Effects of Promotional Materials on Attitudes and Fear towards Colorectal Cancer Screening among Chinese Older Adults: An Experimental Study

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Avoidable readmission in Hong Kong - system, clinician, patient or social factor?

<p>Abstract</p> <p>Background</p> <p>Studies that identify reasons for readmissions are gaining importance in the light of the changing demographics worldwide which has led to greater demand for hospital beds. It is essential to profile the prevalence of avoidable readmissions and understand its drivers so as to develop possible interventions for reducing readmissions that are preventable. The aim of this study is to identify the magnitude of avoidable readmissions, its contributing factors and costs in Hong Kong.</p> <p>Methods</p> <p>This was a retrospective analysis of 332,453 inpatient admissions in the Medical specialty in public hospital system in Hong Kong in year 2007. A stratified random sample of patients with unplanned readmission within 30 days after discharge was selected for medical record reviews. Eight physicians reviewed patients' medical records and classified whether a readmission was avoidable according to an assessment checklist. The results were correlated with hospital inpatient data.</p> <p>Results</p> <p>It was found that 40.8% of the 603 unplanned readmissions were judged avoidable by the reviewers. Avoidable readmissions were due to: clinician factor (42.3%) including low threshold for admission and premature discharge etc.; patient factor (including medical and health factor) (41.9%) such as relapse or progress of previous complaint, and compliance problems etc., followed by system factor (14.6%) including inadequate discharge planning, inadequate palliative care/terminal care, etc., and social factor (1.2%) such as carer system, lack of support and community services. After adjusting for patients' age, gender, principal diagnosis at previous discharge and readmission hospitals, the risk factors for avoidable readmissions in the total population i.e. all acute care admissions irrespective of whether there was a readmission or not, included patients with a longer length of stay, and with higher number of hospitalizations and attendance in public outpatient clinics and Accident and Emergency departments in the past 12 months. In the analysis of only unplanned readmissions, it was found that the concordance of the principal diagnosis for admission and readmission, and shorter time period between discharge and readmission were associated with avoidable readmissions.</p> <p>Conclusions</p> <p>Our study found that almost half of the readmissions could have been prevented. They had been mainly due to clinician and patient factors, in particular, both of which were intimately related to clinical management and patient care. These readmissions could be prevented by a system of ongoing clinical review to examine the clinical practice/decision for discharge, and improving clinical care and enhancing patient knowledge of the early warning signs for relapse. The importance of adequate and appropriate ambulatory care to support the patients in the community was also a key finding to reduce avoidable readmissions. Education on patient self-management should also be enhanced to minimize the patient factors with regard to avoidable readmission. Our findings thus provide important insights into the development of an effective discharge planning system which should place patients and carers as the primacy focus of care by engaging them along with the healthcare professionals in the whole discharge planning process.</p

A randomized, controlled clinical trial: the effect of mindfulness-based cognitive therapy on generalized anxiety disorder among Chinese community patients: protocol for a randomized trial

&lt;b&gt;Background&lt;/b&gt; Research suggests that an eight-week Mindfulness-Based Cognitive Therapy (MBCT) program may be effective in the treatment of generalized anxiety disorders. Our objective is to compare the clinical effectiveness of the MBCT program with a psycho-education programme and usual care in reducing anxiety symptoms in people suffering from generalized anxiety disorder.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods and Design&lt;/b&gt; A three armed randomized, controlled clinical trial including 9-month post-treatment follow-up is proposed. Participants screened positive using the Structure Clinical Interview for DSM-IV (SCID) for general anxiety disorder will be recruited from community-based clinics. 228 participants will be randomly allocated to the MBCT program plus usual care, psycho-education program plus usual care or the usual care group. Validated Chinese version of instruments measuring anxiety and worry symptoms, depression, quality of life and health service utilization will be used. Our primary end point is the change of anxiety and worry score (Beck Anxiety Inventory and Penn State Worry Scale) from baseline to the end of intervention. For primary analyses, treatment outcomes will be assessed by ANCOVA, with change in anxiety score as the baseline variable, while the baseline anxiety score and other baseline characteristics that significantly differ between groups will serve as covariates.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Discussion&lt;/b&gt; This is a first randomized controlled trial that compare the effectiveness of MBCT with an active control, findings will advance current knowledge in the management of GAD and the way that group intervention can be delivered and inform future research

Evidence for H2 Dissociation and Recombination Heat Transport in the Atmosphere of KELT-9b

Phase curve observations provide an opportunity to study the energy budgets of exoplanets by quantifying the amount of heat redistributed from their daysides to their nightsides. Theories of phase curves for hot Jupiters have focused on the balance between radiation and dynamics as the primary parameter controlling heat redistribution. However, recent phase curves have shown deviations from the trends that emerge from this theory, which has led to work on additional processes that may affect hot Jupiter energy budgets. One such process, molecular hydrogen dissociation and recombination, can enhance energy redistribution on ultra-hot Jupiters with temperatures above similar to 2000 K. In order to study the impact of H-2 dissociation on ultra-hot Jupiters, we present a phase curve of KELT-9b observed with the Spitzer Space Telescope at 4.5 mu m. KELT-9b is the hottest known transiting planet, with a 4.5 mu m dayside brightness temperature of 5 sigma confidence. This discrepancy may be due to magnetic effects in the planet's highly ionized atmosphere.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Constraining Exoplanet Metallicities and Aerosols with ARIEL: An Independent Study by the Contribution to ARIEL Spectroscopy of Exoplanets (CASE) Team

Launching in 2028, ESA's Atmospheric Remote-sensing Exoplanet Large-survey (ARIEL) survey of $\sim$1000 transiting exoplanets will build on the legacies of Kepler and TESS and complement JWST by placing its high precision exoplanet observations into a large, statistically-significant planetary population context. With continuous 0.5--7.8~$\mu$m coverage from both FGS (0.50--0.55, 0.8--1.0, and 1.0--1.2~$\mu$m photometry; 1.25--1.95~$\mu$m spectroscopy) and AIRS (1.95--7.80~$\mu$m spectroscopy), ARIEL will determine atmospheric compositions and probe planetary formation histories during its 3.5-year mission. NASA's proposed Contribution to ARIEL Spectroscopy of Exoplanets (CASE) would be a subsystem of ARIEL's FGS instrument consisting of two visible-to-infrared detectors, associated readout electronics, and thermal control hardware. FGS, to be built by the Polish Academy of Sciences' Space Research Centre, will provide both fine guiding and visible to near-infrared photometry and spectroscopy, providing powerful diagnostics of atmospheric aerosol contribution and planetary albedo, which play a crucial role in establishing planetary energy balance. The CASE team presents here an independent study of the capabilities of ARIEL to measure exoplanetary metallicities, which probe the conditions of planet formation, and FGS to measure scattering spectral slopes, which indicate if an exoplanet has atmospheric aerosols (clouds and hazes), and geometric albedos, which help establish planetary climate. Our design reference mission simulations show that ARIEL could measure the mass-metallicity relationship of its 1000-planet single-visit sample to $>7.5\sigma$ and that FGS could distinguish between clear, cloudy, and hazy skies and constrain an exoplanet's atmospheric aerosol composition to $>5\sigma$ for hundreds of targets, providing statistically-transformative science for exoplanet atmospheres.Comment: accepted to PASP; 23 pages, 6 figure

Unplanned readmission rates, length of hospital stay, mortality, and medical costs of ten common medical conditions: a retrospective analysis of Hong Kong hospital data

<p>Abstract</p> <p>Background</p> <p>Studies on readmissions attributed to particular medical conditions, especially heart failure, have generally not addressed the factors associated with readmissions and the implications for health outcomes and costs. This study aimed to investigate the factors associated with 30-day unplanned readmission for 10 common conditions and to determine the cost implications.</p> <p>Methods</p> <p>This population-based retrospective cohort study included patients admitted to all public hospitals in Hong Kong in 2007. The sample consisted of 337,694 hospitalizations in Internal Medicine. The disease-specific risk-adjusted odd ratio (OR), length of stay (LOS), mortality and attributable medical costs for the year were examined for unplanned readmissions for 10 medical conditions, namely malignant neoplasms, heart diseases, cerebrovascular diseases, pneumonia, injury and poisoning, nephritis and nephrosis, diabetes mellitus, chronic liver disease and cirrhosis, septicaemia, and aortic aneurysm.</p> <p>Results</p> <p>The overall unplanned readmission rate was 16.7%. Chronic liver disease and cirrhosis had the highest OR (1.62, 95% confidence interval (CI) 1.39-1.87). Patients with cerebrovascular disease had the longest LOS, with mean acute and rehabilitation stays of 6.9 and 3.0 days, respectively. Malignant neoplasms had the highest mortality rate (30.8%) followed by aortic aneurysm and pneumonia. The attributed medical cost of readmission was highest for heart disease (US$3 199 418, 95$2 579 443-803 393).</p> <p>Conclusions</p> <p>Our findings showed variations in readmission rates and mortality for different medical conditions which may suggest differences in the quality of care provided for various medical conditions. In-hospital care, comprehensive discharge planning, and post-discharge community support for patients need to be reviewed to improve the quality of care and patient health outcomes.</p

Towards a global partnership model in interprofessional education for cross-sector problem-solving

Objectives A partnership model in interprofessional education (IPE) is important in promoting a sense of global citizenship while preparing students for cross-sector problem-solving. However, the literature remains scant in providing useful guidance for the development of an IPE programme co-implemented by external partners. In this pioneering study, we describe the processes of forging global partnerships in co-implementing IPE and evaluate the programme in light of the preliminary data available. Methods This study is generally quantitative. We collected data from a total of 747 health and social care students from four higher education institutions. We utilized a descriptive narrative format and a quantitative design to present our experiences of running IPE with external partners and performed independent t-tests and analysis of variance to examine pretest and posttest mean differences in students’ data. Results We identified factors in establishing a cross-institutional IPE programme. These factors include complementarity of expertise, mutual benefits, internet connectivity, interactivity of design, and time difference. We found significant pretest–posttest differences in students’ readiness for interprofessional learning (teamwork and collaboration, positive professional identity, roles, and responsibilities). We also found a significant decrease in students’ social interaction anxiety after the IPE simulation. Conclusions The narrative of our experiences described in this manuscript could be considered by higher education institutions seeking to forge meaningful external partnerships in their effort to establish interprofessional global health education