Short term prognosis of heart failure after first hospital admission / Pronóstico a corto plazo al alta de la primera hospitalización por insuficiencia cardíaca

BACKGROUND: Death and unexpected readmission are frequent among heart failure patients. We aimed to assess 30-day readmission and mortality rate as well as to identify predictive factors for patients discharged from a first HF related hospital admission. METHODS AND RESULTS: Retrospective, single-center, cohort study, using administrative data from a tertiary care hospital in Barcelona, Spain. Patients discharged alive from a first HF related admission from 2010 to 2014 were assessed for 30-day death, readmission and adverse outcome rate. A Linear Logistic Regression Model was fitted for each outcome. The set accounted for 3642 patients; 50.1% female and 49.9% male. Mean age was 76 years (SD=12). 30-Days rates were 9.2% for readmission, 5.6% for death and 13.8% for adverse outcome. Admission to an ED within 30 days was strongly linked to readmission (OR=6.97), death (OR=2.31) and adverse outcome (OR=8.55), as well as chronic kidney disease (OR=1.44/1.61/2.86 respectively). Discharge to a Long Stay Care (LSC) facility was linked to lower readmission and adverse event rates (OR=.57 and OR=.15). CONCLUSION: Pre and post-index discharge use of health care resources is related to adverse outcome rates. Our findings point out the potential benefit for a more tailored approach in the management of HF patients

ANTECEDENTES: La muerte y readmisión no programada son frecuentes en pacientes con insuficiencia cardiaca (IC). En este estudio evaluamos las tasas y los factores predictivos de muerte y readmisión a 30 días tras el alta de una primera hospitalización por IC. MÉTODOS Y RESULTADOS: Se trata de un estudio de cohorte retrospectivo, unicéntrico, que utiliza datos administrativos de un hospital de tercer nivel en Barcelona, España. Para los pacientes dados de alta vivos, tras un primer episodio de hospitalización por IC descompensada, entre 2010 y 2014, se calcularon las tasas de muerte, readmisión y evento adverso durante los 30 días tras el alta. Para cada variable de interés se ajustó un modelo de regresión logística. La muestra constaba de 3.642 pacientes: 50,1% mujeres y 49,9% varones con una edad media de 76 años (DE=12). Las tasas a los 30 días fueron del 9,2% para la readmisión, 5,6% para la muerte y 13,8% para el evento adverso. Haber sido visitado un servicio de urgencias en el periodo de estudio se asoció a una mayor tasa de readmisión (OR=6,97), muerte (OR=2,31) y evento adverso (OR=8,55), del mismo modo que la insuficiencia renal crónica (OR=1,44/1,61/2,86, respectivamente). El traslado al alta a un centro de larga estancia se asoció a una menor tasa de admisiones y eventos adversos (OR=0,57 y OR=0,15). CONCLUSIONES: El uso de servicios sanitarios pre y postalta guarda una clara relación con la tasa de eventos adversos. Nuestros resultados indican el beneficio potencial de un manejo personalizado de los pacientes con IC

Short term prognosis of heart failure after first hospital admission.

BACKGROUND: Death and unexpected readmission are frequent among heart failure patients. We aimed to assess 30-day readmission and mortality rate as well as to identify predictive factors for patients discharged from a first HF related hospital admission. METHODS AND RESULTS: Retrospective, single-center, cohort study, using administrative data from a tertiary care hospital in Barcelona, Spain. Patients discharged alive from a first HF related admission from 2010 to 2014 were assessed for 30-day death, readmission and adverse outcome rate. A Linear Logistic Regression Model was fitted for each outcome. The set accounted for 3642 patients; 50.1% female and 49.9% male. Mean age was 76 years (SD=12). 30-Days rates were 9.2% for readmission, 5.6% for death and 13.8% for adverse outcome. Admission to an ED within 30 days was strongly linked to readmission (OR=6.97), death (OR=2.31) and adverse outcome (OR=8.55), as well as chronic kidney disease (OR=1.44/1.61/2.86 respectively). Discharge to a Long Stay Care (LSC) facility was linked to lower readmission and adverse event rates (OR=.57 and OR=.15). CONCLUSION: Pre and post-index discharge use of health care resources is related to adverse outcome rates. Our findings point out the potential benefit for a more tailored approach in the management of HF patients.

Applicability of the heart failure Readmission Risk score: A first European study.

BACKGROUND: The Readmission Risk score (RR score) has been considered useful to predict Medicare/Medicaid patients' likelihood of 30-day hospital readmission for heart failure (HF). To our knowledge, the accuracy of this prediction model has not been independently validated in other clinical circumstances in Europe. METHODS: From July 2013 to December 2014, all patients who survived to a first admission due to decompensated HF at our tertiary care teaching hospital were retrospectively included in the study. The RR score was calculated in all patients to predict future 30 and 90-day unplanned all-cause readmissions. RESULTS: A total of 679 patients were included, of them, 52 patients (7.6%) were readmitted by any cause within 30days after discharge, and 98 (14.4%) within 90days. When compared, the average RR scores for patients readmitted was significantly higher to those who did not, either within 30days (22.7 vs. 20.1) or 90days (22.7 vs. 20.1) of discharge. The 30-day C-statistic was 0.649 (95% CI 0.574-0.723) and the 90-day 0.621 (95% CI 0.560-0.681). There was a significant increase in readmission percentages at 30 and 90days with respect to increasing quartiles of RR score. CONCLUSION: Our results only support a modest applicability of this predictive model in patients at 30 and 90days, after a first hospitalization for decompensated HF. Probably, the fact that our readmission rate in patients firstly admitted due to HF was very low, generated a bias in the study, discouraging the use of this score in the de novo HF patients.

Measurement of Spray Drift with a Specifically Designed Lidar System.

Field measurements of spray drift are usually carried out by passive collectors and tracers. However, these methods are labour- and time-intensive and only provide point- and time-integrated measurements. Unlike these methods, the light detection and ranging (lidar) technique allows real-time measurements, obtaining information with temporal and spatial resolution. Recently, the authors have developed the first eye-safe lidar system specifically designed for spray drift monitoring. This prototype is based on a 1534 nm erbium-doped glass laser and an 80 mm diameter telescope, has scanning capability, and is easily transportable. This paper presents the results of the first experimental campaign carried out with this instrument. High coefficients of determination (R² > 0.85) were observed by comparing lidar measurements of the spray drift with those obtained by horizontal collectors. Furthermore, the lidar system allowed an assessment of the drift reduction potential (DRP) when comparing low-drift nozzles with standard ones, resulting in a DRP of 57% (preliminary result) for the tested nozzles. The lidar system was also used for monitoring the evolution of the spray flux over the canopy and to generate 2-D images of these plumes. The developed instrument is an advantageous alternative to passive collectors and opens the possibility of new methods for field measurement of spray drift.

Mapping Vineyard Leaf Area Using Mobile Terrestrial Laser Scanners: Should Rows be Scanned On-the-Go or Discontinuously Sampled?

The leaf area index (LAI) is defined as the one-side leaf area per unit ground area, and is probably the most widely used index to characterize grapevine vigor. However, LAI varies spatially within vineyard plots. Mapping and quantifying this variability is very important for improving management decisions and agricultural practices. In this study, a mobile terrestrial laser scanner (MTLS) was used to map the LAI of a vineyard, and then to examine how different scanning methods (on-the-go or discontinuous systematic sampling) may affect the reliability of the resulting raster maps. The use of the MTLS allows calculating the enveloping vegetative area of the canopy, which is the sum of the leaf wall areas for both sides of the row (excluding gaps) and the projected upper area. Obtaining the enveloping areas requires scanning from both sides one meter length section along the row at each systematic sampling point. By converting the enveloping areas into LAI values, a raster map of the latter can be obtained by spatial interpolation (kriging). However, the user can opt for scanning on-the-go in a continuous way and compute 1-m LAI values along the rows, or instead, perform the scanning at discontinuous systematic sampling within the plot. An analysis of correlation between maps indicated that MTLS can be used discontinuously in specific sampling sections separated by up to 15 m along the rows. This capability significantly reduces the amount of data to be acquired at field level, the data storage capacity and the processing power of computers.

Triple-class virologic failure in HIV-infected patients undergoing antiretroviral therapy for up to 10 years.

BACKGROUND: Life expectancy of people with human immunodeficiency virus (HIV) is now estimated to approach that of the general population in some successfully treated subgroups. However, to attain these life expectancies, viral suppression must be maintained for decades. METHODS: We studied the rate of triple-class virologic failure (TCVF) in patients within the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) who started antiretroviral therapy (ART) that included a nonnucleoside reverse-transcriptase inhibitor (NNRTI) or a ritonavir-boosted protease inhibitor (PI/r) from 1998 onwards. We also focused on TCVF in patients who started a PI/r-containing regimen after a first-line NNRTI-containing regimen failed. RESULTS: Of 45 937 patients followed up for a median (interquartile range) of 3.0 (1.5-5.0) years, 980 developed TCVF (2.1%). By 5 and 9 years after starting ART, an estimated 3.4% (95% confidence interval [CI], 3.1%-3.6%) and 8.6% (95% CI, 7.5%-9.8%) of patients, respectively, had developed TCVF. The incidence of TCVF rose during the first 3 to 4 years on ART but plateaued thereafter. There was no significant difference in the risk of TCVF according to whether the initial regimen was NNRTI or PI/r based (P = .11). By 5 years after starting a PI/r regimen as second-line therapy, 46% of patients had developed TCVF. CONCLUSIONS: The rate of virologic failure of the 3 original drug classes is low, but not negligible, and does not appear to diminish over time from starting ART. If this trend continues, many patients are likely to need newer drugs to maintain viral suppression. The rate of TCVF from the start of a PI/r regimen after NNRTI failure provides a comparator for studies of response to second-line regimens in resource-limited settings.

Hospitalized smokers: compliance with a nonsmoking policy and its predictors.

BACKGROUND: Factors associated with compliance with smoke-free policies among hospitalized smokers are poorly described. A better understanding of these factors may improve smoking cessation during admission and in the long-term. METHODS: Two cross-sectional studies were conducted in an urban teaching hospital in Spain during 2002 and 2004. We interviewed 229 admitted smokers gathering data on smoking history, admission diagnosis, belief that hospitalization is related to smoking, policy's awareness, and smoking during admission and place of smoking. RESULTS: Among hospitalized patients, approximately a third were current smokers. The compliance with the nonsmoking policy in 2002 and 2004 was respectively 71.9% (IC95%: 63.9-79.9) and 60.1% (IC95%: 50.9-69.3). In the multivariate regression model, factors significantly associated with compliance were: contemplation stage, confidence in quitting after discharge, belief that current symptoms or illness were related to smoking, and mild withdrawal symptoms. CONCLUSIONS: Admission in a smoke-free hospital does not guarantee that patients will refrain from smoking. Factors associated with compliance identified may be modified by tailored smoking cessation interventions. Our results might help physicians to understand inpatients' difficulties to abstain from cigarettes and enhance their efforts to take advantage of the hospitalization as a window opportunity to quit.

Reclamaciones en un servicio de urgencias: estudio de 13 años en un hospital universitario / Complaints in an emergency department: a 13-year study in a university hospital

Introducción: Los servicios de urgencias hospitalarios (SUH) han sido concebidos para dar una respuesta óptima a las necesidades del ciudadano. Objetivos: En primer lugar, analizar las reclamaciones recibidas por el servicio de urgencias de un hospital universitario de tercer nivel para plantear recomendaciones para reducir su incidencia. En segundo lugar, determinar si existe asociación entre el tiempo de permanencia en urgencias y el número de reclamaciones recibidas. Material y método: Estudio descriptivo retrospectivo de las reclamaciones dirigidas al Servicio de Urgencias del Hospital Universitari de Bellvitge durante 13 años consecutivos, entre el 1 de enero de 1992 y el 31 de diciembre de 2004. Se trata de un hospital con capacidad para 960 camas, que atiende anualmente a 110.381 individuos adultos por consultas urgentes, excluyendo la obstetricia. Resultados: Durante los 13 años estudiados, el SUH recibió un total de 1.610 reclamaciones, de las que el 19,7% (n = 317) fueron verbales y el 80,3% (n = 1.293), escritas. El 51,2% (n = 824) de los reclamantes fueron hombres. Los motivos más frecuentes fueron demora excesiva para ser atendido en urgencias, con el 48,9% (n = 792), e insatisfacción con la asistencia, con el 14,7% (n = 102). La tasa media de reclamaciones fue de 1,2 cada 1.000 visitas urgentes. Encontramos una asociación moderada-intensa (rho de Spearman = 0,6; p < 0,005), entre el tiempo de permanencia en el SUH y el número de reclamaciones. Conclusiones: La mayoría de las reclamaciones en un SUH son sobre cuestiones organizativas y por insatisfacción con la asistencia. La información aportada por el análisis de las reclamaciones facilita la detección de oportunidades de mejora

Introduction: Emergency departments (ED) were founded to provide an optimal response to population demand. Objectives: Firstly, to analyze the complaints received by the ED of a tertiary teaching hospital during a 13-year period with a view of making recommendations to reduce their incidence. Secondly, to determine whether there is an association between length of stay in the ED and the number of complaints. Material and method: A descriptive, retrospective study of all the complaints sent to the ED of Bellvitge Hospital over 13 consecutive years, from January 1st, 1992 to December 31st, 2004 was performed. The hospital has 960 beds and attends a mean of 110,381 adult emergency visits per year, excluding obstetrics. Results: During the study period, the ED received 1610 complaints, of which 19.7% (n = 317) were oral and 80.3% (n = 1,293) were written. A total of 51.2% (n = 824) of the complainants were men. The most frequent reasons for complaints were excessive waiting time, with 48.9% (n = 792) of the complaints, and lack of satisfaction with the healthcare received, with 14.7% (n = 102) of the complaints. The mean complaint rate was 1.2 per 1000 emergency visits. A moderate-intense association (Spearman's rho = 0.6; p < 0.005) was found between length of stay in the ED and the number of complaints. Conclusions: Most complaints received in the ED concerned organizational procedures and the healthcare received. Information provided by analysis of these complaints can be used to detect opportunities for improvement