Preventing avoidable rehospitalizations by understanding the characteristics of "frequent fliers"

This project used chart review to evaluate 22 patients labeled as "frequent fliers," each with 4 to 8 readmissions over a 6-month period at a Michigan community hospital. The goal was to identify whether the 4 key elements identified by the Institute for Healthcare Improvement for reducing rehospitalization had been put into place for these patients. It found that a clear discharge plan was only documented for 15 (68%) of the 22 patients. Better coordinated care is warranted.     

High altitude medicine.

Altitude illness is common and may result in major disruption of travel plans. Visitors to altitude need to be aware of the various health problems they might encounter and how they may be prevented. Self-diagnosis and treatment is the norm in many remote locations. The hallmark of therapy remains descent, but with newer treatment modalities, this may be easily forgotten. People with preexisting health problems may desire to visit high altitude destinations. It is reasonable to support some strongly motivated people in undertaking such trips, providing they recognize the difficulties of coping with illness in remote locations.     

High sensitivity C-reactive protein.

Though there is no apparent relationship between CRP and cardiovascular disease, the hsCRP may be the most effective single marker of disease among otherwise healthy adults, and is certainly an effective marker when employed in combination with other proven markers such as fibrinogen, homocysteine, and lipid assays. The hsCRP test may not be particularly useful among inpatients, however, as it is typically elevated in acute inflammatory disease. In addition to its apparent ability to predict the risk of cardiovascular disease, the hsCRP test points the way to further identification of risk markers.     

High risk strategies for atherosclerosis.

Calculating a person's chances of developing coronary heart disease (CHD) is not simple, as many risk factors interact in a complex fashion. Thus many markers, though significant in univariate comparisons, are no longer so when multivariate analysis is performed. Those factors contributing independently to risk can be identified only in prospective investigations such as the Münster Heart (PROCAM) or the Framingham studies. In the Münster Heart study, follow-up of middle-aged men for eight years identified the following nine independent risk variables: age, smoking history, personal history of angina pectoris, family history of myocardial infarction, systolic blood pressure, raised plasma low density lipoprotein cholesterol (LDL-C), low plasma high density lipoprotein cholesterol, raised fasting plasma triglyceride and presence of diabetes mellitus. These have been used to generate an algorithm for prediction of first coronary events which is available in interactive fashion on the internet'. Large trials have shown that lowering LDL-C reduces the risk of CHD, and diminishes CHD morbidity and mortality in persons without prior evidence of coronary atherosclerosis (primary prevention). This is even more the case in patients with such evidence (secondary prevention). It appears that lowering of LDL-C also reduces all-cause mortality in secondary prevention.     

High resolution electronic-linear-scanning ultrasonic diagnostic equipment.

Electronic linear-scanning ultrasonic diagnostic equipment so far has suffered from low resolution. In the study presented here, improvement in resolution was obtained by electronic focusing and improved image quality by small-angle deflection.Electronic focusing is a method obtaining a narrow ultrasonic beam by means of phase control. Small-angle deflection is a method to increase scanning line density by deflecting slightly the ultrasonic beam also by means of phase control and thus to obtain information existing between the successive scanning lines of a conventional linear scanning system. Both experimental investigation and clinical application have shown that these techniques are highly effective in increasing lateral resolution and image quality. It has been confirmed that the equipment is practical for routine use.     

High bone turnover in the elderly.

OBJECTIVES: To document lifestyle-associated variations in biochemical markers of bone metabolism in advanced age. STUDY DESIGN: Cross-sectional study. SETTING: Department of Geriatrics, University Hospital, Basel, Switzerland. SUBJECTS: Three hundred twelve ambulatory and 193 institutionalized men and women, aged 54 to 99 yrs. OUTCOME MEASUREMENTS: Biochemical markers of bone resorption (urinary deoxypyridinolin and N-telopeptides), serum vitamin D metabolites, and serum intact parathyroid hormone (iPTH) concentrations were assessed. Mean values of all parameters were correlated with a six-grade activity score. Physical activity score reflected the degree of weight bearing, ranging from walking independently to primarily bed-bound. Ambulatory subjects were measured in summertime and institutionalized subjects in wintertime to accentuate seasonality of vitamin D hormone levels. RESULTS: Excretion of bone resorption markers was significantly higher in the institutionalized and physically inactive patients compared with those who were ambulatory and physically active (p = .0001). Vitamin D deficiency (25-hydroxyvitamin D of <12 ng/mL) was present in 86% of institutionalized and 15% of ambulatory subjects, and 1,25-dihydroxyvitamin D serum concentrations were lower in institutionalized than in ambulatory subjects (p = .0001). Mean serum concentrations for iPTH were similar for both the institutionalized and ambulatory groups. When subjects were arranged according to activity score, mean excretion of urinary bone resorption markers increased with degree of inactivity. CONCLUSION: Despite the difference in vitamin D metabolites, iPTH serum concentrations did not differ significantly between the institutionalized and ambulatory groups. However, institutionalized and physically inactive participants had markedly elevated excretion of urinary bone resorption markers compared with ambulatory and physically active subjects. These results suggest that high bone turnover in the elderly may be caused by physical inactivity related to low mechanical loading rather than secondary hyperparathyroidism.     

High risk pregnancy in the workplace. Influencing positive outcomes.

Childbearing employees are well served by the occupational health nurse who promotes optimal preconceptual and pregnancy health practices, uses community resources, and maintains current knowledge about high risk pregnancy prevention and care. These broad goals of care can lead to decreased absenteeism, healthier and happier employees, and more positive outcomes of pregnancy. For employees with high risk pregnancies, the role of the occupational health nurse includes, but is not limited to, facilitating awareness with the employer, making suggestions for adjusting working conditions, making frequent assessments of the employee's needs, and communicating with prenatal health care providers. Occupational health nurses should never underestimate their role and potential influence on the mother, and on her significant other, for a positive outcome of her pregnancy.