No abstract

No abstract

BackgroundThirty-day readmission rates after acute myocardial infarction (AMI) and heart failure are important patient outcome metrics. Early post-discharge physician follow-up has been promoted as a method of reducing 30-day readmission rates. However, the relationships between early post-discharge follow-up and 30-day readmission for AMI and heart failure are inconclusive. We used nationwide population-based data to examine associations between 7-day physician follow-up and 30-day readmission, and further associations of 7-day same physician (during the index hospitalization and at follow-up) and cardiologist follow-up with 30-day readmission for non-ST-segment-elevation myocardial infarction (NSTEMI) or heart failure.MethodsWe analyzed all patients 18 years or older with NSTEMI and heart failure and discharged from hospitals in 2010 in Taiwan through Taiwan’s National Health Insurance Research Database. Cox proportional hazard models with robust sandwich variance estimates and propensity score weighting were performed after adjustment for patient and hospital characteristics to test associations between 7-day physician follow-up and 30-day readmission.ResultsThe study population for NSTEMI and heart failure included 5,008 and 13,577 patients, respectively. Early physician follow-up was associated with a lower hazard ratio of readmission compared with no early physician follow-up for patients with NSTEMI (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.39–0.57), and for patients with heart failure (HR, 0.54; 95% CI, 0.48–0.60). Same physician follow-up was associated with a reduced hazard ratio of readmission compared with different physician follow-up for patients with NSTEMI (HR, 0.56; 95% CI, 0.48–0.65), and for patients with heart failure (HR, 0.69; 95% CI, 0.62–0.76).ConclusionsFor each condition, patients who have an outpatient visit with a physician within 7 days of discharge have a lower risk of 30-day readmission. Moreover, patients who have an outpatient visit with the same physician within 7 days of discharge have a much lower risk of 30-day readmission.

Pharmaceuticals and personal care products (PPCPs) constitute a class of chemicals of emerging concern due to the potential risks they pose to organisms and the environment, even at low concentrations (ng/L). Recent studies have found that PPCPs are not efficiently removed in secondary wastewater treatment plants (WWTPs). This study has: (1) simultaneously investigated the occurrence of sixty-one PPCPs using solid phase extraction and high-performance liquid chromatography-tandem mass spectrometry, (2) evaluated removal efficiencies of target PPCPs in six WWTPs that discharge effluents into major Taiwanese rivers, and lastly (3) examined matrix interference during analysis of target PPCPs in water samples. The twenty target PPCPs were chosen for their high detection frequencies, high influent concentrations, and stability during wastewater treatment processes. Caffeine and acetaminophen were detected at the highest concentrations (as high as 24,467 and 33,400 ng/L) and were effectively removed (both >96%); other PPCPs were detected in the high ng/L range but were not effectively removed. Matrix interference (by ion suppression or enhancement) during the analysis resulted in underestimation of the removal efficiencies of erythromycin-H(2)O, cefazolin, clarithromycin, ibuprofen, diclofenac, clofibric acid and gemfibrozil.