BACKGROUND & AIMS The rate of readmission to the hospital 30 days after discharge (30-day readmission rate) is used as a quality measure for hospitalized patients, but it has not been studied adequately for patients with advanced liver disease. We investigated the incidence and factors that predict this rate and its relationship with mortality at 90 days. METHODS We analyzed data from patients with advanced liver disease who were hospitalized to an inpatient hepatology service at 2 large academic medical centers in 2008. Patients with elective admission and recipients of liver transplants were not included. During the study period, there were 447 patients and a total of 554 eligible admissions. Multivariate analyses were performed to identify variables associated with 30-day readmission and to examine its relationship with mortality at 90 days. RESULTS The 30-day readmission rate was 20%. After adjusting for multiple covariates, readmission within 30 days was associated independently with model for end-stage liver disease scores at discharge (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02–1.09; P = .002), the presence of diabetes (OR, 1.78; 95% CI, 1.07–2.95; P = .027), and male sex (OR, 1.73; 95% CI, 1.03–2.89; P = .038). After adjusting for age, sex, and model for end-stage liver disease score at discharge, the 90-day mortality rate was significantly higher among patients who were readmitted to the hospital within 30 days than those who were not (26.8% vs 9.8%; OR, 2.6; 95% CI, 1.36 –5.02; P = .004). CONCLUSIONS Patients with advanced liver disease frequently are readmitted to the hospital within 30 days after discharge; these patients have a higher 90-day mortality rate than those who are not readmitted in 30 days. These data might be used to develop strategies to reduce early readmission of hospitalized patients with cirrhosis.
Rationale:The clinical pathology describing infants with chronic lung disease of infancy (CLDI) has been limited and obtained primarily from infants with severe lung disease, who either died or required lung biopsy. As lung tissue from clinically stable outpatients is not available, physiological measurements offer the potential to increase our understanding of the pulmonary pathophysiology of this disease. Objectives: We hypothesized that if premature birth and the development of CLDI result in disruption of alveolar development, then infants and toddlers with CLDI would have a lower pulmonary diffusing capacity relative to their alveolar volume compared with full-term control subjects. Methods: We measured pulmonary diffusing capacity and alveolar volume, using a single breath-hold maneuver at elevated lung volume. Subjects with chronic lung disease of infancy (23-29 wk of gestation; n 5 39) were compared with full-term control subjects (n 5 61) at corrected ages of 11.6 (4.8-17.0) and 13.6 (3.2-33) months, respectively. Measurements and Main Results: Alveolar volume and pulmonary diffusing capacity increased with increasing body length for both groups. After adjusting for body length, subjects with CLDI had significantly lower pulmonary diffusing capacity (2.88 vs. 3.23 ml/ min/mm Hg; P 5 0.0004), but no difference in volume (545 vs. 555 ml; P 5 0.58). Conclusions: Infants and toddlers with CLDI have decreased pulmonary diffusing capacity, but normal alveolar volume. These physiological findings are consistent with the morphometric data obtained from subjects with severe lung disease, which suggests an impairment of alveolar development after very premature birth.
Even though acute anxiety has received substantial rhetorical attention during the COVID-19 pandemic, to our knowledge it has not been subject to scientific inquiry until now. Although this study cannot confirm that any search was linked to a specific acute anxiety event or panic attack, it provides evidence of the collateral psychological effects stemming from COVID-19, and motivates several data-driven recommendations.First, surveillance should continue as changes during the pandemic may spark new increases in acute anxiety that necessitate a response. Second, in light of the pandemic, resource providers should better address acute anxiety. For instance, Illinois launched "Call4Calm," a hotline to help people cope with acute COVID-19 anxiety, and such programs could be expanded nationally. Third, more must be done to link those needing help with help. A "panic attack" Google query does not return any links to helplines, even though Google has pioneered the "OneBox" approach to mental health queries, highlighting life-saving results at the top of a user's search results (including suicide and addiction hotlines) rather than hoping searchers find actionable information by chance alone. The Google OneBox should be expanded to promote resources for acute anxiety, like SAMHSA's Disaster Distress Helpline, to meet potential increased demand during COVID-19 now and in the future.Time-sensitive decision-making during a pandemic underscores the importance of fostering an agile empirical approach that can continually monitor health threats, 6 including the ability to study an outcome without a priori anticipatory data collection. Mining internet searches may improve strategies to discover and subsequently address the collateral mental health consequences of COVID-19.
OBJECTIVES-To examine the association between changes in body mass index (BMI), dementia, and mild cognitive impairment (MCI). DESIGN-Prospective observational study.SETTING-Urban community in Indianapolis, Indiana. PARTICIPANTS-Participantswere African Americans aged 65 and older enrolled in the Indianapolis Dementia Project and followed through 2007. This analysis included 1,331 participants who did not have dementia at their first BMI measurement. MEASUREMENTS-Cognitive assessment and clinical evaluations were conducted every other year to identify participants with dementia or MCI during 12 years of follow-up (mean follow-up 6.4 years). BMI measures; alcohol and smoking history; and medical conditions including history of cancer, hypertension, diabetes mellitus, heart attack, stroke; and depression were collected at each follow-up evaluation. Mixed-effect models were used to examine the differences in BMI between participants who developed dementia or MCI and those who did not, adjusting for covariates.RESULTS-Mean BMI at baseline was 29.8 ± 5.7 for women and 28.3 ± 4.8 for men. Participants with incident dementia or MCI had greater decline in BMI than those without (P=.02 for dementia, P=.04 for MCI). BMI in participants with incident dementia, MCI, and normal © 2010, The American Geriatrics Society Address correspondence to Sujuan Gao, Department of Medicine, Indiana University School of Medicine, 410 West 10th Street, Suite 3000, Indianapolis, IN 46202. sgao@iupui.edu. Author Contributions: Study design: Gao, Hendrie, Unverzagt, Hall. Data acquisition: Hendrie, Unverzagt, Hake, Smith-Gambel, Hall. Data analysis and interpretation: Gao, Nguyen, Hendrie. Preparation of manuscript: Gao, Nguyen, Hendrie, Unverzagt, Hake, Smith-Gambel, Hall. Conflict of Interest:The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Sponsor's Role:The data used in this manuscript are from a NIH-funded study "Indianapolis-Ibadan Dementia Project." The sponsor played no role in the design, method, analysis, or preparation of the manuscript. NIH Public AccessAuthor Manuscript J Am Geriatr Soc. Author manuscript; available in PMC 2012 January 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript cognition did not differ 12 or 9 years before diagnosis, but 6 years before diagnosis, participants with incident dementia had significantly lower BMI than participants with normal cognition (P=. 03), as did participants with MCI (P=.006).CONCLUSION-Decline in BMI appears to be an early marker for dementia. There is a need for the close monitoring of weight loss in older adults. Keywordsbody mass index; dementia; mild cognitive impairment; African AmericansObesity is associated with risk of diabetes mellitus, hypertension, and cardiovascular disease, conditions related to risk of dementia. There are studies confirming that midlife obesity is a risk factor for dem...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.