Factors related to hospital readmissions in people with spinal cord injury in South Africa.

BACKGROUND: People with spinal cord injury (PWSCI) face various challenges after being discharged from rehabilitation that can result in readmission to hospital. Little is known about readmission of PWSCI in South Africa (SA). Readmission is costly, interrupts community involvement and negatively affects quality of life. OBJECTIVES: To investigate readmission rates within 5 years of rehabilitation, causes of readmission and factors related to readmission in PWSCI in Pretoria, SA. METHODS: We quantitatively analysed retrospective data gathered from files of patients admitted to a private rehabilitation facility in Pretoria between January 2008 and December 2012. Data were analysed using Stata 13 statistical software. Descriptive statistics were initially presented. Univariate logistic regression was used to identify individual factors that had significant association with the outcome measure (readmission). Thereafter, multivariate logistic regression was used to identify risk factors for readmission. The level of statistical significance was set at p<0.5. RESULTS: Data from 543 patient files were analysed. In total, 100 patients (18%) were readmitted between January 2008 and December 2012. Twenty-eight of the 100 readmitted patients had a subsequent second readmission, 10 patients had a third readmission, and 2 patients were readmitted for a fourth time. The most common reason for readmission was secondary health conditions (SHCs) (80%), followed by further rehabilitation, including gait rehabilitation (12%). Eight patients (8%) had undocumented reasons for readmission. The common SHCs in the first readmission were pressure ulcers (39%), followed by urinary tract infections (12%), deteriorating neurological status (6%) and constipation (3%). Patients with paraplegia had 2.3 times greater odds of readmission compared with tetraplegics (p=0.000, 95% CI 1.47 - 3.55). Those in the category T1 - T6 level of injury had 2.6 times greater odds of readmission (p=0.04, 95% CI 1.04 - 6.71, while those with incomplete spinal cord injury had 2.5 times greater odds (p=0.001, 95% CI 1.44 - 4.46). CONCLUSIONS: Factors related to patient injury profile such as type, completeness and level of injury were associated with a significant risk of readmission. SHCs were the main cause of readmission, and there is a need for effective programmes for their prevention.

Comparison of equations for the calculation of LDL-cholesterol in hospitalized patients.

BACKGROUND: The Friedewald equation is widely used to calculate LDL-C for cardiovascular risk prediction but is less accurate with comorbidities and extreme lipid values. Several novel formulae have been reported to outperform the Friedewald formula. METHODS: We examined 14,219 lipid profiles and evaluated four formulae (Friedewald, Chen, de Cordova, Hattori) and compared these to direct measurement of LDL-C across various triglyceride (TG), total cholesterol (TC) and HDL-cholesterol (HDL-C) ranges using Beckman reagents and instruments. Linear regression and ROC analysis were performed. RESULTS: The de Cordova formula showed a high correlation with directly measured LDL-C (r=0.90, P<0.001), comparable to the Friedewald calculated values for directly measured LDL-C (r=0.95, P<0.001). The de Cordova formula was favorable in some ranges of HDL, TC and the lowest TG range (r=0.97, P<0.001) but performed least well in comparison with the three other LDL-C calculations (AUC=0.8331), demonstrating inconsistent bias. The Chen formula performed better than Friedewald (AUC=0.9049). The Hattori formula outperformed all formulae including Friedewald over various ranges of lipid values (AUC=0.9097). CONCLUSIONS: We observe favorable correlations of the de Cordova formula with Friedewald at low TG values. However, the Hattori formula appears to be best for application in hospitalized patients, even at extreme lipid values.

Static and dynamic balance ability, lumbo-pelvic movement control and injury incidence in cricket pace bowlers.

OBJECTIVES: This study aimed to establish the difference in lumbo-pelvic movement control, static and dynamic balance at the start and at the end of a cricket season in pace bowlers who sustained an injury during the season and those who did not. DESIGN: This is a longitudinal, observational study. METHODS: Thirty-two, healthy, injury free, male premier league fast, fast-medium and medium pace bowlers between the ages of 18 and 26 years (mean age 21.8 years, standard deviation 1.8 years) participated in the study. The main outcome measures were injury incidence, lumbo-pelvic movement control, static and dynamic balance ability. RESULTS: Fifty-three percent of the bowlers (n=17) sustained injuries during the reviewed cricket season. Lumbo-pelvic movement control tests could not discriminate between bowlers who sustained an injury during the cricket season and bowlers who did not. However, performance in the single leg balance test (p=0.03; confidence interval 4.74-29.24) and the star excursion balance test (p=0.02; confidence interval 1.28-11.93) as measured at the start of the season was better in bowlers who did not sustain an injury during the season. CONCLUSIONS: The improvement in the lumbo-pelvic movement control and balance tests suggests that the intensity and type of physical conditioning that happens throughout the season may have been responsible for this improvement. Poor performance in the single leg balance test and the star excursion balance test at the start of the cricket season may be an indication that a bowler is at heightened risk of injury.

Fertility of N'dama and Bunaji cattle to artificial insemination following oestrus synchronization with PRID and PGF2alpha in the hot humid zone of Nigeria.

A study was undertaken to determine the effectiveness of a progesterone-releasing intravaginal device (PRID) and prostaglandin F2 alpha (PGF2alpha) in synchronizing oestrus in N'dama and Bunaji cows and heifers and the fertility following artificial insemination at the synchronized oestrus. A total of 116 cows and heifers (58 N'dama and 58 Bunaji) were used in two separate trials. In the first trial, oestrus was synchronized using a PRID, which was inserted for 12 days; in the second trial, oestrus was synchronized by giving two injections of PGF2alpha 13 days apart. Only animals that did not respond to the first injection were given the second injection. At the end of each treatment period, the animals were observed for oestrus for 7 days and inseminated approximately 12 h following detection of oestrus. Standing to be mounted was the single criterion used to judge an animal to have been in oestrus. PGF2alpha and PRID were both effective in synchronizing oestrus in N'dama and Bunaji cows and heifers. The respective oestrus response rates, pregnancy rate and conception rates for PRID and PGF2alpha were 85.7%, 53.6% and 62.5% for PRID, and 91.7%, 68.3% and 74.6% for PGF2alpha. N'dama cattle showed significantly (p<0.05) better oestrus response rate, pregnancy rate and conception rate than Bunaji cattle following both PRID and PGF2alpha treatments. The pregnancy rate and conception rate following PGF2alpha treatment were better (p < 0.05) than for PRID, although the oestrus response rate did not differ. It is concluded that both PRID and PGF2alpha are effective in synchronizing oestrus in N'dama and Bunaji cattle in the hot humid zone of Nigeria and the fertility to artificial insemination at the synchronized oestrus was normal and acceptable. Thus, PRID and PGF2alpha can effectively be used in intensive breeding programmes for the rapid multiplication and distribution of both cattle breeds, especially the N'dama, which is a unique and beneficial animal genetic resource for the tsetse infested hot humid zone of Nigeria.