scholarly journals No Change in Fireworks-Related Burn Center Admissions: A 10-Year Analysis of the Admission Rates, Treatment, and Costs

2021 ◽  
Vol 2 (1) ◽  
pp. 31-40
Author(s):  
Daan Van Yperen ◽  
Margriet Van Baar ◽  
Suzanne Polinder ◽  
Paul Van Zuijlen ◽  
Gerard Beerthuizen ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Healthcare Costs ◽  
Total Body Surface Area ◽  
Admission Rate ◽  
National Database ◽  
Multicenter Cohort Study ◽  
Admission Rates ◽  
Burn Center ◽  
The Past ◽  
Number Of Patients

The aim of this study was to provide insight into the admission rate, treatment, and healthcare costs of patients with fireworks-related burns admitted to a Dutch burn center in the past 10 years. We hypothesized that, like the nationwide number of injuries, the number of patients admitted to a burn center with fireworks-related burn injuries would have decreased during the study period. In this retrospective multicenter cohort study, all patients with fireworks-related burns admitted to a Dutch burn center between 2009 and 2019 were eligible. Patients were identified from a national database and data were obtained regarding admission details, patient and injury characteristics, treatment, and healthcare costs. A total of 133 patients were included. On average, 12 patients were admitted per year. No increase or decrease was observed during the study period. The median total body surface area burned was 1% (P25–P75 0.5–2.5) and 75% of the burns were of partial thickness. Thirteen (10%) patients were admitted to the ICU and 66 (50%) underwent surgical treatment. The mean total healthcare costs across all 133 patients were estimated at €9040 (95% CI €5830 to €12,260) per patient. In contrast to the hypothesis, no increase or decrease was observed in burn center admissions over the past 10 years. Most burns were of small size, but nevertheless, all patients were admitted to a burn center and half of them underwent surgical treatment.

scholarly journals Clinical Cancer Advances 2020: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology

2020 ◽  
Vol 38 (10) ◽  
pp. 1081 ◽  
Author(s):  
Merry Jennifer Markham ◽  
Kerri Wachter ◽  
Neeraj Agarwal ◽  
Monica M. Bertagnolli ◽  
Susan Marina Chang ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Research ◽  
Cancer Treatment ◽  
Annual Report ◽  
Research Priorities ◽  
The Past ◽  
Clinical Cancer ◽  
Number Of Patients ◽  
Systemic Therapies

Each year Clinical Cancer Advances: ASCO’s Annual Report on Progress Against Cancer highlights the most important clinical research advances of the past year, including the Advance of the Year, and identifies priority areas where ASCO believes research efforts should be focused moving forward. In 2020, ASCO names the Refinement of Surgical Treatment of Cancer as the Advance of the Year. Years of progress in developing new systemic cancer therapies has not only improved patient survival and quality of life but is now transforming surgical approaches to cancer treatment. The emergence of novel systemic therapies combined in new and better ways is significantly changing the role of cancer surgery. ASCO’s selection of Refinement of Surgical Treatment of Cancer as the 2020 Advance of the Year recognizes recent strides seen in the effectiveness of these treatments in reducing the amount of surgery, and even the need for it, while increasing the number of patients who can undergo surgery when needed. Other advances highlighted in the report include progress in cancer prevention, molecular diagnostics, and cancer treatment—surgery, radiotherapy, combination therapy, immunotherapy, and other types of therapies. The report also features ASCO's 2020 list of Research Priorities to Accelerate Progress Against Cancer. These priorities represent promising areas of research that have the potential to significantly improve the knowledge base for clinical decision-making and address vital unmet needs in cancer care. A MESSAGE FROM ASCO’S PRESIDENT Shortly before I was elected President of ASCO, I attended the 65th birthday party of a current patient. She had been diagnosed 10 years earlier with metastatic breast cancer and hadn’t been sure she wanted to move forward with further treatment. With encouragement, she elected to participate in a clinical trial of an investigational drug that is now widely used to treat breast cancer. Happily, here we were, celebrating with her now-married daughters, their husbands, and three beautiful grandchildren, ages 2, 4, and 8. Such is the importance of clinical trials and promising new therapies. Clinical research is about saving and improving the lives of individuals with cancer. It’s a continuing story that builds on the efforts of untold numbers of researchers, clinicians, caregivers, and patients. ASCO’s Clinical Cancer Advances report tells part of this story, sharing the most transformative research of the past year. The report also includes our latest thinking on the most urgent research priorities in oncology. ASCO’s 2020 Advance of the Year—Refinement of Surgical Treatment of Cancer—highlights how progress drives more progress. Surgery has played a fundamental role in cancer treatment. It was the only treatment available for many cancers until the advent of radiation and chemotherapy. The explosion in systemic therapies since then has resulted in significant changes to when and how surgery is performed to treat cancer. In this report, we explore how treatment successes have led to less invasive approaches for advanced melanoma, reduced the need for surgery in renal cell carcinoma, and increased the number of patients with pancreatic cancer who can undergo surgery. Many research advances are made possible by federal funding. With the number of new US cancer cases set to rise by roughly a third over the next decade, continued investment in research at the national level is crucial to continuing critical progress in the prevention, screening, diagnosis, and treatment of cancer. While clinical research has translated to longer survival and better quality of life for many patients with cancer, we can’t rest on our laurels. With ASCO’s Research Priorities to Accelerate Progress Against Cancer, introduced last year and updated this year, we’ve identified the critical gaps in cancer prevention and care that we believe to be most pressing. These priorities are intended to guide the direction of research and speed progress. Of course, the effectiveness or number of new treatments is meaningless if patients don’t have access to them. High-quality cancer care, including clinical trials, is out of reach for too many patients. Creating an infrastructure to support patients is a critical part of the equation, as is creating connections between clinical practices and research programs. We have much work to do before everyone with cancer has equal access to the best treatments and the opportunity to participate in research. I know that ASCO and the cancer community are up for this challenge. Sincerely, Howard A. “Skip” Burris III, MD, FACP, FASCO ASCO President, 2019-2020

601 Burn Injuries Associated with At-home Hair Braiding

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S152-S153
Author(s):  
Afaaf Shakir ◽  
Megan Teele ◽  
Annemarie O’Connor ◽  
Lawrence J Gottlieb ◽  
Sebastian Q Vrouwe
Keyword(s):  
African American ◽  
Total Body Surface Area ◽  
Hot Water ◽  
Burn Injuries ◽  
Wound Management ◽  
Patient Demographics ◽  
Burn Center ◽  
Number Of Patients ◽  
The Mean ◽  
At Home

Abstract Introduction Hair braiding that incorporates synthetic extensions has increased in popularity across all age groups. During the styling process, the ends of the braid are commonly dipped in hot water. As a result of this practice, an increasing number of patients have presented to our Burn Center after containers of recently boiled water are accidentally tipped over and spilled onto patients. Here, we report on patient demographics, outcomes, and our experience managing this injury pattern. Methods A retrospective chart review was performed of all patients who sustained burn injuries associated with at-home hair braiding presenting to an ABA-verified Burn Center between January 1, 2006 and July 31, 2020. Data on patient demographics, injury characteristics, wound management and, burn outcomes was collected. Results A total of 41 patients presented over the study period with burn injuries related to at-home hair braiding. The frequency of this type of burn increased over time, with 54% of injuries occurring in the last three years (2018–2020). The mean patient age was 7.5 years (range 0.7 – 32 years). Demographically, the vast majority of patients were under 18 years of age (90%), female (95%), and African American (98%). Seventy-three percent of injuries occurred at the patient’s home and 88% of incidents involved another person in the hair braiding process. The mean total body surface area of burn was 5% (range 1–20%). The most commonly involved areas were the back (54%), thigh/leg (37%), neck (24%), shoulder (24%), and arm/forearm (22%). Ninety percent were entirely partial thickness injuries with 10% of patients suffering some degree of full thickness injury. Ninety percent of patients required inpatient admission, and 36% of patients required at least one operative procedure. For those managed as inpatients, the average length of stay was 5.4 days (range 1–30 days). Three patients were reported to experience complications with one developing respiratory failure and two with delayed wound healing. Conclusions Hair braiding, with the use of scalding water to seal and set the ends of braids, can lead to significant accidental burn injuries. At our institution, these injuries occur predominantly in young African-American females. These burns can result in acute hospitalization and the need for surgical intervention. This is the largest series of this injury type to date with trends towards increasing frequency in the most recent time period.

scholarly journals Comparisons of 30-Day Admission and 30-Day Total Healthcare Costs Between Patients Who Were Treated With Oritavancin or Vancomycin for a Skin Infection in the Outpatient Setting

2019 ◽  
Vol 6 (12) ◽  
Author(s):  
Thomas P Lodise ◽  
Christina Palazzolo ◽  
Kerry Reksc ◽  
Elizabeth Packnett ◽  
Mark Redell
Keyword(s):  
Single Dose ◽  
Hospital Admission ◽  
Healthcare Costs ◽  
Cohort Analysis ◽  
Admission Rate ◽  
Outpatient Setting ◽  
Cost Driver ◽  
Day Hospital ◽  
Outpatient Prescription ◽  
Admission Rates

Abstract Objective Hospital admission is a key cost driver among patients with skin and soft tissue infections (SSTI). Data suggest that many SSTI patients are hospitalized unnecessarily and can be managed effectively and safely in an outpatient setting at a substantially lower cost. Oritavancin (ORI) is a single-dose treatment that has the potential to shift care from the inpatient to the outpatient setting. This study sought to compare the 30-day hospital admission rates and mean healthcare costs among SSTI patients who received outpatient ORI or vancomycin (VAN). Method Over a 1-year period, outpatient prescription claims for VAN and ORI among patients with SSTIs and no hospitalization in past 3 days were for VAN and ORI were analyzed using a retrospective cohort analysis of the Truven Health MarketScan Databases. Results During the study period, 120 and 6695 patients who received ORI and VAN, respectively, met inclusion criteria. Groups were well matched at baseline. After covariate adjustment, patients who received ORI had a significantly lower 30- day admission rate versus patients who received VAN (6.1% vs 16.2%, respectively; P = .003). Mean healthcare costs 30-day post index were comparable between ORI and VAN patients ($12 695 vs $12 717, respectively; P = 1.0). Conclusions Results suggest that ORI provides a single-dose alternative to multidose VAN for treatment of SSTI in the outpatient setting and may result in lower 30-day hospital admission rates.

Trends in Intensive Care for Patients with COVID-19 in England, Wales and Northern Ireland

2020 ◽  
Author(s):  
James C Doidge ◽  
Paul R Mouncey ◽  
Karen Thomas ◽  
Doug W Gould ◽  
Paloma Ferrando-Vivas ◽  
...  
Keyword(s):  
Intensive Care ◽  
Northern Ireland ◽  
Admission Rate ◽  
Patient Characteristics ◽  
Peak Period ◽  
Admission Rates ◽  
Time Period ◽  
Number Of Patients ◽  
Opposing Effects ◽  
Over Time

Aim: To report changes in admission rates, patient characteristics, processes of care and outcomes for all patients with COVID-19 admitted to intensive care units (ICUs) in England, Wales and Northern Ireland. Methods: Population cohort of all 10,287 patients with COVID-19 appearing in the Case Mix Programme national clinical audit from 1 February to 2 July, 2020. Analyses were stratified by time period (pre-peak, peak, post-peak) and geographical region, and multivariable regressions were used to estimate differences in 28-day mortality, adjusting for variation in patient characteristics over time. Results: Admissions to ICU peaked on 1 April, nine days after commencement of “lockdown”, and occurred simultaneously across regions. The number of patients in ICU peaked ten days later. Compared with patients admitted during the pre- and post-peak periods, patients admitted during the peak were younger and had lower levels of prior dependency but more severe respiratory and renal dysfunction. Use of invasive ventilation and renal replacement reduced over time. Twenty-eight-day mortality reduced from 43.5% (95% CI 41.6% to 45.5%) pre-peak to 34.3% (95% CI 32.3% to 36.2%) post-peak; a difference of −8.8% (95% CI: −5.2%, −12.3%) after adjusting for patient characteristics. London experienced the highest admission rate and had higher mortality during the peak period but a greater reduction in post-peak mortality. Conclusion: Observed trends suggest opposing effects of ICU strain and clinical learning. Further investigation is needed to identify modifiable system factors that could alleviate strain in future epidemics and changes in clinical practice that contributed to improved patient outcomes.

scholarly journals Epidemiology of Community-Acquired Pneumonia in Edmonton, Alberta: An Emergency Department-Based Study

2005 ◽  
Vol 12 (3) ◽  
pp. 139-142 ◽  
Author(s):  
Thomas J Marrie ◽  
Jane Q Huang
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Age Groups ◽  
Admission Rate ◽  
Community Acquired Pneumonia ◽  
Seasonal Effect ◽  
Admission Rates ◽  
Younger Age ◽  
Number Of Patients

Patients aged 17 years and older who presented to seven emergency departments in Edmonton, Alberta over a two-year period with community-acquired pneumonia (n=8144) were studied. The admission rates were 271/100,00 and 296/100,000 persons for year 1 and year 2 of the study, respectively. The admission rate increased with increasing age, peaking at 4639/100,000/year for those 90 years of age and older. In contrast, the percentage of patients who were admitted to an intensive care unit was highest for those in the younger age groups between 17 and 59 years of age. From 59 years of age and older, there was a progressive decline in the percentage of patients admitted to an intensive care unit, with approximately 1% of those in the 90 years and older age group admitted. A pronounced seasonal effect on the number of patients presenting to emergency department was also noted. During the winter months, there was up to a 50% increase in the number of cases compared with the summer months.

scholarly journals An Investigation of Variation in Emergency Admission Rates between New Zealand General Practices: a national database linkage study

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Hywel Lloyd ◽  
Andrew Tomlin ◽  
Susan Dovey
Keyword(s):  
New Zealand ◽  
Role Models ◽  
Admission Rate ◽  
Emergency Admission ◽  
National Database ◽  
Long Term Conditions ◽  
Emergency Admissions ◽  
Admission Rates ◽  
General Practices

ABSTRACT ObjectiveTo quantify variation in emergency admission rates between all New Zealand general practices and to investigate the influence of patients with long-term conditions. ApproachThis retrospective cohort study linked three national data collection. The Primary Health Organisation (PHO) Enrolment Collection provided practice register data on age sex ethnicity and deprivation. The National Minimum Dataset for Hospital Events (NMDS) allowed access to discharge data. The national Pharmaceutical Collection enabled medicine use to provide a proxy measures of patient morbidity. Expected emergency admission rates for each practice in 2014 were calculated using indirect standardisation with the total registered patient population of all study practices as the reference population. A standardised emergency admission ratio (SAR) of the actual admission rate to the expected admission rate was calculated for each practice. ResultOver the fourteen year period 2001-2014 total emergency admissions from all causes in New Zealand increased by 42%. Arranged and waiting list admissions increased by 29% over the same period. Emergency admissions represented 54% of all admissions by 2014 and increased by 56%. Patients with hospital diagnoses for long-term conditions accounted for 56.5% of all emergency admissions and 78.6% of all associated bed days. More females had unplanned admissions than males (p<0.001, 95% CI 0.48%-0.59%) and more Maori (p<0.001, 95% CI 1.33%-1.49%) and Pacific Island patients (p<0.001, 95% CI 0.96%-1.17%) were admitted than Europeans. Increasing deprivation status was significantly associated with an increased likelihood of admission (p<0.001; chi-squared test for trend). Practices with the highest SARs in 2014 tended to have the highest admission rates in that year and in previous years. They also had high admission rates for both high and low risk patient groups. ConclusionThis study indicates that there is considerable variation in the emergency admission rates of New Zealand general practices and in their standardised emergency admission rates after adjusting for differences in patient demography. A more meaningful measure of true disease morbidity is required to understand more the role ‘models of care’ play in the degree of variation of emergency admission. Keywords: Emergency Admission, practice variation, primary care, New Zealand

614 Addressing Increasing Mental Health Needs in Burn Patient Population: Dedicated Burn Center Psychologist

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S160-S161
Author(s):  
Melanie K Dae ◽  
Tyler M Smith ◽  
Anne L Lambert Wagner
Keyword(s):  
Mental Health ◽  
Mental Health Treatment ◽  
Medication Management ◽  
Full Time ◽  
Psychological Conditions ◽  
Burn Center ◽  
The Past ◽  
Number Of Patients ◽  
Mental Health Support ◽  
Part Time

Abstract Introduction During the past four years, mental health coverage at our burn center has evolved and become more robust. The emotional aspects of burn recovery are well documented; patients often present with co-morbid psychological conditions and develop psychological conditions as a result of the traumatic experience of their injury and subsequent hospitalization. To address this need, our burn center created a burn psychology fellowship and hired a dedicated full-time attending psychologist. Methods The burn center medical director has advocated for increased mental health support for several years. Mental health support was initially provided by the Psychiatry Consultation-Liaison team, and primarily focused on medication management for patients with severe mental illness. Recognizing the need for additional support, the burn center hired a part-time psychologist. After two years of part-time dedicated psychology coverage, a full-time position was approved. Through quantitative data review over the past several years, the number of patients with psychiatric diagnoses and the number of patients connected to mental health treatment during their hospitalization was analyzed. Results The overall patient census at the burn center has increased over the past several years (n=319 FY2016 vs n=506 FY2020). Burn patients with mental health diagnoses has increased along with and beyond the overall patient census growth; 34% (n=173) of patients admitted had a documented psych diagnosis in FY2020 compared to just 21% (n=68) of patients admitted in FY2016. Conclusions Integrating full-time psychology coverage dedicated to the burn center has allowed our patients to be evaluated and treated sooner, which has resulted in shortened time to psychotherapy and psychiatric medication management, and improved discharge planning to include outpatient mental health treatment. A full-time burn psychologist has improved holistic patient care of our burn patient population to positively aid in their overall recovery process.

Advances In Asthma Care

2003 ◽  
Vol 1 (1) ◽  
pp. 87-90 ◽  
Author(s):  
Chris Garvey
Keyword(s):  
Healthcare Costs ◽  
Professional Organizations ◽  
Current Status ◽  
Asthma Care ◽  
Advanced Level ◽  
Clinical Criteria ◽  
Asthma Knowledge ◽  
The Past ◽  
The Us ◽  
Examination Process

Asthma rates in the US have risen during the past 25 years, as have asthma-related morbidity and healthcare costs. Professional organizations involved in asthma care have identified the need to assure that an advanced level of asthma knowledge and skill is available to patients with asthma, their families, and insurers. This need led to development of the certification for asthma educators. The Certified Asthma Educator (AE-C) must meet specific clinical criteria and pass a standardized examination designed to evaluate knowledge and skill for providing competent asthma education and coordination. The development and current status of the Certified Asthma Educator examination process and content are discussed, as are goals of the certification

scholarly journals 272 Morbid Obesity in Lower Limb Arthroplasty: Short Length of Stay and Favourable One-Year Outcomes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Sharrock ◽  
A Nugur ◽  
S Hossain
Keyword(s):  
Morbid Obesity ◽  
Length Of Stay ◽  
Lower Limb ◽  
Average Length ◽  
Perioperative Complications ◽  
Joint Infection ◽  
Admission Rate ◽  
Tendon Injury ◽  
Morbidly Obese ◽  
Admission Rates

Abstract Introduction There are concerns that BMI is associated with a greater length of stay (LOS) and perioperative complications in lower limb arthroplasty. Method We analysed data from a six-month period to see if there was a correlation between BMI and LOS. We performed a subgroup analysis for patients with morbid obesity (BMI &gt;40). Results 285 TKRs and 195 THRs were analysed. For TKRs, the average length of stay was 2.7 days. There was no significant correlation between BMI and LOS (r=-0.0447, p = 0.2267). The morbidly obese category (n = 33) had the shortest LOS (2.5 days) compared to other BMI categories. 30-day readmission rate was 6%. 90-day re-admission rate was 12%. Six patients had minor wound issues requiring no intervention or antibiotics only. The was one prosthetic joint infection, one stitch abscess, one DVT and one patellar tendon injury. For THRs, the average LOS was 2.9 days. There was no significant correlation between BMI and LOS (r = 0.007, p = 0.4613). The morbid obese category (n = 9) had the shortest LOS (1.9 days) compared to other BMI categories. No patients were readmitted within 90 days or had documented complications. Conclusions Increased BMI is not associated with increased LOS. The morbidly obese had the shortest LOS, and commendable complication and re-admission rates.

Outcomes of Surgical and Nonsurgical Treatment for Colorectal Cancer in Nonagenarian Patients

2021 ◽  
pp. 000313482199506
Author(s):  
Youngbae Jeon ◽  
Kyoung-Won Han ◽  
Won-Suk Lee ◽  
Jeong-Heum Baek
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Surgical Treatment ◽  
Postoperative Complications ◽  
Postoperative Mortality ◽  
Nonsurgical Treatment ◽  
Perioperative Outcomes ◽  
Rank Test ◽  
Kaplan Meier ◽  
Number Of Patients

Purpose This study is aimed to evaluate the clinical outcomes of surgical treatment for nonagenarian patients with colorectal cancer. Methods This retrospective single-center study included patients diagnosed with colorectal cancer at the age of ≥90 years between 2004 and 2018. Patient demographics were compared between the operation and nonoperation groups (NOG). Perioperative outcomes, histopathological outcomes, and postoperative complications were evaluated. Overall survival was analyzed using Kaplan-Meier methods and log-rank test. Results A total of 31 patients were included (16 men and 15 women), and the median age was 91 (range: 90‐96) years. The number of patients who underwent surgery and who received nonoperative management was 20 and 11, respectively. No statistical differences in baseline demographics were observed between both groups. None of these patients were treated with perioperative chemotherapy or radiotherapy. Surgery comprised 18 (90.0%) colectomies and 2 (10.0%) transanal excisions. Short-term (≤30 days) and long-term (31‐90 days) postoperative complications occurred in 7 (35.0%) and 4 (20.0%) patients, respectively. No complications needed reoperation, such as anastomosis leakage or bleeding. No postoperative mortality occurred within 30 days: 90-day postoperative mortality occurred in two patients (10.0%), respectively. The median overall survival of the operation group was 31.6 (95% confidence interval: 26.7‐36.5) and that of NOG was 12.5 months (95% CI: 2.4‐22.6) ( P = 0.012). Conclusion Surgical treatment can be considered in carefully selected nonagenarian patients with colorectal cancer in terms of acceptable postoperative morbidity, with better overall survival than the nonsurgical treatment.

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