Outcomes after early versus delayed antibiotic treatment of liver abscess in Japan: A nationwide retrospective cohort study.

BACKGROUND: The optimal timing of antibiotic administration in patients with a liver abscess undergoing liver aspiration or drainage is unknown. METHODS: This was a retrospective cohort study using the Diagnosis Procedure Combination database, a national inpatient database in Japan. RESULTS: A total of 34,424 patients who were emergently hospitalized due to liver abscess between July 2010 and March 2020 were included. Of these, 31,248 (90.8%) received antibiotics on the day of admission (early antibiotics group), and 3176 (9.2%) did not (delayed antibiotics group). Multivariable logistic regression analyses showed that in-hospital mortality of patients in the early antibiotics group was significantly lower than that in the delayed antibiotics group (odds ratio, 0.61; 95% confidence interval, 0.52-0.72; p <0.001). Patients in the early antibiotics group had a significantly lower proportion of clinical deterioration (odds ratio, 0.73; 95% confidence interval, 0.63-0.84; p <0.001) and shorter length of stay (adjusted difference, -5.2 days; 95% confidence interval, -6.2 to -4.1 days; p <0.001) than those in the delayed antibiotics group. CONCLUSIONS: Starting antibiotic treatment on the day of admission was associated with lower mortality, a lower proportion of clinical deterioration, and a shorter length of hospital stay.

Emergency hospitalization caused by non-COVID-19 respiratory diseases before and during the COVID-19 pandemic: A retrospective observational cohort study.

Background: The coronavirus disease 2019 (COVID-19) pandemic as well as the subsequent prevention and control measures is like a quasi-experiment intervention that might have changed the features of emergency hospitalizations. Mortality is high in patient hospitalization due to emergency respiratory diseases (ERD). Therefore, we compared the characteristics of these patients before and during the pandemic. Exploring this issue might contribute to decision-making of emergency management when most of the resources and attention has been devoted to combat COVID-19. Methods: This study was a retrospective observational cohort study. All emergency hospitalizations due to ERD from January 1, 2019 to December 31, 2020 in a tertiary hospital in China were included. Data including patients' age, sex, and clinical outcomes were extracted. Air quality was collected from the official online platform. Clinical characteristics were compared and odds ratios were calculated. Results: The ERD hospitalization rate was lower in 2020 than in 2019 (6.4 vs. 4.3%, χ2 = 55.449, P = 0.000) with a 50.65% reduction; however, the patients were older in 2020 than in 2019 (P = 0.000) with a higher proportion of admission to the intensive care unit (ICU) (46 vs. 33.5%, χ2 = 20.423, P = 0.000) and a longer ICU stay (P = 0.000). The overall intubation rate, hospital mortality, and rate of discharge due to ineffective treatment in 2020 were higher than those in 2019 (15.6 vs. 8%, χ2 = 18.578, P = 0.000; 4.2 vs. 1.1%, χ2 = 4.122, P = 0.000; 5.5 vs. 2.4%, χ2 = 8.93, P = 0.000, respectively). The logistic regression analysis indicated hospitalizations due to ERD were mainly associated with PM2.5 and sulfur dioxide on the day, and on the 4th and 5th days before admission (P = 0.034 and 0.020, 0.021 and 0.000, 0.028, and 0.027, respectively) in 2019. However, in 2020, the relationship between parameters of air quality and hospitalization changed. Conclusion: The COVID-19 pandemic has changed the characteristics of emergency hospitalization due to ERD with a larger proportion of severe patients and poorer prognosis. The effect of air quality on emergencies were weakened. During the COVID-19 pandemic, it is necessary to pay more attention to the non-COVID-19 emergency patients.

Causes for Emergency Hospitalization of Neurological Patients With Palliative Care Needs.

Background: Acute and unexpected hospitalization can cause serious distress, particularly in patients with palliative care needs. Nevertheless, the majority of neurological inpatients receiving palliative care are admitted via an emergency department. Objective: Identification of potentially avoidable causes leading to acute hospitalization of patients with neurological disorders or neurological symptoms requiring palliative care. Methods: Retrospective analysis of medical records of all patients who were admitted via the emergency department and received palliative care in a neurological ward later on (n = 130). Results: The main reasons for acute admission were epileptic seizures (22%), gait disorders (22%), disturbance of consciousness (20%), pain (17%), nutritional problems (17%), or paresis (14%). Possible therapy limitations, (non)existence of a patient decree, or healthcare proxy was documented in only 31%. Primary diagnoses were neoplastic (49%), neurodegenerative (30%), or cerebrovascular (18%) diseases. Fifty-nine percent were directly admitted to a neurological ward; 25% needed intensive care. On average, it took 24 h until the palliative care team was involved. In contrast to initially documented problems, key challenges identified by palliative care assessment were psychosocial problems. For 40% of all cases, a specialized palliative care could be organized. Conclusion: Admissions were mainly triggered by acute events. Documentation of the palliative situation and treatment limitations may help to prevent unnecessary hospitalization. Although patients present with a complex symptom burden, emergency department assessment is not able to fully address multidimensionality, especially concerning psychosocial problems. Prospective investigations should develop short screening tools to identify palliative care needs of neurological patients already in the emergency department.

Survey of serious adverse events and safety evaluation of oral anticancer drug treatment in Japan: A retrospective study.

The present study assessed the safety of outpatient oral anticancer chemotherapeutic drugs by investigating the type and frequency of serious adverse effects (SAEs). Emergency hospitalization, unplanned consultations and telephone calls were investigated in 1,832 patients who received oral anticancer drug treatment at the National Cancer Center Hospital East between December 1, 2014 and November 30, 2015. Oral cytotoxic anticancer and molecular targeted drugs were administrated to 1,140 (62.2%) and 692 (37.8%) patients, respectively. A total of 52 (2.8%) SAEs were reported, with 32 (2.8%) occurring following cytotoxic anticancer drug administration and 20 (2.9%) occurring after molecular targeted drug treatment. The most common SAE was gastrointestinal toxicity. The median time to SAE occurrence was 32 days (range, 5-1,705 days). The rate of unplanned consultations and telephone calls were 5.5 and 37.9% among all patients, respectively, with skin reactions being the most common reason for unplanned consultations. SAEs often occurred early after treatment initiation. It was concluded that measures against gastrointestinal toxicity are particularly important were administering chemotherapeutic agents.

Predictors and Outcomes of Hospitalization for Influenza: Real-World Evidence from the United States Medicare Population.

INTRODUCTION: The purpose of this study was to identify predictors of initial hospitalization and describe the outcomes of high-risk patients hospitalized with influenza. METHODS: Data were taken from the 5% national US Medicare database from 2012 to 2015. Patients (aged at least 13 years) were required to have at least one diagnosis for influenza and have continuous health plan enrollment for 6 months before (baseline) and 3 months (follow-up) after the date of influenza diagnosis. Patients who died during follow-up were included. Patients were categorized as initially hospitalized if hospitalized within 0-1 day of diagnosis. High-risk initially hospitalized patients were defined as patients aged at least 65 years or those that had a diagnostic code for chronic lung disease, cardiovascular or cerebrovascular disease, or weakened immune system during baseline period. Logistic regression models were developed to determine predictors of initial hospitalization. RESULTS: The study population included 8127 high-risk patients who were initially hospitalized and 16,784 who were not hospitalized. Among high-risk patients, 89.3% were diagnosed in the emergency room, whereas 7.5% and 3.2% were diagnosed in a physician's office or other Medicare settings, respectively. Chronic obstructive pulmonary disorder, congestive heart failure, chronic kidney disease, older age, being male, other comorbidities, number of comorbidities, and baseline healthcare resource use were the predictors of hospitalization. Median length of stay for the hospitalization was 5.0 days, and the 30-day readmission rate was 14%. All-cause mortality rate was 5.1% during the inpatient stay and 9.2% within 30 days of diagnosis. Hospitalized patients with influenza incurred an increase of $16,568 per patient in total all-cause healthcare costs from pre-influenza to post-influenza diagnosis. CONCLUSION: The study characterized the burden of hospitalization for influenza and found that hospitalized high-risk patients experience greater comorbidity burden, higher likelihood of multiple inpatient admissions, and costly medical interventions compared to patients who were not hospitalized.

[Impact of psychoeducation on compliance of inpatients with first episode psychosis]. / Vliyanie psikhoobrazovaniya na komplaentnost' patsientov s pervym psikhoticheskim epizodom v usloviyakh statsionara.

OBJECTIVE: To assess the impact of brief group inpatient psychoeducation interventions on compliance of patients with first episode psychosis (FEP) and emergency hospitalization. MATERIAL AND METHODS: One hundred and fifty-eight patients of treatment group and 79 patients of the control group were enrolled into the study. All patients were hospitalized emergently due to psychotic condition. Patients in treatment group had group psychoeducation sessions (5 sessions), patients in the control group received basic treatment only. Before discharge from the hospital, patients were accessed with PANSS, CGI-S, CGI-I and «Medication compliance scale¼. RESULTS: Patient in treatment group showed significantly better results than the control group in medication compliance scale assessment (p<0.001). The rate of readmissions was significantly higher in the control group than in the psychoeducation group (p=0.02). CONCLUSION: Brief psychoeducation for inpatients with FEP and emergency hospitalizations has beneficial effect on patients' compliance.

Effects of ambient benzene and toluene on emergency COPD hospitalizations: A time series study in Hong Kong.

BACKGROUND: Although numerous studies have demonstrated that the criteria air pollutants increased the risk of exacerbation of chronic obstructive pulmonary disease (COPD), few have explored the effects of ambient benzene and toluene on COPD. OBJECTIVE: This study aimed to evaluate the short-term effects of ambient benzene and toluene on emergency COPD (eCOPD) hospitalizations. METHODS: We obtained daily mean and maximum concentrations of benzene and toluene during April 1, 2011 - December 31, 2014 from the Hong Kong Environmental Protection Department, and daily counts of eCOPD hospitalizations from the Hospital Authority. Generalized additive distributed lag models were used to estimate the percentage excess risk (ER%) of eCOPD hospitalizations per interquartile range (IQR) increase in ambient benzene and toluene. RESULTS: The ER% estimates of eCOPD hospitalizations post cumulative exposure of up to two days were 2.62% (95%CI: 0.17% to 5.13%) and 1.42% (0.16% to 2.69%), for per IQR increase of daily mean benzene (1.4µg/m3) and toluene (4.6µg/m3), respectively. People below the age of 65 had a significantly higher risk of eCOPD hospitalizations associated with daily maximum toluene than the elderly. CONCLUSIONS: Ambient benzene and toluene might be environmental stressors for acute exacerbations of COPD in the Hong Kong population.

Investigation of 375 Patients Who Were Admitted to the Emergency Department in the Acute Ward and Were Administered Kampo Medicine to Improve Early Symptoms / 日本東洋医学雑誌

We examined 375 patients who were administered Kampo medicine for emergency hospitalization in the acute period ward for 6 years and to improve early illness and symptoms. There were many significant uses of hozai. Of the top 5 types of Kampo medicine administered, 4 were hochuekkito, ninjinyoeito, rikkunshito, and daikenchuto. In the case of emergency hospital admission, it was considered that there were many uses of hozai for poor oral intake, walking disorder, and low level of consciousness, among others. Next, there were many risuizai uses.

Risk Factors of Emergency Hospitalization in Japanese Nursing Home Residents / 日本プライマリ・ケア連合学会誌

<p><b>Introduction: </b>The purpose of this study was to investigate the risk factors for emergency hospitalization in Japanese nursing home residents.</p><p><b>Methods: </b>Our retrospective cohort study included 170 nursing home residents who had stayed in two nursing homes in Saitama for more than one year by May 1, 2013. The association between emergency hospitalization within one year and 17 factors was examined initially by univariate analysis. Putative factors with P-values <0.05 on univariate analysis were considered in the multivariate analysis.</p><p><b>Results: </b>A total of 70 (41.2%) of 170 nursing home residents were hospitalized emergently at least once within one year. In a logistic regression model, diagnosis of chronic heart failure (OR: 5.73, 95%CI: 1.37-23.84), presence of a decubitus ulcer (OR: 16.70, 95%CI: 1.89-147.41), and 5% loss of body weight over a one-year interval (OR: 2.47, 95%CI: 1.07-5.68) were associated with emergency hospitalization.</p><p><b>Conclusion: </b>Diagnosis of chronic heart failure, presence of a decubitus ulcer, and a 5% loss of body weight over a one-year interval were risk factors for emergency hospitalization in Japanese nursing home residents.</p>

Reacción adversa a medicamentos como causa de hospitalización de emergencia de adultos mayores / Adverse drug reactions in elderly patients as reason of emergency hospitalization

Introducción. Las reacciones adversas a medicamentos son frecuentes y prevenibles. Objetivos. Describir la medicación habitual, potencialmente inadecuada y reacciones adversas como causa de hospitalización. Material y Métodos. Estudio descriptivo en hospitalizados de 65 años o más, en emergencia del hospital Rebagliati. Muestreo sistemático de 238 pacientes. Entrevista a paciente o cuidador y revisión de historia clínica. Instrumentos: criterios STOPP para prescripción inadecuada y algoritmo de Karl y Lasagna para reacciones adversas. Resultados. Masculino 47,1 %, edad promedio 78,36 (± 7,83) años; 238 pacientes recibían 731 fármacos (en promedio, 3 fármacos por paciente), los más frecuentes fueron enalapril y ácido acetilsalicílico. Medicación potencialmente inadecuada en 24,6 %, mayor frecuencia glibenclamida y digoxina. De los ingresos, 7,6 % tenían como causa probable reacción adversa a medicamentos; los más frecuentes fueron glibenclamida, insulina y clopidogrel y su presentación clínica más frecuente, hipoglicemia, arritmia cardíaca y sangrado digestivo. Conclusiones. La medicación habitual más frecuente fue cardiovascular, alta frecuencia de medicación potencialmente inadecuada y reacción adversa a medicamentos como causa de ingreso.

Introduction. Adverse drug reactions are frequent and avoidable. Aims. To describe habitual medication, potentially inadequate medication and adverse drug reactions as reason of hospitalization. Material and Methods. Descriptive study in 65 or more yearold inpatients, emergency of Rebagliati hospital. Systematic sampling of 238 patients. Interview to patient or keeper and checked clinical history. Instruments: Screening Tool of Older Person’s Potentially Inappropriate and Karl and Lasagna’s algorithm. Results. Male 47,1 %, average age 78,36 (± 7,83) years. 731 medicaments were prescribed in 238 patients (3 medicaments for patient), enalapril and aspirin were most frequent. Potentially inadequate medication was in 24,6 %, being the most frequent glibenclamide and digoxin. 7,6 % of inpatient presented adverse drug reaction as reason of admission; glibenclamide, insulin and clopidogrel were frequent; and the clinical presentation was hypoglycemia, arrhythmia and digestive bleeding. Conclusions. The frequent habitual medication was cardiacvascular, frequent potentially inadequate medication and adverse drug reactions patients as reason of hospitalization.

Health-related quality of life in adult inpatients affected by anorexia nervosa.

OBJECTIVE: Poor awareness of illness in anorexia nervosa (AN) may render the assessment of health-related quality of life (HRQoL) difficult. We aimed at evaluating severe AN patients' HRQoL at discharge using different instruments and correlating this measure with clinical variables. METHODS: We enrolled 71 adult AN inpatients admitted through the emergency department. At admission, all participants completed the following: Medical Outcome Short Form Health Survey, Eating Disorder Inventory-2 and Temperament and Character Inventory. At admission and discharge, body mass index, EuroQoL Health Questionnaire/Visual Analogue Scale and Clinical Global Impression were evaluated. RESULTS: The HRQoL was severely impaired at baseline, but it improved at discharge. HRQoL correlated with eating psychopathology and personality, but not with body mass index or Clinical Global Impression. CONCLUSION: The HRQoL effectively captured patients' improvement at discharge. Given its correlations with clinical variables, this instrument may be useful in clinical practice.

Reacciones y eventos adversos por medicamentos en ancianos que consultan un servicio de urgencias / Adverse drug reactions and adverse drug events in elderly patients consulting a hospital emergency unit

Objetivo: Determinar eventos adversos y reacciones adversas medicamentosas en ancianos que consultan a un servicio de urgencias. Dise±o: Estudio observacional comparativo de corte transversal. Pacientes y métodos: Se estudiaron 400 pacientes (>60 a±os) que consultaron al servicio de urgencias del Hospital de Caldas (Manizales, Colombia) (marzo-mayo 2004). Se evaluaron variables demogrßficas, diagnóstico primario al ingreso, enfermedades asociadas, uso de medicamentos, el estado funcional (índice de Barthel) y el tipo y severidad de los eventos y reacciones adversas a medicamentos. Se realizo anßlisis bivariado y regresión logística. Resultados: El promedio de edad fue 72.8±8.2 a±os en su mayoría mujeres (52.3%). La frecuencia de eventos y reacciones adversas a medicamentos fue 6.8%. Los sistemas orgßnicos comprometidos mßs frecuentes fueron gastrointestinal (48.1%), endocrino y metabólico (37%). El 28.3% no tomaban medicamentos. El promedio de uso de medicamentos por paciente fue 2.9±1.7. Los grupos de medicamentos mßs utilizados fueron antiplaquetarios, hipoglicemiantes, diuréticos, analgésicos-AINEs y cardiovasculares. En el anßlisis bivariado el estado funcional y el número de medicamentos se asociaron con los eventos y reacciones adversas a medicamentos (OR=3.5 IC 95% 1.58-7.87, OR=3.5, IC 95% 1.6-7.82; respectivamente), sin embargo, en el anßlisis multivariado el número de enfermedades asociadas fue la única variable asociada (OR=3.2, IC 95% 1.95-5.42). Conclusiones: Los eventos y reacciones adversas a medicamentos son una causa frecuente, importante y no bien estudiada de ancianos que consultan los servicios de urgencia. El número de enfermedades fue el principal determinante de riesgo de ingreso al servicio de urgencias.

Objective: To determine adverse drug events (ADE) and adverse drug reactions (ADR) in elderly patients consulting a third level hospital emergency unit (EU). Design: Cross sectional study. Patients and methods: Four hundred patients aged sixty years or older consulting the EU (Caldas Hospital, Manizales, Colombia) (March-May 2004). Data on demographic characteristics, primary diagnosis, associated conditions and evaluation of medications intake were taken from the clinical records. Functional state was measured according with BarthelÆs index. Type and severity of ADE and ADR were categorized. Algorithms were used for ADR operational assessment. Results: The mean of age of patients was 72.8±8.2 years, and 52.3% were females. Frequency of ADE and ADR was 6.8%. Organic systems affected were 48.1% gastrointestinal, 37% endocrine and metabolic. 28.3% of the patients were not on medication. Mean use of medications per patient was 2.9±1.7. Type of medications involved, in order of frequency, was antiplatelet, hypoglicemic, diuretic, NSAIDs and cardiovascular. Intake of medication (Odds Ratio (OR)=3.52, (IC95% =1.58-7.87), and functional status (OR=3.54 (IC95% = 1.6-7.82) were associated factors for emergency unit admission for ADE or ADR. In the logistic regression the presence of an associated illness constituted the only independent associated factor for hospitalization (OR=3.2 IC 95% 1.95-5.42). Conclusions: ADE and ADR are frequent, important and not well studied causes for consultation of elderly patients at the EU. The number of associated illness was the main risk factor for hospitalization by ADE or ADR.