A systematic review examining reducing unplanned hospital admissions in adults with cancer

Review question:1.What interventions have been tested and have successfully reduced unplanned hospital admissions in adults with cancer?2.What are the factors associated with unplanned hospital admissions in adults with cancer

Delayed discharges and unplanned admissions from the Day Care Unit at Mater Dei Hospital, Malta

Day care units are playing an increasingly important role in healthcare provision, however they require the development of specialised resources to fulfil their role. The rate of unplanned admissions following day-case procedures is considered as one of several indicators of the quality of day-case services available.1 The aim of this study is to identify how often there are delayed discharged or unplanned admissions following day-cases at the Day Care Unit at Mater Dei Hospital (MDH), Malta. A list of patients whose discharge did not go as planned was forwarded daily to the authors by the Bed Management Unit at MDH. The medical files of these patients were then reviewed and data collected. This included demographics, type of procedure carried out and reasons for delayed discharge or unplanned admission. The study was carried out over 45 days.peer-reviewe

Planned and Unplanned Bequests

We make the distinction between bequests that are planned as part of some lifetime optimization stemming from a bequest motive, and those that are unplanned and result when the date of death differs from what the consumer might forecast. Lifetime optimization should lead to a negative effect or no effect of the expected horizon on the size of the bequest, and to a negative relation between unexpectedly long life and the bequest. Using data on wealthy decedents and their parents, we form measures of the expected horizon based on parents' longevity. There is no relation between unexpectedly early or late death and the bequest, but a significant positive relation between the bequest and the length of the horizon. Several explanations for this unforeseen result are offered, including the inference that uncertainty about length of life is important in studying bequest behavior.

Impact of Outpatient vs Inpatient ABSSSI Treatment on Outcomes: A Retrospective Observational Analysis of Medical Charts Across US Emergency Departments

Background The objective of this study was to characterize treatment of patients with acute bacterial skin and skin structure infections (ABSSSIs) and describe the association between hospital admission and emergency department (ED) visits or readmissions within 30 days after initial episode of care (IEC). Methods This was a retrospective, observational, cohort study of adults with ABSSSI who presented to an ED between July 1, 2012, and June 30, 2013. Patient, health care facility, and treatment characteristics, including unplanned ED visits or readmissions, were obtained through manual chart review and abstraction. Adjusted logistic regression analysis examined likelihood of all-cause unplanned ED visits or readmissions between admitted and nonadmitted patients. Results Records from 1527 ED visits for ABSSSI from 40 centers were reviewed (admitted, n = 578 [38%]; nonadmitted, n = 949 [62%]). Admitted patients were typically older (mean age, 52.2 years vs 43.0 years), more likely to be morbidly obese (body mass index \u3e 40 kg/m2; 17.3% vs 9.1%), and had more comorbidities (Charlson Comorbidity Index ≥ 4; 24.4% vs 6.8%) compared with those not admitted. In the primary analysis, adjusted logistic regression, controlling for comorbidities and severity of illness, demonstrated that there was a similar likelihood of all-cause unplanned ED visits or readmissions between admitted and nonadmitted patients (odds ratio, 1.03; 95% confidence interval, 0.74–1.43; P = .87). Conclusions ABSSSI treatment pathways leveraging outpatient treatment vs hospital admission support similar likelihood of unplanned 30-day ED visits or readmissions, an important clinical outcome and quality metric at US hospitals. Further research regarding the decision criteria around hospital admission to avoid potentially unnecessary hospitalizations is warranted

Increasing Short-Stay Unplanned Hospital Admissions among Children in England; Time Trends Analysis '97-'06

BACKGROUND: Timely care by general practitioners in the community keeps children out of hospital and provides better continuity of care. Yet in the UK, access to primary care has diminished since 2004 when changes in general practitioners' contracts enabled them to 'opt out' of providing out-of-hours care and since then unplanned pediatric hospital admission rates have escalated, particularly through emergency departments. We hypothesised that any increase in isolated short stay admissions for childhood illness might reflect failure to manage these cases in the community over a 10 year period spanning these changes. METHODS AND FINDINGS: We conducted a population based time trends study of major causes of hospital admission in children 2 days. By 2006, 67.3% of all unplanned admissions were isolated short stays <2 days. The increases in admission rates were greater for common non-infectious than infectious causes of admissions. CONCLUSIONS: Short stay unplanned hospital admission rates in young children in England have increased substantially in recent years and are not accounted for by reductions in length of in-hospital stay. The majority are isolated short stay admissions for minor illness episodes that could be better managed by primary care in the community and may be evidence of a failure of primary care services

Lessons from an unplanned scientific and academic life

It is salutary, before reaching the middle of one’s eighties, whilst time is still available and memory is still in good order, to review a long life in its highlights, so as to better appreciate the circumstances that shaped and steered that life through its many days. Besides this appreciation, such a review permits a listing of lessons learned through that life, its joys as well as its woes, in the hope that they may be useful to young readers of your story. Like all other such stories, mine was the story of an individual, who lived under unique circumstances and reacted to them in a unique way. My story is best treated in terms of where it was experienced, that being: Malta (1929 to 1952), Oxford (1952 to 1956), Singapore (1956 to 1960), Khartoum (1960 to 1965), and Saskatoon (1965 to the time of writing). Each transition was necessitated by its own circumstance, brought fresh challenges and sustained a global career with few regrets and much personal and professional satisfaction.peer-reviewe

A qualitative evaluation of home based contraceptive and sexual health care for teenage mothers

This paper reports on the findings from a qualitative study exploring the experiences of teenage mothers using a nurse-led, home-based contraceptive service designed to prevent repeat unplanned pregnancies. The aim was to understand if, and how the service was effective in equipping teenage mothers to make informed choices about contraception, thus preventing a second pregnancy. Unplanned teenage pregnancy remains a significant focus of health and social policy in the United Kingdom (UK). Despite the long-term pattern of declining conception rates, the UK continues to report higher rates than comparable countries elsewhere in Europe. Current estimates suggest that approximately one fifth of births amongst under 18’s are repeat pregnancies (Teenage Pregnancy Independent Advisory Group, 2009). Services that are designed to reduce second unplanned pregnancies are an important element in promoting teenage sexual health. However, there has been no UK research that explores this kind of service and the experiences of service users. We conducted a qualitative interview study. From 2013–2014 we interviewed 40 teenage mothers who had engaged with the nurse-led, home-based contraceptive service. The data demonstrates that the service was effective in preventing repeat pregnancies in a number of cases. Among the aspects of the service which were found to contribute to its effectiveness were privacy, convenience, flexibility, appropriately timed access, the non-judgemental attitude of staff and ongoing support

A Validated Method for Identifying Unplanned Pediatric Readmission

Objective To validate the accuracy of pre-encounter hospital designation as a novel way to identify unplanned pediatric readmissions and describe the most common diagnoses for unplanned readmissions among children. Study design We examined all hospital discharges from 2 tertiary care children's hospitals excluding deaths, normal newborn discharges, transfers to other institutions, and discharges to hospice. We performed blinded medical record review on 641 randomly selected readmissions to validate the pre-encounter planned/unplanned hospital designation. We identified the most common discharge diagnoses associated with subsequent 30-day unplanned readmissions. Results Among 166 994 discharges (hospital A: n = 55 383; hospital B: n = 111 611), the 30-day unplanned readmission rate was 10.3% (hospital A) and 8.7% (hospital B). The hospital designation of “unplanned” was correct in 98% (hospital A) and 96% (hospital B) of readmissions; the designation of “planned” was correct in 86% (hospital A) and 85% (hospital B) of readmissions. The most common discharge diagnoses for which unplanned 30-day readmissions occurred were oncologic conditions (up to 38%) and nonhypertensive congestive heart failure (about 25%), across both institutions. Conclusions Unplanned readmission rates for pediatrics, using a validated, accurate, pre-encounter designation of “unplanned,” are higher than previously estimated. For some pediatric conditions, unplanned readmission rates are as high as readmission rates reported for adult conditions. Anticipating unplanned readmissions for high-frequency diagnostic groups may help focus efforts to reduce the burden of readmission for families and facilities. Using timing of hospital registration in administrative records is an accurate, widely available, real-time way to distinguish unplanned vs planned pediatric readmissions

A STUDY OF PLANNED IMPULSIVE BUYING ON CONSUMERS IN INDONESIA

ABSTRACT Marketing process in a company will be successful if they can understand the unique character of their consumers. Unique characteristic of Indonesian consumer who unplanned and who have unplanned spending pattern became such opportunities for the company to sell their product. Research gap about buying behaviour between previous researchers became the problem of this research. The purpose of this study is to examine the effect of interaction, situational factors and fashion involvement on positive emotion and planned impulsive buying. This research was limited on planned impulsive buying, whereas consumer already made such plan to go shopping but in fact they bought more than what they already planned before because of spontanious or suddenly cause. Sample collection technique used in this research was purposive sampling where respondents have to meet the criteria established by the researcher. The result from path analysis proved that the first hypothesis that the interaction with the salesforce on unplanned impulsive buying was rejected. The second hypothesis until the last hypothesis accepted. This study provides an overview of the importance to give a big discount (sale) programs, product variation and new trend products which will improve positive emotion and increase planned impulsive buying. Situational factors like crowd levels of store, comfortable shopping place, and well-organized layout also raise positive emotion and planned impulsive buying. In fact, most of the respondent felt that the crowded shopping situation makes them curious and raises positive emotions that motivated to make a purchase. Key words: Planned Impulsive Buying, Positive Emotions, Interaction with Salesforce, Situational Factors, Fashion Involvemen

Unplanned Coauthorship

Unplanned coauthorship refers to the process by which contributors to a creative work are treated by copyright law as coauthors of the work based entirely on their observable behavior during its creation. The process entails a court imputing the status of coauthors to the parties ex post, usually during a claim for copyright infringement. For years now, courts and scholars have struggled to identify a coherent rationale for unplanned coauthorship and situate it within copyright’s set of goals and objectives. This Article offers a novel framework for understanding the rules of unplanned coauthorship using insights from theories of shared intentionality. Unplanned coauthorship enables courts to balance copyright’s commitment to authorial autonomy and individual ownership against the demands of cooperation, collaboration, and information sharing that the creative process invariably entails. Through these rules, copyright law recognizes that certain forms of creativity depend entirely on mechanisms of collaboration for their continuing existence. In such instances of collaborative creativity, the very process of collaboration provides creators with additional and independent reasons for their creative endeavor, a motivation referred to as the collaborative impulse. Characteristic of all joint activities undertaken with a shared intention, the collaborative impulse derives from a motivational commitment to the joint task that collaborating creators develop, causing them to pay equal attention to both the means and the ends of their creativity. The Article shows how the rules of unplanned coauthorship allow copyright law to nurture these domains of collaborative creativity by protecting the collaborative impulse and simultaneously rendering it fully compatible with copyright’s utilitarian goal of promoting creativity through exclusive rights