Early predictors of hospital admission in emergency department patients with chronic obstructive pulmonary disease

Background

Streamlining emergency department (ED) care of patients with chronic obstructive pulmonary disease (COPD) may be an important strategy in managing the increasing burden of this disease.

Study objectives

The aim of this study was to identify factors predictive of hospital admission in ED patients with COPD, specifically factors that can be used early in the ED episode of care.

Methods

Using retrospective regression analysis, case data from 321 randomly selected medical records from five Australian EDs were analysed. Patient characteristics, triage and ED system features, physiological status, and ED treatment during the first four hours of ED care were compared between discharged and admitted patients.

Results

Factors available on ED arrival associated with increased likelihood of admission were: age (OR = 1.04, p = 0.008) respiratory symptoms affecting activities of daily living (OR = 1.8, p = 0.043) and signs of respiratory dysfunction (OR = 2.5, p = 0.005). Factors available from the first four hours of ED care associated with increased likelihood of admission were: age (OR = 1.04, p = 0.021), oxygen use at four hours (OR = 3.5, p = 0.002) and IV antibiotic administration (OR = 2.6, p = 0.026). There were conflicting findings regarding the association between ambulance transport and admission.

Conclusion

There were significant differences in the characteristics of patients who were admitted or not admitted to hospital. Knowledge of these differences may be used to tailor care directed at anticipated outcome (home or hospital admission).     

The effect of enteral supplementation of neutral and acidic oligosaccharides on the response to vaccinations in preterm infants

Tijdschrift voor Kindergeneeskunde -     

Western Australian women’s perceptions of conflicting advice around breast feeding

Objective

to explore women’s perceptions of conflicting advice around breast feeding from formal support networks, specifically health professionals involved in postnatal support.

Design, setting and participants

a qualitative exploratory design was employed using the critical incident technique. Data were obtained from 62 Western Australian women who responded to an invitation to share incidents of receiving conflicting advice. Women who had breast fed a child within the past 12 months shared their experience through a telephone interview (n=50) or completing a brief questionnaire (n=12) addressing the following questions: Describe a situation in detail where you felt you received conflicting advice about breast feeding from a health professional. How did this situation affect you and/or your breast feeding?

Findings

a modified constant comparison method was used to analyse the critical incidents revealing commonalities under who offered conflicting advice; what contributed to advice being perceived as conflicting; topic areas more inclined to being regarded as conflicting; what protected against advice being perceived as conflicting; the consequences of receiving conflicting advice; and strategies that women used to manage these incidents.

Key conclusions and implications for practice

advice that was viewed as conflicting extended beyond the provision of information that was inconsistent or directly contradictory, and included issues around information overload and disparities between the mother’s and health professional’s expectations. The manner of presenting information or advice, the skills of using effective communication, demonstration of a caring attitude with an empathic approach and focusing upon the woman as an individual were seen to be important to minimise these incidents. Attention to women’s perceptions and the consequences of conflicting advice must be addressed, otherwise the credibility and confidence in health professionals’ knowledge and ability to support breast feeding is questioned, resulting in a valuable support network being selectively ignored.     

Born after infant loss: The experiences of subsequent children

Objective

to gain an in-depth understanding of subsequent children’s experiences of being born into and raised in a family following an infant death.

Design

an exploratory qualitative study.

Setting

semi-structured interview in the participants’ homes. Data were collected over a five-month period in 2009 and analysed using thematic analysis.

Participants

a purposive sample of 10 subsequent children (five boys and five girls) was used. Children whose parents had accessed the support services offered by two bereavement support agencies were recruited. Participants were asked to describe their experiences of being a subsequent child. Interviews were conducted when the subsequent child was at least 13 years of age.

Findings

all participants spent time describing how they felt about being a subsequent child. They described how they had experienced life as a subsequent child, how they considered others felt about them (especially their mother), and finally how they felt about their deceased sibling.

Key conclusions and implications for practice

all participants in this study provided a picture of emotional well-being. They were aware of their family history, and all appreciated the grief and loss which their parents had suffered. However, they did not believe that this had impacted negatively on them; rather, most talked about positive effects including feeling loved and special because of the circumstances resulting in their birth. Even those who recognised that they may not have been born had their sibling lived accepted this and appeared to be emotionally secure and well adjusted. These findings suggest that intervention with bereaved parents at the time of the perinatal/infant death and soon after is beneficial to the experiences of the subsequent child. Further research to determine the nature and extent of this benefit is warranted.     

Destructive deformation of the digits with auto-amputation: a review of pseudo-ainhum

Pseudo-ainhum is an auto-amputation of the digits. Although extremely rare, it is a traumatic and painful experience that can be alleviated with early recognition and intervention. The scientific literature is filled with reports of this interesting but unfortunate phenomenon. To date, a firm causative aetiology has not yet been established. Although reports on this phenomenon have attempted to further our understanding of pseudo-ainhum, a clear understanding has been complicated by the interchangeable use of terms describing this auto-amputation. In this review, we discuss the current understanding, diagnostic criteria, and management of pseudo-ainhum. Furthermore, the nomenclature of pseudo-ainhum is clarified. Ideally, this will allow for more efficient exploration of pseudo-ainhum, its causes, and therapeutic approaches.     

The lipid profile in psoriasis: a controlled study

BACKGROUND: Psoriasis is an inflammatory dermatosis that is characterized with hyperproliferation of keratinocytes and inflammatory infiltration in the epidermis and dermis. The high prevalence of atherosclerosis has been reported in psoriatic patients. High serum lipid level has been suggested in the pathogenesis of this phenomenon. In this study, our purpose was to compare the lipid profile in psoriatic patients with non-affected persons. METHODS: This study was designed and conducted as a case-control assay with 50 cases in the patient and control groups, respectively. The lipid profile, including serum level of triglyceride, cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL), were assessed in both groups. RESULTS: The patient and control groups each consisted of 50 cases (39 male and 11 female). The serum triglyceride, cholesterol, and LDL was significantly higher in psoriatic patients (P < 0.05) but not for HDL (P = 0.29). CONCLUSION: This study, like previous assays, shows that high serum lipid level is significantly more common in psoriasis. This fact may be responsible for higher prevalence of cardiovascular accident in psoriatic patients. It may be useful to do early screening and treatment of hyperlipidaemia in psoriasis to prevent the atherosclerosis and its complications.     

Lung function in adult patients with cystic fibrosis after using the eFlow® rapid for one year

Background

The new generation nebuliser PARI eFlow^® rapid allows a highly efficient aerosol delivery at reduced inhalation time. However, lung function data during long-term use of this device are not available until now.

Methods

70 clinically stable adult cystic fibrosis patients participated in this observation study. Lung function tests were performed prospectively 12 weeks after and again 9 to 12 months after switching the inhalation device from a conventional jet nebulizer to the PARI eFlow^® rapid. Lung function data were collected retrospectively from the visits 1 year as well as 12 weeks prior to the switch-over. Lung function data for all time points were only available for 59 patients. Treatment time and patient''s satification were recorded for both conventional and new nebuliser in all 70 patients.

Results

After 1 year of inhalation with eFlow^® rapid, the mean change in FEV1% was -- 1.4% (n = 59 patients). The decrease in FEV1 was smaller than the change in FEV1 after 1 year of inhalation with the conventional jet nebuliser (control period, -3.1%), although this difference was not statistically significant. The same effect was seen in MEF25[%] ''(-2.6% with conventional nebuliser compared to --1.6% after eFlow^® rapid). Concerning the FVC, there was a greater improvement after 1 year of inhalation with the eFlow^® rapid than with the jet nebuliser (+ 2.9% vs. +1.1%). For PEF%, there was an increase during the control period, whereas after inhalation with eFlow^® rapid there was a decrease (+1.1% vs. --2.9%). All changes were not significantly different. The eFlow^® rapid reduced total daily inhalation time by two-thirds (conventional nebuliser: 31.1 min/day; eFlow^® rapid: 10.2 min/day, n = 70 patients)

Conclusion

Inhalation with the new nebuliser eFlow rapid does not alter FEV1, FVC or PEF significantly after 1 year of inhalation. The treatment time could be reduced significantly by the eFlow^® rapid.