DATA: Demographic information linked with utilisation of health services in the years 2006-2014 was used to predict risk of hospitalisation or death in 2015 using a longitudinal administrative database of 527 458 children aged 1-13 years residing in the Regione Emilia-Romagna (RER), Italy, in 2014. OUTCOME MEASURES: Models designed to predict risk of hospitalisation or death in 2015 for problems that are potentially avoidable were developed and evaluated using the C-statistic, for calibration to assess performance across levels of predicted risk, and in terms of their sensitivity, specificity and positive predictive value. RESULTS: Of the 527 458 children residing in RER in 2014, 6391 children (1.21%) were hospitalised for selected conditions or died in 2015. 49 486 children (9.4%) of the population were classified in the \u27At Higher Risk\u27 group using a threshold of predicted risk \u3e2.5%. The observed risk of hospitalisation (5%) for the \u27At Higher Risk\u27 group was more than four times higher than the overall population. We observed a C-statistic of 0.78 indicating good model performance. The model was well calibrated across categories of predicted risk. CONCLUSIONS: It is feasible to develop a population-based model using a longitudinal administrative database that identifies the risk of hospitalisation for a paediatric population. The results of this model, along with profiles of children identified as high risk, are being provided to the paediatricians and other healthcare professionals providing care to this population to aid in planning for care management and interventions that may reduce their patients\u27 likelihood of a preventable, high-cost hospitalisation

Asthma hospitalisations in Australia 2010-11

This report provides an overview of asthma hospitalisation patterns over time and across population groups.SummaryAsthma is a common chronic condition of the airways, associated with episodes of wheezing, breathlessness, chest tightness and cough. Hospitalisation for asthma is rarely required as most symptoms are managed in the community through medication use and primary health care interventions. However, in cases where asthma exacerbations cannot be managed at home, hospitalisation may be required. This report provides an overview of these asthma hospitalisation patterns over time and across population groups. In 2010-11 there were 37,830 hospitalisations where asthma was the principal diagnosis. The asthma hospitalisation rate (175 per 100,000 population) is low compared with other countries. Hospitalisation for asthma decreased between 1998-99 and 2010-11. There was an overall reduction in the rate of hospitalisation for asthma among both children (33%) and adults (45%). Asthma hospitalisation rates varied across population groups in 2010-11: The rate for Indigenous Australians was 2.1 times the rate for Other Australians.Among adults, rates were higher in areas that were more remote (83 per 100,000 population in Major cities and 214 per 100,000 in Very remote regions). This pattern was reversed among children, where rates were lower in areas that were more remote (511 per 100,000 in Major cities and 404 per 100,000 in Very remote regions).Rates were higher among people living in areas with the lowest socioeconomic status (209 per 100,000 population) than for those living in areas with the highest socioeconomic status (134 per 100,000 population).Rates for people born in a non-English-speaking country were lower than for those born in an English-speaking country, with the exception of those aged over 65, where the rates were higher. Children had higher rates of hospitalisation for asthma than adults (495 compared with 92 per 100,000 population) although adults tended to stay in hospital for asthma longer than children: on average, 2.9 days compared with 1.5 days. One in four people hospitalised with a principal diagnosis of asthma in 2010-11 had an acute respiratory infection recorded as an additional diagnosis. Direct health expenditure for asthma was $655 million in 2008-09. The pattern of expenditure on asthma differs somewhat from the pattern for diseases overall. Half (50%) of all asthma expenditure in 2008-09 was attributed to prescription pharmaceuticals, (compared to 14% across all diseases) and a substantially lower proportion of asthma expenditure was attributed to admitted patient hospital care (20%), compared with total recurrent health expenditure across all diseases (52%)

What happened to my legs when I broke my arm?

This case report describes an incident that occurred during the course of a research intervention study. Participants in the study were continually monitored with an activPAL activity monitor. Whilst wearing the monitor a participant had a fall causing musculoskeletal trauma requiring hospital admission. The patient was admitted for an acute hospital stay (3 days) for management of the upper limb injury. The case report presents the measurement of the participant’s sedentary time before the incident, during hospitalisation and post discharge. The report is relevant for education and service design both in hospital and in the community settings as it demonstrates the rapid influence of an upper limb injury and consequences beyond the hospital bed. This report is novel as it presents not only hospitalisation and post hospital activity, but also provides insight into the individual’s actual objective (rather than retrospective self-report) activity patterns before hospitalisation. The infographic presentation has been chosen to allow quick and easy understanding of information

Frailty is independently associated with increased hospitalisation days in patients on the liver transplant waitlist

AIM: To investigate the impact of physical frailty on risk of hospitalisation in cirrhotic patients on the liver transplant waitlist. METHODS: Cirrhotics listed for liver transplantation at a single centre underwent frailty assessments using the Fried Frailty Index, consisting of grip strength, gait speed, exhaustion, weight loss, and physical activity. Clinical and biochemical data including MELD score as collected at the time of assessment. The primary outcome was number of hospitalised days per year; secondary outcomes included incidence of infection. Univariable and multivariable analysis was performed using negative binomial regression to associate baseline parameters including frailty with clinical outcomes and estimated incidence rate ratios (IRR). RESULTS: Of 587 cirrhotics, 64% were male, median age (interquartile range) was 60 (53-64) years and MELD score was 15 (12-18). Median Fried Frailty Index was 2 (1-3); 31.6% were classified as frail (fried frailty ≥ 3). During 12 mo of follow-up, 43% required at least 1 hospitalisation; 38% of which involved major infection. 107/184 (58%) frail and 142/399 (36%) non-frail patients were hospitalised at least once (P < 0.001). In univariable analysis, Fried Frailty Index was associated with total hospitalisation days per year (IRR = 1.51, 95%CI: 1.28-1.77; P ≤ 0.001), which remained significant on multivariable analysis after adjustment for MELD, albumin, and gender (IRR for frailty of 1.21, 95%CI: 1.02-1.44; P = 0.03). Incidence of infection was not influenced by frailty. CONCLUSION: In cirrhotics on the liver transplant waitlist, physical frailty is a significant predictor of hospitalisation and total hospitalised days per year, independent of liver disease severity

Some Reflections on Liberty : Bruce Winick’s ‘Civil Commitment: A Therapeutic Jurisprudence Model’

In the United States, involuntary hospitalisation of the mentally ill through the civil commitment process results in a curtailment of the fundamental liberty interest of freedom from external restraint; part of the constitutional guarantee. Apart from the loss of freedom through physical confinement, the labelling that inevitably accompanies commitment can give rise to significant social stigma and restricted life chances. In the last fifty-years, the power of doctors to commit on a best interests basis has been replaced by a legal process in which the grounds for involuntary hospitalisation have been restricted and the rights of patients prioritised. The problems inherent to both models have led to the development of therapeutic jurisprudence in which the therapeutic possibilities of law and the legal process are studied with the aim of optimising the therapeutic outcomes of commitment. Any model of involuntary hospitalisation necessarily gives rise to basic philosophical and political questions about the nature of individual liberty, of freedom and of the relationship between the individual and the state. As historically contingent concepts, what meaning can be attached to them and the goal of striving for a better balance in the context of the mentally ill between freedom and coercion

Hospitalisation

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Chronic exposure to ivabradine reduces readmissions in the vulnerable phase after hospitalization for worsening systolic heart failure: a post-hoc analysis of SHIFT

Aims: During the post-discharge phase following a heart failure hospitalization (HFH), patients are at high risk of early readmission despite standard of care therapy. We examined the impact of chronic exposure to ivabradine on early readmissions in patients hospitalized for heart failure during the course of the SHIFT study (Systolic Heart Failure treatment with the If inhibitor ivabradine Trial). Methods and results: A total of 1186 of the 6505 randomized patients experienced at least one HFH during the study, and had a more severe profile than those without HFH. Of these 1186 patients, 334 patients (28%) were rehospitalized within 3 months for any reason, mostly for cardiovascular causes (86%), including HFH (61%). Ivabradine was associated with fewer all-cause hospitalizations at 1 month [incidence rate ratio (IRR) 0.70, 95% confidence interval (CI) 0.50–1.00, P &#60; 0.05], 2 months (IRR 0.75, 95% CI 0.58–0.98, P = 0.03), and 3 months (IRR 0.79, 95% CI 0.63–0.99, P = 0.04). A trend for a reduction in cardiovascular and HF hospitalizations was also observed in ivabradine-treated patients. Conclusion: We demonstrate in this post-hoc analysis that chronic exposure to ivabradine reduces the incidence of all-cause hospitalizations during the vulnerable phase after a HFH. Further studies are needed to investigate if in-hospital or early post-discharge initiation of ivabradine could be useful to improve early outcomes in patients hospitalized for HF

Systemic hypertension in cats with acute kidney injury

Retrospective study of cats presenting to the Queen Mother Hospital for Animals, Royal Veterinary College with acute kidney injury between 2007 and 2015. Systolic blood pressure was measured using Doppler sphygmomanometry and systemic hypertension was defined pressures ê150 mmHg. Median systolic blood pressure measurement, grade of acute kidney injury (as defined by the International Renal Interest Society), serum creatinine on admission, anuria or oliguria, length of hospitalisation, survival to discharge and six‐month survival were all recorded