Early Readmissions After Acute Myocardial Infarction

This study aims to evaluate the rate, predictors, and causes of 30-day readmissions in a single tertiary hospital in the United Kingdom. We conducted a retrospective study of all patients admitted between 2012 and 2014 with a diagnosis of acute myocardial infarction, who were in the Myocardial Infarction National Audit Project register. Data on patient demographics, comorbidities, care received, and in-hospital mortality were collected. Rates of 30-day readmission and causes of readmission were evaluated. Univariate and multiple logistic regressions were used to identify predictors of all-cause, cardiac, and noncardiac readmission. A total of 1,869 patients were included in the analysis and 171 had an unplanned readmission with 30 days (9%). Noncardiac problems represented half of all readmissions with the dominant cause noncardiac chest pain (50%). A variety of other noncardiac causes for readmission were identified and the most common were lower respiratory tract infection (4.3%), gastrointestinal problems (4.9%), bleeding (3.7%), dizziness, syncope, or fall (3.0%), and pulmonary embolus (2.4%). For cardiac causes of readmissions, common causes included acute coronary syndrome (17.1%), stable angina (11.6%), and heart failure (9.8%). Readmitted patients were more likely to be older, anemic, and less likely to receive coronary angiogram and percutaneous coronary intervention. After adjustment, the only predictor of all-cause readmission was older age. For noncardiac readmission, previous myocardial infarction was associated with significantly fewer readmissions. Our results suggest that early readmission after discharge with diagnosis of acute myocardial infarction is common. Chest pain is the most frequent cause of readmission, and interventions to reduce noncardiac chest pain admissions are needed

Development of an individualised, supervised and progressed therapist led exercise programme for Plantar Heel Pain (Plantar Fasciitis)

Purpose: To describe the development, and content of a physiotherapist and podiatrist led individualised, supervised and progressed exercise programme for use in a feasibility and pilot randomised controlled trial (RCT) testing interventions for Plantar Heel Pain (PHP).Methods: There is limited guidance on how clinicians should use exercise to effectively treat PHP (often referred to as Plantar Fasciitis), which is a common cause of foot pain. The Physiotherapy Research Facilitator team helped develop, arrange and attend a research development group, where a programme was developed from best available evidence, stakeholders (including Physiotherapists, Podiatrists, researchers, GPs, patients, research users), and clinical consensus. A systematic review of randomised and quasi-randomised controlled trials of exercise therapy was undertaken, with an additional synthesis of available national guidelines and previous clinical surveys identifying exercises routinely used in clinical practice. The Results of this provided the basis for a stakeholder group meeting where the principles of the type, dose and delivery of exercise were discussed and prioritised. Assessment requirements and selected exercises were fed into a clinical consensus process through which a protocol for an intervention of Physiotherapist and Podiatrist led exercise was finalised.Results: The intervention is designed to be individualised and includes a choice from 20 separate exercises which comprise foot specific stretches and exercises of the; plantar fascia, intrinsic foot muscles, key ankle related and lower limb muscle groups as required. Selection is individualised and determined according to clinical assessment of soft tissue tightness or weakness in the foot and ankle complex and lower limb. Each exercise prescribed is supported by a photograph illustration and specific easy to follow instructions aiming to improve patient understanding and adherence. Progression is permitted in up to 6 consultations. The programme developed is accompanied by a high quality patient information and self-management advice leaflet. This exercise programme was then used by the Physiotherapy Research Facilitators to train clinicians in its use for the intervention during the feasibility and pilot RCT.Conclusion(s): We combined clinical expertise and research evidence with national guidance in order to develop a physiotherapist/podiatrist led, individualised, progressed and supervised exercise intervention for use within a feasibility and pilot RCT. The feasibility of the intervention is being evaluated within the TREADON trial (ISRCTN 12160508).Implications: Working in collaboration with other Allied Health Professionals, service users, researchers and managers is fast becoming an essential part of any research project. This group structure and facilitation Method allowed for open discussion and group critique for practical application and use

Body mass index and complications following major gastrointestinal surgery: a prospective, international cohort study and meta‐analysis

Aim Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a meta-analysis of all available prospective data.Methods This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien-Dindo Grades III-V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results.Results This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery for malignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49-2.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46-0.75, P < 0.001) compared to normal weight patients.Conclusions In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease