Factors affecting unplanned readmissions from community hospitals to acute hospitals: a prospective observational study

<p><b>INTRODUCTION</b>While the readmission rate from community hospitals is known, the factors affecting it are not. Our aim was to determine the factors predicting unplanned readmissions from community hospitals (CHs) to acute hospitals (AHs).</p><p><b>MATERIALS AND METHODS</b>This was an observational prospective cohort study, involving 842 patients requiring post-acute rehabilitation in 2 CHs admitted from 3 AHs in Singapore. We studied the role of the Cumulative Illness Rating Scale (CIRS) organ impairment scores, the Mini-mental State Examination (MMSE) score, the Shah modified Barthel Index (BI) score, and the triceps skin fold thickness (TSFT) in predicting the rate of unplanned readmissions (UR), early unplanned readmissions (EUPR) and late unplanned readmissions (LUPR). We developed a clinical prediction rule to determine the risk of UR and EUPR.</p><p><b>RESULTS</b>The rates of EUPR and LUPR were 7.6% and 10.3% respectively. The factors that predicted UR were the CIRS-heart score, the CIRS-haemopoietic score, the CIRS-endocrine / metabolic score and the BI on admission. The MMSE was predictive of EUPR. The TSFT and CIRS-liver score were predictive of LUPR. Upon receiver operator characteristics analysis, the clinical prediction rules for the prediction of EUPR and UR had areas under the curve of 0.745 and 0.733 respectively. The likelihood ratios of the clinical prediction rules for EUPR and UR ranged from 0.42 to 5.69 and 0.34 to 3.16 respectively.</p><p><b>CONCLUSIONS</b>Patients who have UR can be identified by the admission BI, the MMSE, the TSFT and CIRS scores in the cardiac, haemopoietic, liver and endocrine/metabolic systems.</p>

Attitudes of first-year medical students in Singapore towards older people and willingness to consider a career in geriatric medicine

<p><b>INTRODUCTION</b>Training of future physicians in the care of elderly patients will need to evolve in accordance with the exponential increase of elderly patients, but some may have preconceived attitudes affecting their management. This study determined medical students' attitudes towards older people and their willingness to consider a career in Geriatric Medicine.</p><p><b>MATERIALS AND METHODS</b>All 250 first-year medical students, prior to any formal clinical exposure at the National University of Singapore School of Medicine, were asked to participate voluntarily in the study based on the UCLA Geriatrics Attitudes Scale. The 14-item questionnaire consisted of a mixture of positively and negatively worded questions answered on a 5-point Likert scale. A fifteenth question enquired about their willingness to consider Geriatric Medicine as a potential career choice.</p><p><b>RESULTS</b>The mean UCLA attitudes score was 3.58 [+/-standard deviation (SD), 0.41] suggesting a generally positive attitude. There was a strong association between attitude scores and willingness to consider Geriatric Medicine as a career (R = 0.48, P <001). However, only one third of the cohort was willing to consider a career in Geriatric Medicine. There was no difference in attitude scores between male and female students, but females were significantly more likely to consider Geriatric Medicine as a potential career choice.</p><p><b>CONCLUSION</b>First-year medical students in Singapore have a generally positive attitude towards older people, although only 1 in 3 persons was willing to consider a career in Geriatric Medicine. Higher attitude scores and female gender were the main predictors of willingness to consider a career in Geriatric Medicine.</p>