Room for one more? A review of the literature on ‘inappropriate’ admissions to hospital for older people in the English NHS

This paper reports the findings of a review of the literature on emergency admissions to hospital for older people in the UK, undertaken between May and June 2014 at the Health Services Management Centre, University of Birmingham. This review sought to explore: the rate of in/appropriate emergency admissions of older people in the UK; the way this is defined in the literature; solutions proposed to reduce the rate of inappropriate admissions; and the methodological issues which particular definitions of ‘inappropriateness’ raise. The extent to which a patient perspective is included in these definitions of inappropriateness was also noted, given patient involvement is such a key policy priority in other areas of health policy. Despite long-standing policy debates, relatively little research has been published on formal rates of ‘inappropriate’ emergency hospital admissions for older people in the UK NHS in recent years. What has been produced indicates varying rates of in/appropriateness, inconsistent ways of defining appropriateness and a lack of focus on the possible solutions to address the problem. Significantly, patient perspectives are lacking, and we would suggest that this is a key factor in fully understanding how to prevent avoidable admissions. With an ageing population, significant financial challenges and a potentially fragmented health and social care system, the issue of the appropriateness of emergency admission is a pressing one which requires further research, greater focus on the experiences of older people and their families, and more nuanced contextual and evidence-based responses

Persistent threats to validity in single‐group interrupted time series analysis with a cross over design

Rationale, aims and objectivesThe basic single‐group interrupted time series analysis (ITSA) design has been shown to be susceptible to the most common threat to validity—history—the possibility that some other event caused the observed effect in the time series. A single‐group ITSA with a crossover design (in which the intervention is introduced and withdrawn 1 or more times) should be more robust. In this paper, we describe and empirically assess the susceptibility of this design to bias from history.MethodTime series data from 2 natural experiments (the effect of multiple repeals and reinstatements of Louisiana’s motorcycle helmet law on motorcycle fatalities and the association between the implementation and withdrawal of Gorbachev’s antialcohol campaign with Russia’s mortality crisis) are used to illustrate that history remains a threat to ITSA validity, even in a crossover design.ResultsBoth empirical examples reveal that the single‐group ITSA with a crossover design may be biased because of history. In the case of motorcycle fatalities, helmet laws appeared effective in reducing mortality (while repealing the law increased mortality), but when a control group was added, it was shown that this trend was similar in both groups. In the case of Gorbachev’s antialcohol campaign, only when contrasting the results against those of a control group was the withdrawal of the campaign found to be the more likely culprit in explaining the Russian mortality crisis than the collapse of the Soviet Union.ConclusionsEven with a robust crossover design, single‐group ITSA models remain susceptible to bias from history. Therefore, a comparable control group design should be included, whenever possible.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136538/1/jep12668.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136538/2/jep12668_am.pd

Change in hematologic indices over time in pediatric inflammatory bowel disease treated with azathioprine

Azathioprine leads to changes in mean corpuscular volume (MCV) and white blood cell (WBC) indices reflecting efficacy or toxicity. Understanding the interactions between bone marrow stem cells and azathioprine could highlight abnormal response patterns as forerunners for hematologic malig-nancies. This study gives a statistical description of factors influencing the relationship between MCV and WBC in children with inflammatory bowel disease treated with azathioprine. We found that leukopenia preceded macro¬cytosis. Macrocytosis is therefore not a good predictor of leukopenia. Further studies will be necessary to determine the subgroup of patients at increased risk of malignancies based on bone marrow response

Incidental giant renal oncocytoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Large renal oncocytomas are not very rare entities. To the best of our knowledge, we report one of the largest oncocytomas in the English literature. The tumor was incidentally diagnosed and, based on the preoperative clinical and radiographic findings, was therefore considered to be a renal cell carcinoma.</p> <p>Case presentation</p> <p>A 48-year-old Caucasian diabetic man had an abdominal ultrasound for chronic abdominal discomfort, which revealed a large mass on the left kidney. An abdominal computed tomography scan revealed a contrast enhancing, well defined, heterogenous large mass (16.5 × 13.9 cm) originating from the left lower pole with cystic and solid areas. A magnetic resonance imaging scan was performed with no evidence of renal vein or caval thrombus or embolus. A radical nephrectomy was performed through a left flank intercostal incision and the pathology diagnosed renal oncocytoma. The postoperative course was uneventful and the patient was discharged six days later.</p> <p>Conclusion</p> <p>Several reports have characterised this essentially benign renal histiotype, which represents 5% to 7% of all solid renal masses. Unfortunately, most renal oncocytomas cannot be differentiated from malignant renal cell carcinomas by clinical or radiographic criteria. Central stellate scar and a spoke-wheel pattern of feeding arteries are unreliable diagnostic signs and are of poor predictive value. These tumors are treated operatively with radical or partial nephrectomy or thermal ablation, depending on the clinical circumstances. We report on, to the best of our knowledge, the fourth largest lesion of this type of renal pathology.</p

Chromosome segregation errors generate a diverse spectrum of simple and complex genomic rearrangements

Cancer genomes are frequently characterized by numerical and structural chromosomal abnormalities. Here we integrated a centromere-specific inactivation approach with selection for a conditionally essential gene, a strategy termed CEN-SELECT, to systematically interrogate the structural landscape of mis-segregated chromosomes. We show that single-chromosome mis-segregation into a micronucleus can directly trigger a broad spectrum of genomic rearrangement types. Cytogenetic profiling revealed that mis-segregated chromosomes exhibit 120-fold-higher susceptibility to developing seven major categories of structural aberrations, including translocations, insertions, deletions, and complex reassembly through chromothripsis coupled to classical non-homologous end joining. Whole-genome sequencing of clonally propagated rearrangements identified random patterns of clustered breakpoints with copy-number alterations resulting in interspersed gene deletions and extrachromosomal DNA amplification events. We conclude that individual chromosome segregation errors during mitotic cell division are sufficient to drive extensive structural variations that recapitulate genomic features commonly associated with human disease

Impact of deprivation and rural residence on treatment of colorectal and lung cancer

For common cancers, survival is poorer for deprived and outlying, rural patients. This study investigated whether there were differences in treatment of colorectal and lung cancer in these groups. Case notes of 1314 patients in north and northeast Scotland who were diagnosed with lung or colorectal cancer in 1995 or 1996 were reviewed. On univariate analysis, the proportions of patients receiving surgery, chemotherapy and radiotherapy appeared similar in all socio-economic and rural categories. Adjusting for disease stage, age and other factors, there was less chemotherapy among deprived patients with lung cancer (odds ratio 0.39; 95% confidence intervals 0.16 to 0.96) and less radiotherapy among outlying patients with colorectal cancer (0.39; 0.19 to 0.82). The time between first referral and treatment also appeared similar in all socio-economic and rural groups. Adjusting for disease stage and other variables, times to lung cancer treatment remained similar, but colorectal cancer treatment was quicker for outlying patients (adjusted hazard ratio 1.30; 95% confidence intervals 1.03 to 1.64). These findings suggest that socio-economic status and rurality may have a minor impact on modalities of treatment for colorectal and lung cancer, but do not lead to delays between referral and treatment

Choreography, controversy and child sex abuse: Theoretical reflections on a cultural criminological analysis of dance in a pop music video

This article was inspired by the controversy over claims of ‘pedophilia!!!!’ undertones and the ‘triggering’ of memories of childhood sexual abuse in some viewers by the dance performance featured in the music video for Sia’s ‘Elastic Heart’ (2015). The case is presented for acknowledging the hidden and/or overlooked presence of dance in social scientific theory and cultural studies and how these can enhance and advance cultural criminological research. Examples of how these insights have been used within other disciplinary frameworks to analyse and address child sex crime and sexual trauma are provided, and the argument is made that popular cultural texts such as dance in pop music videos should be regarded as significant in analysing and tracing public perceptions and epistemologies of crimes such as child sex abuse

Percutaneous transhepatic cholangiography and biliary drainage after liver transplantation: A five-year experience

Evaluation of the biliary tract by percutaneous transhepatic cholangiography (PTC) is often required in liver transplant patients with an abnormal postoperative course. Indications for PTC include failure of liver enzyme levels to return to normal postoperatively, an elevation of serum bilirubin or liver enzyme levels, suspected bile leak, biliary obstructive symptoms, cholangitis, and sepsis. Over a 5-year period 625 liver transplants in 477 patients were performed at the University Health Center of Pittsburgh. Fifty-three patients (56 transplants) underwent 70 PTCs. Complications diagnosed by PTC included biliary strictures, bile leaks, bilomas, liver abscesses, stones, and problems associated with internal biliary stents. Thirty-two percutaneous transhepatic biliary drainage procedures were performed. Ten transplantation patients underwent balloon dilatation of postoperative biliary strictures. Interventional radiologic techniques were important in treating other complications and avoiding additional surgery in many of these patients. © 1987 Springer-Verlag New York Inc

Pattern-Sensitive Epilepsy. I: A Demonstration of a Spatial Frequency Selective Epileptic Response to Gratings

Rare individuals suffer epileptic seizures when they view certain images, particularly stripes. Contrast-threshold functions (the ability to see faint stripes of various widths) were determined for two pattern-sensitive brothers, and the epileptogenicity of various patterns was assessed for one of them. Sine wave grating contrast-detection thresholds for the two subjects were essentially normal, with lowest thresholds at approximately 2 cycles/ degree (c/deg). Epileptiform discharges occurred maximally at 5 c/deg with a 1-octave 50% bandwidth. Pattern epileptogenicity was increased by the addition of a third harmonic sine wave grating to its fundamental, but was unaffected by the phase relation of the two gratings. The frequency selectivity of epileptic responsiveness was quantitatively similar to a “spatial frequency channel.” Inhibitory interactions were not present. The findings suggest relations between the phenomena of pattern-sensitive epilepsy and hypothesized spatial frequency channels which merit further exploration. RESUMEN De manera excepcional, hay personas que pueden tener ataques epilÉpticos cuando ven ciertas imÁgenes, particularmente rayas. Se determinaron los umbrales para contrastes (la capacidad de ver rayas de diversas anchuras y muy tenues) en dos hermanos sensibles a patrones y se estableciÓ la epileptogeneidad de di versos patrones en uno de ellos. Los umbrales para contrastes fueron esencialmente normales en los dos sujetos cuando se utilizeÓ una rejilla hecha con ondas sinusoidales, siendo el umbral inferior unos 2 ciclos/ grado (c/deg). Descargas epileptiformes tuvieron lugar de modo mÁximo a 5 c/deg con una amplitud de banda del 50% de una octava. la capacidad epileptogÉnica del partÓn aumentÓ cuando se aÑadiÓ una tercera sinusoide armÓnica a la rejilla base pero esa capacidad no se viÓ alterada por la relaciÓn de fase entre las dos rejillas. La selectividad de la frecuencia de la respuesta epileptogÉnica fue cuantitativamente similar al “canal de frecuencia espacial”. No se observaron interacciones inhibitorias. Los hallazgos sugieren que hay relaciones entre la epilepsyÍa secundaria a patrones visuales y los hipotÉticos canales de frecuencia espacial, lo cual merece mÁs investigaciÓn.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65270/1/j.1528-1157.1980.tb04075.x.pd