Evaluation of re-hospitalized COVID-19 patients in a hospital

SUMMARY PURPOSE: This study intends to investigate the reasons for re-hospitalization, complaints, and prognoses of COVID-19 patients after being discharged. METHODS: COVID-19 patients who were re-hospitalized at the Sakarya University Training and Research Hospital were examined. Reverse transcriptase-polymerase chain reaction (RT-PCR), tomography and laboratory results, demographic characteristics, and prognostic results were recorded retrospectively. RESULTS: A total of 60 patients, including 26 males (43.3%) and 34 females (56.7%), with repeated admissions to the hospital for COVID-19 symptoms, were included in the study with a mean age of 56.9 (± 22.5) (median value = 61, age range = 3-88). The number of days of the second hospitalization was statistically significantly higher (p < 0.05). Patient age and number of days of hospitalization were strongly positively correlated (p < 0.01). A total of 11 patients (18%) had negative results in their first RT-PCR and subsequently tested positive in their second hospitalization. In addition, 10 (17.5%) of the patients who underwent thoracic tomography had unilateral involvement, 34 (59.6%) had bilateral involvement, and 13 (22.8%) had no significant results. Note that 4 (6.6%) of the patients re-hospitalized died in the hospital, while 56 (93.4%) were discharged once more. All of the four patients that died were female with a mean age of 81.5 years. CONCLUSION: Particularly patients with advanced age and comorbidities should be examined more carefully when discharged; if their complaints are repeated, they should be advised to quickly contact the emergency service.

RESUMO OBJETIVO: Este estudo pretende investigar as causas para re-hospitalizações, as reclamações e os prognósticos de pacientes com COVID-19 após a alta hospitalar. MÉTODOS: Pacientes com COVID-19 internados que foram re-hospitalizados no Sakarya University Training and Research Hospital foram examinados. Os resultados da reação em cadeia de polimerase precedida de transcrição reversa (RT-PCR), tomografia e dos exames laboratoriais, as características demográficas e os resultados prognósticos foram registrados retrospectivamente. RESULTADOS: Um total de 60 pacientes, 26 do sexo masculino (43,3%) e 34 do sexo feminino (56,7%), com internações repetidas devido a sintomas de COVID-19 foram incluídos no estudo, com uma idade média de 56,9 (± 22,5) (mediana = 61, faixa etária = 3-88). O número de dias da segunda internação foi estatisticamente significativamente maior (p < 0,05). A idade do paciente e o número de dias de internação apresentaram uma forte correlação positiva (p < 0,01). Um total de 11 pacientes (18%) apresentaram resultados negativos no primeiro RT-PCR e posteriormente tiveram resultados positivos na segunda internação. Além disso, 10 (17,5%) dos pacientes submetidos a tomografia de tórax apresentaram envolvimento unilateral, 34 (59,6%) bilateral, e 13 (22,8%) não apresentaram resultados significativos. Nota-se que 4 (6,6%) dos pacientes re-hospitalizados morreram no hospital, enquanto 56 (93,4%) receberam alta mais uma vez. Todos os quatro pacientes que morreram eram do sexo feminino, com idade média de 81,5 anos. CONCLUSÃO: Principalmente pacientes com idade avançada e comorbidades devem ser examinados com mais cuidado no momento da alta hospitalar; caso suas queixas se repitam, eles devem ser aconselhados a contatar o serviço de emergência o quanto antes.

The Influence of Maximal Aerobic Capacity on the Two Years Cardiac Related Re-Hospitalization in Patients with Heart Failure with Reduced Ejection Fraction in Korean Society

PURPOSE: This study examined the influence of the maximal aerobic capacity on the two-year cardiac-related re-hospitalization in patients with heart failure with a reduced ejection fraction (HFrEF) in Korean society.METHODS: The maximal aerobic capacity of the study population (n=95, male 63%) was evaluated using a cardiopulmonary exercise (CPX) testing system. Each patient was followed up for two years to divide the HFrEF patients into two groups according to cardiac-related re-hospitalization: re-hospitalization (RH) group (n=29, 30%) and no re-hospitalization (NRH) group (n=66, 70%).RESULTS: The relative peak VO₂ (mL/kg/min, p<0.001), exercise duration (p<0.001), respiratory exchange ratio (VCO₂/VO₂, p=0.001), systolic blood pressure (SBP) reserve (p=0.004), heart rate (HR) reserve (p=0.007), SBP max (p=0.02), and HR max (p=0.039) were significantly lower in the RH group than the NRH group during the CPX test. On the other hand, the ventilatory efficiency (VE/VCO₂ slope, p=0.02) and age (p=0.022) were significantly higher in the RH group than in the NRH group. In binary logistic regression analysis, the relative peak VO₂ (p=0.001, Wald Chi-square 10.137) was the strongest predictive factor on cardiac-related re-hospitalization, which was followed by VCO₂/VO₂ (p=0.019, Wald Chi-square 5.54). On the other hand, age (p=0.063, Wald Chi-square 3.445) did not have a significant influence on cardiac related re-hospitalization.CONCLUSION: The maximal aerobic capacity, especially the relative peak VO₂, is the strongest factor on cardiac-related re-hospitalization within two years in patients with HFrEF in Korean society.

Increased Readmission Risk and Healthcare Cost for Delirium Patients without Immediate Hospitalization in the Emergency Department

OBJECTIVE: Hospitalization of patients with delirium after visiting the emergency department (ED) is often required. However, the readmission risk after discharge from the ED should also be considered. This study aimed to explore whether (i) immediate hospitalization influences the readmission risk of patients with delirium; (ii) the readmission risk is affected by various risk factors; and (iii) the healthcare cost differs between groups within 28 days of the first ED visit. METHODS: Using the National Health Insurance Research Database, the data of 2,780 subjects presenting with delirium at an ED visit from 2000 to 2008 were examined. The readmission risks of the groups of patients (i.e., patients who were and were not admitted within 24 hours of an ED visit) within 28 days were compared, and the effects of the severities of different comorbidities (using Charlson’s comorbidity index, CCI), age, gender, diagnosis and differences in medical healthcare cost were analyzed. RESULTS: Patients without immediate hospitalization had a higher risk of readmission within 3, 7, 14, or 28 days of discharge from the ED, especially subjects with more severe comorbidities (CCI≥3) or older patients (≥65 years). Subjects with more severe comorbidities or older subjects who were not admitted immediately also incurred a greater healthcare cost for re-hospitalization within the 28-day follow-up period. CONCLUSION: Patients with delirium with a higher CCI or of a greater age should be carefully considered for immediate hospitalization from ED for further examination in order to reduce the risk of re-hospitalization and cost of healthcare.

Areca Nut Chewing and the Risk of Re-hospitalization and Mortality Among Patients With Acute Coronary Syndrome in Pakistan / 예방의학회지

OBJECTIVES: Areca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users. METHODS: A prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS. RESULTS: Of the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p < 0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p < 0.001). CONCLUSIONS: The 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events.

Clinical Observation of Tiotropium Bromide Assisted with Bronchoalveolar Lavage for Bronchiectasis Com-plicated with Lung Infection / 中国药房

OBJECTIVE:To investigate the effects of tiotropium bromide assisted with bronchoalveolar lavage (BAL) on short-term efficacy,quality of life and re-hospitalization rate of patients with bronchiectasis complicated with lung infection. METH-ODS:A total of 140 patients with bronchiectasis complicated with lung infection selected from our hospital during Oct. 2013-Dec. 2015 were divided into control group and observation group by lottery,with 70 cases in each group. Based on intervention therapy, control group received BAL. Observation group was additionally given Tiotropium bromide powder inhalation 18 μg ,once a day before going to bed,on the basis of control group. Both groups were treated for 4 weeks. Clinical efficacy was compared between 2 group;pulmonary ventilation function indexes,blood gas analysis indexes,BODE index scores and QLI scores before and after treatment,re-hospitalization rate and the occurrence of ADR were also compared between 2 groups. RESULTS:The total response rate of observation group was 91.43%,which was significantly higher than that of control group(78.57%),with statistical signif-icance (P0.05). After treatment,FVC,FEV1,FEV1%,p(O2) and QLI score of 2 groups were increased significantly,while p(CO2)and BODE index scores were decreased significantly,com-pared to before treatment;all indexes of the observation group was significantly better than the control group,with statistical sig-nificance (P<0.05). The re-hospitalization rate of observation group 3,6 months after treatment was significantly lower thanthat of control group,with statistical significance(P<0.05). No ADR was found in 2 groups. CONCLUSIONS:For patients with bronchiectasis complicated with lung infection,tiotropium bromide assisted with BAL can effectively relieve the clinical symp-toms and signs,improve lung ventilation function and the quality of daily life and can be helpful to reduce the risk of re-hospital-ization with good safety.

Effects Evaluation of Clinical Pharmacists Participating in Disease Management of Chronic Heart Failure / 中国药房

OBJECTIVE:To evaluate the effects of clinical pharmacists participating in disease management of chronic heart failure(CHF). METHODS:A total of 180 CHF inpatients selected from cardiovascular medicine department of our hospital during Jan. 2013 to Dec. 2014 were divided into control group and pharmacist management group according to random number table,with 90 cases in each group. The control group was given routine treatment. The pharmacist management group additionally received indi-vidualized pharmaceutical care,such as pharmaceutical monitoring,psychological counseling,medication education and 6-month follow-up. The comprehensive self-care ability of the 2 groups were compared on admission and on discharge;re-hospitalization and mortality were compared between 2 groups within 6 months after discharged;the patients’NYHA classification,LVEF,plas-ma level of NT-proBNP and quality of life were compared between 2 groups on admission and 6 months after discharge. RE-SULTS:There was no statistical significance in the cognition of patients to disease,self-care ability,medication compliance score and total comprehensive self-care ability score between 2 groups on admission (P>0.05). Each score and total score of 2 groups were better on discharge than on admission,and the pharmacist management group was better than control group,with statistical significance(P0.05). There was no statistical significance in NYHA classification,LVEF,plasma level of NT-proBNP be-tween 2 groups on admission(P>0.05). 6 months after discharge,the above 3 indexes of pharmacist management group as well as NYHA classification and plasma level of NT-proBNP of control group were improved significantly compared to on admission;NYHA classification,LVEF and plasma level of NT-proBNP of pharmacist management group were better than those of control group at corresponding period,with statistical significance (P0.05). 6 months after discharge,each score and total score of 2 groups were all better than on admission,and the pharmacist management group was better than control group, with statistical significance (P<0.05). CONCLUSIONS:The participation of clinical pharmacists in the disease management of CHF can significantly improve comprehensive self-care ability,decrease re-hospitalization rate,ameliorate cardiac function and en-hance the quality of life.

Situation and Related Factors of Maintenance Medication Treatment in Schizophrenic Patients Re-hospitalized for Relapse / 中国康复理论与实践

@#Objective To survey the situation and related factors of maintenance medication treatment in schizophrenic patients re-hospitalized for relapse. Methods 362 patients re-admitted with schizophrenia and their relatives were interviewed with questionnaire which included 16 factors that might affect maintenance medication treatment. Results 63.8% patients stopped medication and 21.1% patients were on low-dose maintenance medication treatment by themselves, while 7.7% patients were on reasonable dose anti-psychotics in 2 years. The time of maintenance medication treatment related with insight (OR=2.2144, P=0.001), family care (OR=4.8842, P=0.025), outcomes of treatment (OR=2.2056, P=0.007) and negative life events (OR=0.4529, P=0.003). Conclusion Schizophrenic patients re-admitted with relapse often withdraw or reduce their medication by themselves, which risked with poor insight, poor therapeutic effect, poor care from their family, and more negative life events

Catechol-O-Methyl Transferase Gene Polymorphism and Treatment Response to Clozapine in Refractory Schizophrenia / 대한정신약물학회지

OBJECTIVE: Disturbances in the biogenic amine pathways have been hypothesized to be the biochemical basis of schizophrenia. Catechol-O-methyl transferase (COMT) gene is an important candidate gene due to its function to metabolically inactivating these amines. We investigated the association between 472 G/A (158val/met) and -287 A/G polymorphisms of COMT gene with response to clozapine treatment in refractory schizophrenia. METHODS: One hundred twenty patients of refractory schizophrenia, who were treated with clozapine longer than six months, were participated in this study. We evaluated treatment response on the basis of the difference of re-hospitalization frequency and hospitalization duration before and after the first clozapine administration day. Genotyping of the 472 G/A and -287 A/G polymorphisms was performed by SNapShot method. RESULTS: In 472 G/A polymor-phism, there were no significant differences of the re-hospitalization frequency and the hospitalization duration between the A (-) group and A (+) group, and also no differences among GG, GA, and AA groups. In -287 A/G polymorphism, there were no significant differences between G (-) group and G (+) group. However, we observed significant differences in the re-hospitalization frequency (F=4.38, p=0.015) and in the hospitalization duration (F=3.90, p=0.024) among three genotype groups. CONCLUSION: We found that the treatment response to clozapine was not associated with COMT 472 G/A polymorphism but was positively associated with -287 A/G polymorphism in refractory schizophrenia. However, This association is not strong enough to conclude the association between -287 A/G polymorphism in COMT gene and clozapine response. Further studies with a large sample are required to verify this positive finding more clearly.