Unplanned hospital admissions (UHA) in older adult populations are a recurring problem in older adults with cancer. Older adults comprise approximately 60% of cancer diagnoses and receive the majority of cancer treatment. However, little is known about why older adults under treatment for cancer experience a high number of unplanned hospital admissions. A review of the literature provided few study findings and a gap in the current knowledge was identified regarding the factors associated with unplanned hospital admissions in older adults under treatment for cancer. A conceptual framework based on the literature and this researcher's clinical experienced guided this study. The purpose of this study was to explore the factors related to unplanned hospital admissions and determine if one or more factors are predictive of unplanned hospital admissions of older adults with cancer. A convenience sample of 129 dyads of older adults with cancer and their family caregivers were approached and enrolled in the adult oncology outpatient infusion centers and inpatient units within a community cancer center in central Florida. Patient demographic and clinical data were obtained through a retrospective medical record review. Family caregiver demographic and side effect knowledge data was collected prospectively during interviews with family caregivers using a newly developed tool, Nurse Assessment of Family Caregiver Knowledge and Action Tool (NAFCKAT). The NAFCKAT contains 11 items to determine baseline knowledge about side effects and plan for managing side effects. A fever subsection consists of 4 knowledge and 2 action questions and a dehydration subsection consists of 2 knowledge and 2 action questions. Preliminary research was conducted to determine reliability and validity of the NAFCKAT. Excellent inter-reliability was found for the tool and preliminary support for validity was determined for the fever subscale. Descriptive statistics and logistic regression analyses were used to evaluate data collected from patient medical records and NAFCKAT scores. Study findings revealed that unplanned hospital admissions were more likely to occur when older adults had the presence of impaired function prior to treatment initiation and/or experienced side effects of infection /fever and vomiting/diarrhea during treatment. The presence of impaired function and family caregiver support (knowledge and availability) did not moderate the relationship between side effects and unplanned hospital admissions. Findings suggest that the presence of impaired function and side effects of infection and fever, and vomiting and diarrhea, predict unplanned hospital admissions in older adults during the active cancer treatment phase. Nurses should advocate for and conduct targeted assessments to identify the presence of functional impairments prior to cancer treatment initiation. In addition, nurses should actively monitor for the presence of cancer treatment-related side effects during the treatment phase of the cancer trajectory. Information gained from these assessments will assist nurses to provide practical and tailored strategies to support older adults and their family caregivers during cancer treatment and reduce the risk for unplanned hospital admissions.

Yes / Repeated hospital admissions are prevalent in older people. The role of medication in repeated hospital admissions has not been widely studied. The hypothesis that medication-related risk factors for initial hospital admissions were also associated with repeated hospital admissions was generated. To examine the association between medication-related risk factors and repeated hospital admissions in older people living with frailty. A retrospective case-control study was carried out with 200 patients aged ≥75 years with unplanned medical admissions into a large teaching hospital in England between January and December 2015. Demographic, clinical, and medication-related data were obtained from review of discharge summaries. Statistical comparisons were made between patients with 3 or more hospital admissions during the study period (cases) and those with 2 or fewer admissions (controls). Regressions were performed to establish independent predictors of repeated hospital admissions. Participants had a mean age of 83.8 years (SD 5.68) and 65.5% were female. There were 561 admission episodes across the sample, with the main reasons for admissions recorded as respiratory problems (25%) and falls (17%). Univariate logistic regression revealed five medication-related risks to be associated with repeated hospital admissions: Hyper-polypharmacy (defined as taking ≥10 medications) (OR 2.50, p < 0.005); prescription of potentially inappropriate medications (PIMs) (OR 1.89; p < 0.05); prescription of a diuretic (OR 1.87; p < 0.05); number of high risk medication (OR 1.29; p < 0.05) and the number of 'when required' medication (OR 1.20; p < 0.05). However, the effects of these risk factors became insignificant when comorbid disease was adjusted for in a multivariable model. Medication-related risk factors may play an important role in future repeated admission risk prediction models. The modifiable nature of medication-related risks factors highlights a real opportunity to improve health outcomes.

Yes / New healthcare models are being explored to enhance care coordination, efficiency, and outcomes. Evidence is scarce regarding the impact of vertical integration of primary and secondary care on emergency department (ED) attendances, unplanned hospital admissions, and readmissions. Aim To examine the impact of vertical integration of an NHS provider hospital and 10 general practices on unplanned hospital care Design and setting A retrospective database study using synthetic controls of an NHS hospital in Wolverhampton integrated with 10 general practices, providing primary medical services for 67 402 registered patients. Method For each vertical integration GP practice, a synthetic counterpart was constructed. The difference in rate of ED attendances, unplanned hospital admissions, and unplanned hospital readmissions was compared, and pooled across vertical integration practices versus synthetic control practices pre-intervention versus post-intervention. Results Across the 10 practices, pooled rates of ED attendances did not change significantly after vertical integration. However, there were statistically significant reductions in the rates of unplanned hospital admissions (−0.11, 95% CI = −0.18 to −0.045, P = 0.0012) and unplanned hospital readmissions (−0.021, 95% CI = −0.037 to −0.0049, P = 0.012), per 100 patients per month. These effect sizes represent 888 avoided unplanned hospital admissions and 168 readmissions for a population of 67 402 patients per annum. Utilising NHS reference costs, the estimated savings from the reductions in unplanned care are ∼£1.7 million. Conclusion Vertical integration was associated with a reduction in the rate of unplanned hospital admissions and readmissions in this study. Further work is required to understand the mechanisms involved in this complex intervention, to assess the generalisability of these findings, and to determine the impact on patient satisfaction, health outcomes, and GP workload.

The debate surrounding marijuana legalization has increased its popularity in recent years, as the state of California seriously considers the complete legalization of the substance for those ages 21 and over. This would make California the first government in recorded history to regulate the cultivation and sale of marijuana on a commercial level. Advocates back the economic positives concerning high tax revenues, but those opposed argue that the dangers associated with public health greatly outweigh any monetary gain. The present study attempts to reveal the possible public health concerns, even potential benefits, caused by marijuana use and its distribution. Specifically, measures of California’s Medical Marijuana Program will be assessed on the total number of drug treatment admissions in each county, taking into account treatment type and which type of drug is primarily responsible for said admissions. Findings reveal influences by both gateway and substitution effects, creating both positive and negative correlations throughout the field of public health. The influences of intangible variables, like that of the black market, make the results difficult to generalize. However, significant correlations can be found among specific health factors, like Heroin use, Crack/Cocaine use, and Residential Treatment.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-03-17T13:49:08Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação_ROGERIO CAFE_PPGGES_23-10-15_VERSÃO DEFINITIVA.pdf: 1292713 bytes, checksum: d8eb776bb426021bac4cd19ba9c8e826 (MD5) / Made available in DSpace on 2016-03-17T13:49:09Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação_ROGERIO CAFE_PPGGES_23-10-15_VERSÃO DEFINITIVA.pdf: 1292713 bytes, checksum: d8eb776bb426021bac4cd19ba9c8e826 (MD5) Previous issue date: 2015-01-15 / O presente estudo, sob forma de análise descritiva, tem como objetivos a análise das supostas forças de correlação entre as variáveis e suas implicações, seus diferentes comportamentos, nas questões que envolvem as internações hospitalares observando o comportamento de cada variável, inclusive as construídas sob bases populacionais diferentes, justificando as possíveis causas e consequências, entre a ocorrência das mesmas. Para isto, foram utilizadas variáveis como a “Internação por doença infecciosa intestinal em menor de 1 ano” (Int M), a “Internação por doença infecciosa intestinal em menor de 1 ano, per capita, (Int M PC) e algumas variantes destas, obtidas/construídas de dados secundários do ano de 2010 do DATASUS e SEPLANDE, para efetuar as correlações utilizando o Microsoft Excel. A análise principal apresentou fracas correlações porém não nulas, onde todas as sete variáveis observadas aumentaram os coeficientes de Pearson da primeira com relação a segunda variável. Observou-se a diferença das forças de correlação quando comparadas variáveis construídas sob base populacionais diferentes, bem como a interferência do fator per capita. Além disso, a pesquisa buscou avaliar o problema, identificar as possíveis causas, sugerindo ações específicas e estudos específicos e complementares. Destaca a gravidade do problema para que sejam implementadas políticas públicas específicas e para que mais recursos sejam dirigidos às ações de prevenções das internações hospitalares por doenças infecciosas intestinais no estado de Alagoas. Sugere a ampliação do atendimento da atenção básica em todos os municípios do estado de Alagoas, da quantidade de leitos hospitalares, equipamentos disponíveis para o Sistema Único de Saúde (SUS), para reduzir o número de óbitos decorrentes de tais internações. São limitações deste estudo o pequeno número de variáveis utilizadas e a possibilidade de se proceder com outro teste estatístico para convalidar as que foram efetuadas. / This study, in the form of descriptive analysis aims to analyze the supposed correlation between variables forces and their implications, their different behavior, on issues involving hospitalizations observing the behavior of each variable, including those built on different population basis, justifying the possible causes and consequences of the occurrence thereof. For this, variables such as "hospitalization for intestinal infectious disease in less than 1 year" (Int M) and "hospitalization for intestinal infectious disease in less than 1 year per capita” (Int PC M) were used, as well as some variants derived from these two, obtained from secondary data by DATASUS and SEPLANDE in 2010, to make correlations using Microsoft Excel. The primary analysis showed weak correlations but not zero, where all seven observed variables increased Pearson’s coefficients of the first with respect to the second variable. There was a difference of correlation forces when compared to variables constructed under different population basis, as well as the interference of per capita factor. In addition, the survey sought to assess the problem, identify possible causes, suggesting specific actions and specific and complementary studies. It highlights the seriousness of the problem so that specific public policies and more resources can be implemented as preventive actions for hospitalizations due to intestinal infectious diseases in the state of Alagoas.It also suggests the expansion of primary health care services in all municipalities of the state of Alagoas, the number of hospital beds, equipment available for the Unified Health System (SUS), to reduce the number of deaths from such admissions. Limitations of this study are: the small number of variables used and the possibility of proceeding with another statistical test to validate the ones conducted.

No description available.

Older people living with frailty are at a higher risk of medication-related incidents due to frequent hospitalisation, complex health needs and polypharmacy. There is evidence that identifying patients at high risk of hospital readmission can enhance the impact of interventions to prevent readmission. However, there is insufficient evidence of the role of medication in readmission in this vulnerable patient group, and what pharmacists can do to reduce readmissions. This research used a mixed-method approach to examine the association between medicines-related risks and readmissions, and the pharmacists’ interventions thought to be important by key stakeholders to reduce readmissions. Medicines-related risks such as polypharmacy, potentially inappropriate medicines and high risk medicines did not have a strong association with repeated hospital admission in multivariable logistic regression. Patients who had multi-morbidities, and non-supported discharge, had a higher risk of repeated hospital admissions. A consensus survey study with three iterative rounds identified a list of pharmacists’ interventions viewed as high priority for reducing readmissions in frail elderly patients. The interventions with the highest scores included medicines reconciliation at discharge, on admission, preparation of discharge summary, provision of tailored patient education about medicines and inter-disciplinary working in ward rounds. A systematic intervention development method was used to further develop an intervention, underpinned by the theoretical domains framework. There is a need to further explore the role of medication-related risks in contributing to readmission using other validated tools and larger datasets. This could be used to inform development of future risk stratification tools to identify high risk patients in order to target interventions to maximise its impact. / University of Bradford and Sheffield Teaching Hospital studentship

No / Dementia is common in older people admitted to acute hospitals. There are concerns about the quality of care they receive. Behavioural and psychiatric symptoms of dementia (BPSD) seem to be particularly challenging for hospital staff. Aims To define the prevalence of BPSD and explore their clinical associations. Method Longitudinal cohort study of 230 people with dementia, aged over 70, admitted to hospital for acute medical illness, and assessed for BPSD at admission and every 4 (± 1) days until discharge. Other measures included length of stay, care quality indicators, adverse events and mortality. Results Participants were very impaired; 46% at Functional Assessment Staging Scale (FAST) stage 6d or above (doubly incontinent), 75% had BPSD, and 43% had some BPSD that were moderately/severely troubling to staff. Most common were aggression (57%), activity disturbance (44%), sleep disturbance (42%) and anxiety (35%). Conclusions We found that BPSD are very common in older people admitted to an acute hospital. Patients and staff would benefit from more specialist psychiatric support.

Yes / Acute hospital admission is distressing for care home residents. Ambulatory care sensitive conditions, such as respiratory and urinary tract infections, are conditions that can cause unplanned hospital admission but may have been avoidable with timely detection and intervention in the community. The Better Health in Residents in Care Homes (BHiRCH) programme has feasibility tested and will pilot a multicomponent intervention to reduce these avoidable hospital admissions. The BHiRCH intervention comprises an early warning tool for noting changes in resident health, a care pathway (clinical guidance and decision support system) and a structured method for communicating with primary care, adapted for use in the care home. We use practice development champions to support implementation and embed changes in care. Methods and analysis: Cluster randomised pilot trial to test study procedures and indicate whether a further definitive trial is warranted. Fourteen care homes with nursing (nursing homes) will be randomly allocated to intervention (delivered at nursing home level) or control groups. Two nurses from each home become Practice Development Champions trained to implement the intervention, supported by a practice development support group. Data will be collected for 3 months preintervention, monthly during the 12-month intervention and 1 month after. Individual-level data includes resident, care partner and staff demographics, resident functional status, service use and quality of life (for health economic analysis) and the extent to which staff perceive the organisation supports person centred care. System-level data includes primary and secondary health services contacts (ie, general practitioner and hospital admissions). Process evaluation assesses intervention acceptability, feasibility, fidelity, ease of implementation in practice and study procedures (ie, consent and recruitment rates). / UK NIHR grant number RP-PG-0612-20010.

Yes / The novel coronavirus SARS-19 produces 'COVID-19' in patients with symptoms. COVID-19 patients admitted to the hospital require early assessment and care including isolation. The National Early Warning Score (NEWS) and its updated version NEWS2 is a simple physiological scoring system used in hospitals, which may be useful in the early identification of COVID-19 patients. We investigate the performance of multiple enhanced NEWS2 models in predicting the risk of COVID-19. Our cohort included unplanned adult medical admissions discharged over 3 months (11 March 2020 to 13 June 2020 ) from two hospitals (YH for model development; SH for external model validation). We used logistic regression to build multiple prediction models for the risk of COVID-19 using the first electronically recorded NEWS2 within ± 24 hours of admission. Model M0' included NEWS2; model M1' included NEWS2 + age + sex, and model M2' extends model M1' with subcomponents of NEWS2 (including diastolic blood pressure + oxygen flow rate + oxygen scale). Model performance was evaluated according to discrimination (c statistic), calibration (graphically), and clinical usefulness at NEWS2 ≥ 5. The prevalence of COVID-19 was higher in SH (11.0 %=277/2520) than YH (8.7 %=343/3924) with a higher first NEWS2 scores ( SH 3.2 vs YH 2.8) but similar in-hospital mortality (SH 8.4 % vs YH 8.2 %). The c-statistics for predicting the risk of COVID-19 for models M0',M1',M2' in the development dataset were: M0': 0.71 (95 %CI 0.68-0.74); M1': 0.67 (95 %CI 0.64-0.70) and M2': 0.78 (95 %CI 0.75-0.80)). For the validation datasets the c-statistics were: M0' 0.65 (95 %CI 0.61-0.68); M1': 0.67 (95 %CI 0.64-0.70) and M2': 0.72 (95 %CI 0.69-0.75) ). The calibration slope was similar across all models but Model M2' had the highest sensitivity (M0' 44 % (95 %CI 38-50 %); M1' 53 % (95 %CI 47-59 %) and M2': 57 % (95 %CI 51-63 %)) and specificity (M0' 75 % (95 %CI 73-77 %); M1' 72 % (95 %CI 70-74 %) and M2': 76 % (95 %CI 74-78 %)) for the validation dataset at NEWS2 ≥ 5. Model M2' appears to be reasonably accurate for predicting the risk of COVID-19. It may be clinically useful as an early warning system at the time of admission especially to triage large numbers of unplanned hospital admissions. / The Health Foundation (Award No 7380) and the National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC) (Award No PSTRC-2016-006) / Research Development Fund Publication Prize Award winner, Aug 2021.