Clinical and health care utilization variables can predict 90-day hospital re-admission in adults with Crohn's disease for point of care risk evaluation.

BACKGROUND: Hospital re-admission for persons with Crohn's disease (CD) is a significant contributor to morbidity and healthcare costs. We derived prediction models of risk of 90-day re-hospitalization among persons with CD that could be applied at hospital discharge to target outpatient interventions mitigating this risk. METHODS: We performed a retrospective study in persons with CD admitted between 2009 and 2016 for an acute CD-related indication. Demographic, clinical, and health services predictor variables were ascertained through chart review and linkage to administrative health databases. We derived and internally validated a multivariable logistic regression model of 90-day CD-related re-hospitalization. We selected the optimal probability cut-point to maximize Youden's index. RESULTS: There were 524 CD hospitalizations and 57 (10.9%) CD re-hospitalizations within 90 days of discharge. Our final model included hospitalization within the prior year (adjusted odds ratio [aOR] 3.27, 95% confidence interval [CI] 1.76-6.08), gastroenterologist consultation within the prior year (aOR 0.185, 95% CI 0.0950-0.360), intra-abdominal surgery during index hospitalization (aOR 0.216, 95% CI 0.0500-0.934), and new diagnosis of CD during index hospitalization (aOR 0.327, 95% CI 0.0950-1.13). The model demonstrated good discrimination (optimism-corrected c-statistic value 0.726) and excellent calibration (Hosmer-Lemeshow goodness-of-fit p-value 0.990). The optimal model probability cut point allowed for a sensitivity of 71.9% and specificity of 70.9% for identifying 90-day re-hospitalization, at a false positivity rate of 29.1% and false negativity rate of 28.1%. CONCLUSIONS: Demographic, clinical, and health services variables can help discriminate persons with CD at risk of early re-hospitalization, which could permit targeted post-discharge intervention.

Outcomes and cost analysis of patients with dementia in the intensive care unit: a population-based cohort study.

BACKGROUND: Dementia is a neurological syndrome affecting the growing elderly population. While patients with dementia are known to require significant hospital resources, little is known regarding the outcomes and costs of patients admitted to the intensive care unit (ICU) with dementia. METHODS: We conducted a population-based retrospective cohort study of patients with dementia admitted to the ICU in Ontario, Canada from 2016 to 2019. We described the characteristics and outcomes of these patients alongside those with dementia admitted to non-ICU hospital settings. The primary outcome was hospital mortality but we also assessed length of stay (LOS), discharge disposition, and costs. RESULTS: Among 114,844 patients with dementia, 11,341 (9.9%) were admitted to the ICU. ICU patients were younger, more comorbid, and had less cognitive impairment (81.8 years, 22.8% had ≥ 3 comorbidities, 47.5% with moderate-severe dementia), compared to those in non-ICU settings (84.2 years, 15.0% had ≥ 3 comorbidities, 54.1% with moderate-severe dementia). Total mean LOS for patients in the ICU group was nearly 20 days, compared to nearly 14 days for the acute care group. Mortality in hospital was nearly three-fold greater in the ICU group compared to non-ICU group (22.2% vs. 8.8%). Total healthcare costs were increased for patients admitted to ICU vs. those in the non-ICU group ($67,201 vs. $54,080). CONCLUSIONS: We find that patients with dementia admitted to the ICU have longer length of stay, higher in-hospital mortality, and higher total healthcare costs. As our study is primarily descriptive, future studies should investigate comprehensive goals of care planning, severity of illness, preventable costs, and optimizing quality of life in this high risk and vulnerable population.

In vitro detection of apoptosis using oscillating and pulsed gradient diffusion magnetic resonance imaging.

Cellular apoptosis, a common pathway towards tumor regression, is induced by many radiotherapy and chemotherapy regimens. Imaging methods that can detect apoptosis may be able to assess treatment response earlier than typical tumor volume measurements. In this paper, a wide range of diffusion experiments and a simple model of diffusion in tissues were used to probe the microstructural effects of apoptosis. Experiments were conducted on acute myeloid leukemia cell pellets, where apoptosis was induced by treatment with the chemotherapeutic agent cisplatin. Seventy-two hours following cisplatin treatment, pulsed and oscillating gradient diffusion measurements were utilized to assess effects across a broad range of structural scales. The presence of apoptosis, which was histologically confirmed by TUNEL (terminal deoxynucleotidyl transferase UTP nick end labelling) staining, significantly changed diffusion properties. To describe these changes, the data were fit to the parallel plane model, which characterizes the effects of restricted diffusion in terms of three parameters: d, the restricted size, Dfree , the intrinsic, free diffusion coefficient of the solvent, and Drest , the long time or "restricted" diffusion coefficient. Apoptotic samples exhibited significant decreases in parameters d and Dfree and a significant increase in Drest . These changes appear consistent with the established morphological effects of apoptosis. In particular, the decrease in d may be a result of the combined effects of cell shrinkage, nuclear fragmentation and membrane blebbing, the decrease in Dfree may relate to cytosolic condensation, while the increase in Drest can be attributed to increased membrane permeability and extracellular volume fraction. By non-invasively detecting apoptosis, the methods reported in this study have the potential to improve upon current MRI methods for monitoring therapeutic response. Furthermore, these methods may offer sufficient specificity to differentiate between apoptosis and other modes of cell death, such as oncosis or necrosis.