Unique characteristics of end-of-life hospitalizations in Parkinson disease

IntroductionPersons with Parkinson disease (PD) are hospitalized at higher rates, have longer lengths of stay, and are more likely to die in the hospital than age-matched peers. Although prior studies have compared inpatient outcomes between persons with and without PD, little is known about inpatient outcomes across the PD trajectory, or whether hospitalizations occurring in the last 6 months of life differ from earlier hospitalizations.MethodsThis cross-sectional study compared Medicare Part A and B beneficiaries aged 65 and older with a qualifying PD diagnosis who were hospitalized in 2017: decedents who died between 7/1/2017 and 12/31/2017 from all causes and were hospitalized at least once in their last 6 months of life, and non-decedents who were hospitalized between 1/1/2017 and 6/30/2017 and lived 6 or more months after discharge. End-of-life (EoL) hospitalizations were defined as those occurring in the last 6 months of life. Descriptive analyses compared patient-level variables (e.g., demographics, comorbidities, treatment intensity) and encounter-level variables (e.g., length of stay, total charges) between groups. Multivariable logistic regression models also compared rates of intensive care unit (ICU) admission and 30-day readmission between hospitalized decedents and hospitalized non-decedents, adjusting for age, sex, race/ethnicity, rural residence, and Charlson Comorbidity Index Score.ResultsOf 26,492 Medicare decedents with PD, 16,187 (61.1%) were hospitalized in their last 6 months of life. Of 347,512 non-decedents with PD, 62,851 (18.1%) were hospitalized in a 6-month period. Hospitalized decedents were slightly older than hospitalized non-decedents (82.3 [SD 7.40] vs. 79.5 [SD 7.54] years) and had significantly more comorbidities. Compared to non-EoL hospitalizations, EoL hospitalizations were slightly longer (5 [IQR 3–9] vs. 4 [IQR 3–7] days) and more expensive based on total charges per admission ($36,323 [IQR 20,091-69,048] vs.$32,309 [IQR 18,789–57,756]). In covariate-adjusted regression models using hospitalized non-decedents as the reference group, hospitalized decedents were more likely to experience an ICU admission (AOR 2.36; CI 2.28–2.45) and 30-day readmission (AOR 2.43; CI 2.34–2.54).DiscussionHospitalizations occurring in the last 6 months of life among persons with PD in the United States are longer, more costly, and more resource intensive than earlier hospitalizations and may stem from medical comorbidities. Once hospitalized, ICU admission and 30-day readmission may aid in prognostication and serve as markers of transition to the EoL period

An Accuracy Assessment of Absolute Gravimetric Observations in Fennoscandia

We compare a suite of absolute gravimeters used to monitor the temporal changes of gravity at a number of sites in Fennoscandia. Direct comparisons are made from simultaneous observations at selected sites within and outside of the postglacial uplift region. We also compare results at sites visited by two instruments with some separation in time. We conclude from four years of data that gravity differences are obtained within an rms error of ± 3 Gal. The data reveal no systematic biases between the instruments, but occasional shifts from one year to another are noted. We consider that annual instrument comparisons are required to ensure data integrity in a regional observing program that extends over more than a decade

A shortened version of Raven's standard progressive matrices for children and adolescents

Numerous developmental studies assess general cognitive ability, not as the primary variable of interest, but rather as a background variable. Raven's Progressive Matrices is an easy to administer non-verbal test that is widely used to measure general cognitive ability. However, the relatively long administration time (up to 45 min) is still a drawback for developmental studies as it often leaves little time to assess the primary variable of interest. Therefore, we used a machine learning approach - regularized regression in combination with cross-validation - to develop a short 15-item version. We did so for two age groups, namely 9 to 12 years and 13 to 16 years. The short versions predicted the scores on the standard full 60-item versions to a very high degree r = 0.89 (9-12 years) and r = 0.93 (13-16 years). We, therefore, recommend using the short version to measure general cognitive ability as a background variable in developmental studies

Gout epidemiology: results from the UK General Practice Research Database, 1990–1999

Objective: To examine the epidemiology of gout and gout treatment in the United Kingdom using a large national practice based population. Methods: Data from the UK General Practice Research Database from 1990 to 1999 were examined. Physician diagnoses and drug codes were used, and trends in gout incidence and treatment examined. Additionally, disease prevalence for the year 1999 was assessed. To examine the association of gout with comorbid disease, the prevalence of select health conditions and drug use was compared with the corresponding prevalences seen in osteoarthritis, adjusting for both age and sex. Results: From 1 January 1990 to 31 December 1999 overall gout incidence remained relatively stable, ranging from a low of 11.9 cases (95% confidence interval (CI) 11.5 to 12.3) in 1991 to a high of 18.0 cases (95% CI 17.6 to 18.4) per 10 000 patient-years in 1994. Gout prevalence in 1999 was 1.4% with rates approaching 7% in men over the age of 65. Drugs used for the treatment of gout remained constant in prevalent cases with the exception of a significant decline in non-steroidal anti-inflammatory drug use over the 10 year follow up. Compared with patients with osteoarthritis, patients with gout were significantly more likely to have cardiovascular disease, hypertension, diabetes, and chronic renal failure, and were more likely to have used diuretics or ciclosporin, or both. Conclusion: Although gout is common in the UK, particularly among older men, the incidence of the disease seems to have remained stable during the 1990s

Long-term course of hospitalisation for schizophrenia: Part 1. Risk for rehospitalisation

The probability of rehospitalization following the initial discharge on which a diagnosis of schizophrenia was made is described using data from psychiatric case registers in Victoria, Australia; Maryland, U.S.A.; Denmark; and Salford, England. The percentage eventually rehospitalized, after followup intervals as long as two decades, varies from about 50 to 80 percent in the four service systems. Survival curves for duration in the community without rehospitalization bend sharply in the period between 2 and 3 years following discharge in all four cohorts and are almost flat after 20 years. Early age of onset predicts higher risk for rehospitalization in multivariate proportional hazards models in each cohort. When age of onset is included as a covariate, neither gender nor marital status has consistent or statistically significant effects on risk for rehospitalization

Table_1_Unique characteristics of end-of-life hospitalizations in Parkinson disease.DOCX

IntroductionPersons with Parkinson disease (PD) are hospitalized at higher rates, have longer lengths of stay, and are more likely to die in the hospital than age-matched peers. Although prior studies have compared inpatient outcomes between persons with and without PD, little is known about inpatient outcomes across the PD trajectory, or whether hospitalizations occurring in the last 6 months of life differ from earlier hospitalizations.MethodsThis cross-sectional study compared Medicare Part A and B beneficiaries aged 65 and older with a qualifying PD diagnosis who were hospitalized in 2017: decedents who died between 7/1/2017 and 12/31/2017 from all causes and were hospitalized at least once in their last 6 months of life, and non-decedents who were hospitalized between 1/1/2017 and 6/30/2017 and lived 6 or more months after discharge. End-of-life (EoL) hospitalizations were defined as those occurring in the last 6 months of life. Descriptive analyses compared patient-level variables (e.g., demographics, comorbidities, treatment intensity) and encounter-level variables (e.g., length of stay, total charges) between groups. Multivariable logistic regression models also compared rates of intensive care unit (ICU) admission and 30-day readmission between hospitalized decedents and hospitalized non-decedents, adjusting for age, sex, race/ethnicity, rural residence, and Charlson Comorbidity Index Score.ResultsOf 26,492 Medicare decedents with PD, 16,187 (61.1%) were hospitalized in their last 6 months of life. Of 347,512 non-decedents with PD, 62,851 (18.1%) were hospitalized in a 6-month period. Hospitalized decedents were slightly older than hospitalized non-decedents (82.3 [SD 7.40] vs. 79.5 [SD 7.54] years) and had significantly more comorbidities. Compared to non-EoL hospitalizations, EoL hospitalizations were slightly longer (5 [IQR 3–9] vs. 4 [IQR 3–7] days) and more expensive based on total charges per admission ($36,323 [IQR 20,091-69,048] vs.$32,309 [IQR 18,789–57,756]). In covariate-adjusted regression models using hospitalized non-decedents as the reference group, hospitalized decedents were more likely to experience an ICU admission (AOR 2.36; CI 2.28–2.45) and 30-day readmission (AOR 2.43; CI 2.34–2.54).DiscussionHospitalizations occurring in the last 6 months of life among persons with PD in the United States are longer, more costly, and more resource intensive than earlier hospitalizations and may stem from medical comorbidities. Once hospitalized, ICU admission and 30-day readmission may aid in prognostication and serve as markers of transition to the EoL period.</p