Assessment of Time to Hospital Encounter after an Initial Hospitalization for Heart Failure: Results from a Tertiary Medical Center

Background. Hospital inpatient readmissions for patients admitted initially with the primary diagnosis of heart failure (HF) can be as high as 20–25% within 30 days of discharge. This, however, does not include admissions for observations or emergency department (ED) visits within the same time frame and does not show a time-dependent hospital encounter following discharge after an index admission. We present data on time-dependent hospital encounter of HF patients discharged after an index admission for a primary diagnosis of HF. Methods. The study recruited patients from 2 hospitals within the same health system. 500 consecutive admissions with the ICD diagnosis of HF were reviewed by inclusion and exclusion screening criteria. The 166 eligible remaining patients were tracked for post hospital discharge encounters consisting of hospital admissions, observation stays, and ED visits. Only those with a primary diagnosis of heart failure were included. Demographics were recorded on all patients. Days until hospital inpatient readmissions or hospital encounters were displayed in Kaplan–Meier plots. Results. A total of 166 patients met inclusion criteria (mean age 79.3 years, males 54%). For the first 90 days following the index admission, there were a total of 287 follow-up visits (1.7 per patient), 1158 total hospitalization days (2.6 per visit, 7.0 per patient, and 8.6 per 100 days at risk), and 21 deaths (12.7%). At 30 days, 25% and 52% of patients had an inpatient readmission or a hospital encounter, respectively. The median time to inpatient readmission was 117 days and to hospital encounter was 27 days. Conclusion. Time-dependent excess days in acute care (unplanned inpatient admission, outpatient observation, and ED visit) rather than 30-day hospital inpatient readmission rate is a more realistic measure of the intensity of care required for HF patients after index admission

Medication use in the context of everyday living as understood by seniors

Recognizing that older adults are among the biggest consumers of medication, and the demographic group most likely to suffer an adverse drug reaction (ADR), this paper details the findings from a recent study on how older adults come to understand medication and its related use. Using a qualitative content analysis method, semi-structured interviews were conducted with 21 individuals from British Columbia, Canada. Study participants ranged in age from 65 to 89 years (male = 9, female = 11). Using NVIVO® 7 software, data were subjected to comparative thematic content analysis in an effort to capture the role of medication use in the context of everyday living as understood by older adults. While there was variability in how older adults come to understand their medication use, an overarching theme was revealed whereby most participants identified their prescription medications as being life-sustaining and prolonging. Deeper thematic content analysis of participant narratives drew attention to three key areas: (A) medications are viewed as a necessary, often unquestioned, aspect of day-to-day life (B) a relationship is perceived to exist between the amount of medications taken and ones current state of health (C) the overall medication experience is positively or negatively influenced by the doctor patient relationship and the assumption that it is the physicians role to communicate medication information that will support everyday living. The article concludes that medical authority and the complexities surrounding medication use need to undergo significant revision if community dwelling older adults are to experience greater success in safely managing their health and medication-related needs

Combined PET/MR: Where Are We Now? Summary Report of the Second International Workshop on PET/MR Imaging April 8-12, 2013, Tubingen, Germany

This workshop was held a year after the initial positron emission tomography/magnetic resonance (PET/MR) workshop in Tubingen, which was recently reported in this journal. The discussions at the 2013 workshop, however, differed substantially from those of the initial workshop, attesting to the progress of combined PET/MR as an innovative imaging modality. Discussions were focused on the search for truly novel, unique clinical and research applications as well as technical issues such as reliable and accurate approaches for attenuation and scatter correction of PET emission data. The workshop provided hands-on experience with PET and MR imaging. In addition, structured and moderated open discussion sessions, including six dialogue boards and two roundtable discussions, provided input from current and future PET/MR imaging users. This summary provides a snapshot of the current achievements and challenges for PET/MR