Hospital Admissions from Nursing Homes: Rates and Reasons

Hospital admissions from nursing homes have not previously been investigated in Norway. During 12 months all hospital admissions (acute and elective) from 32 nursing homes in Bergen were recorded via the Norwegian ambulance register. The principal diagnosis made during the stay, length of stay, and the ward were sourced from the hospital's data register and data were merged. Altogether 1,311 hospital admissions were recorded during the 12 months. Admissions from nursing homes made up 6.1% of the total number of admissions to medical wards, while for surgical wards they made up 3.8%. Infections, fractures, cardiovascular and gastri-related diagnoses represented the most frequent admission diagnoses. Infections accounted for 25.0% of admissions, including 51.0% pneumonias. Of all the admissions, fractures were the cause in 10.2%. Of all fractures, hip fractures represented 71.7. The admission rate increased as the proportion of short-term beds increased, and at nursing homes with short-term beds, admissions increased with increasing physician coverage. Potential reductions in hospitalizations for infections from nursing homes may play a role to reduce pressure on medical departments as may fracture prevention. Solely increasing physician coverage in nursing homes will probably not reduce the number of hospitalizations

Can Electronic Tools Help Improve Nursing Home Quality?

Background. Nursing homes face challenges in the coming years due to the increased number of elderly. Quality will be under pressure, expectations of the services will rise, and clinical complexity will grow. New strategies are needed to meet this situation. Modern clinical information systems with decision support may be part of that. Objectives. To study the impact of introducing an electronic patient record system with decision support on the use of warfarin, neuroleptics and weighing of patients, in nursing homes. Methods. A prevalence study was performed in seven nursing homes with 513 subjects. A before-after study with internal controls was performed. Results. The prevalence of atrial fibrillation in the seven nursing homes was 18.8%. After intervention, the proportion of all patients taking warfarin increased from 3.0% to 9.8% (P = 0.0086), neuroleptics decreased from 33.0% to 21.5% (P = 0.0121), and the proportion not weighed decreased from 72.6% to 16.0% (P < 0.0001). The internal controls did not change significantly. Conclusion. Statistics and management data can be continuously produced to monitor the quality of work processes. The electronic health record system and its system for decision support can improve drug therapy and monitoring of treatment policy

Wind tunnel experiment with an EPP-wing to investigate aeroelastic effects of nonlinear elastic stiffnesses

Background: Nonlinear elastic, especially degressive, stiffnesses can reduce the wing root bending moment for design loadcases, while the cruise flight shape remains unchanged. Objective: The aim of the wind tunnel experiment is to show up the behaviour of a wing with a degressive stiffness. The tested wing is made of expanded polypropylene foam (EPP). Method: A flexural bending test is conducted to gain the bending stiffness of EPP for different densities and a wind tunnel test is performed to obtain the dependency between bending moment and deflection. The findings are compared to the results of an aeroelastic method based on a nonlinear elastic beam. Results: The bending stiffness of EPP material exhibit a nonlinear degressive stiffness. The foam wing has a softening characteristic for ascending loads. The numerical beam method for nonlinear elastic wings shows up a good agreement with the experiment and points out the load reducing effect of nonlinear structures

Aeroelastic method to investigate nonlinear elastic wing structures

Stiffness directions of wing structures are already part of the optimisation in aircraft design. Aircraft like the A350 XWB and the Boeing 787 mainly consist of such composite material, whose stiffness directions can be optimised. To proceed with this stiffness optimisation, the aim of this work is to modify and optimise also the linear stress-strain relation. On that account, the Hooke's law is exchanged by a multi-linear formulation to analyse any nonlinear elastic structural technology on wing structures. The wing structures, which are used to investigate the nonlinear behaviour, are deduced from a mid-range and a long-range aircraft configuration. These wings are analysed with an extended beam method and coupled with a VLM solution to calculate the aeroelastical loading. The proposed beam method is capable of analysing any multi-linear wing structure technology. A degressive structural behaviour shows up a good potential to reduce the bending moment which is one of the main drivers of the structural weight

Potential Estimation of Load Alleviation and Future Technologies in Reducing Aircraft Structural Mass

In recent years, load alleviation technologies have been more widely used in transport aircraft. For aircraft already in service, load alleviation can contribute in extending the fatigue life, or enable small configurational changes. If load alleviation is considered in the aircraft design process, the structural mass of the aircraft can be reduced. This paper investigates various maneuver and gust load alleviation algorithms as well as potential future technologies regarding flight operation, turbulence forecast and material science, and it evaluates the mass reduction that can be achieved. In doing so, a long-range transport aircraft was taken as the reference, and the considered load case conditions were 1-cos gusts, maneuvers and quasi-steady landing. Based upon the loads, the composite structure of the lifting surfaces was optimized, while the secondary masses as well as the wing planform were kept unchanged. With all technologies implemented, a reduction of the wing box mass by 26.5% or 4.4% of the operating empty mass could be achieved

Estimating health adjusted age at death (HAAD)

Objectives: At any point in time, a person’s lifetime health is the number of healthy life years they are expected to experience during their lifetime. In this article we propose an equity-relevant health metric, Health Adjusted Age at Death (HAAD), that facilitates comparison of lifetime health for individuals at the onset of different medical conditions, and allows for the assessment of which patient groups are worse off. A method for estimating HAAD is presented, and we use this method to rank four conditions in six countries according to several criteria of “worse off” as a proof of concept. Methods: For individuals with specific conditions HAAD consists of two components: past health (before disease onset) and future expected health (after disease onset). Four conditions (acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), schizophrenia, and epilepsy) are analysed in six countries (Ethiopia, Haiti, China, Mexico, United States and Japan). Data from 2017 for all countries and for all diseases were obtained from the Global Burden of Disease Study database. In order to assess who are the worse off, we focus on four measures: the proportion of affected individuals who are expected to have HAAD<20 (T20), the 25th and 75th percentiles of HAAD for affected individuals (Q1 and Q3, respectively), and the average HAAD (aHAAD) across all affected individuals. Results: Even in settings where aHAAD is similar for two conditions, other measures may vary. One example is AML (aHAAD = 59.3, T20 = 2.0%, Q3-Q1 = 14.8) and ALL (58.4, T20 = 4.6%, Q3-Q1 = 21.8) in the US. Many illnesses, such as epilepsy, are associated with more lifetime health in high-income settings (Q1 in Japan = 59.2) than in low-income settings (Q1 in Ethiopia = 26.3). Conclusion: Using HAAD we may estimate the distribution of lifetime health of all individuals in a population, and this distribution can be incorporated as an equity consideration in setting priorities for health interventions.publishedVersio

Acute hospital admissions among nursing home residents: a population-based observational study

<p>Abstract</p> <p>Background</p> <p>Nursing home residents are prone to acute illness due to their high age, underlying illnesses and immobility. We examined the incidence of acute hospital admissions among nursing home residents versus the age-matched community dwelling population in a geographically defined area during a two years period. The hospital stays of the nursing home population are described according to diagnosis, length of stay and mortality. Similar studies have previously not been reported in Scandinavia.</p> <p>Methods</p> <p>The acute hospitalisations of the nursing home residents were identified through ambulance records. These were linked to hospital patient records for inclusion of demographics, diagnosis at discharge, length of stay and mortality. Incidence of hospitalisation was calculated based on patient-time at risk.</p> <p>Results</p> <p>The annual hospital admission incidence was 0.62 admissions per person-year among the nursing home residents and 0.26 among the community dwellers. In the nursing home population we found that dominant diagnoses were respiratory diseases, falls-related and circulatory diseases, accounting for 55% of the cases. The median length of stay was 3 days (interquartile range = 4). The in-hospital mortality rate was 16% and 30 day mortality after discharge 30%.</p> <p>Conclusion</p> <p>Acute hospital admission rate among nursing home residents was high in this Scandinavian setting. The pattern of diagnoses causing the admissions appears to be consistent with previous research. The in-hospital and 30 day mortality rates are high.</p