The Association Between Admission to A Tertiary Children’s Hospital and Future Unplanned Dental Presentation

Objective: Dentistry should aim to prevent rather than focus on end-stage treatment which is more costly and less effective. This study investigated the association between unplanned dental presentations and any previous admissions at a tertiary hospital for children. Design: A retrospective analysis of 351 unplanned dental presentations at PCH was performed. Setting: A tertiary children’s hospital, the Perth Children’s Hospital (PCH). Main outcome measures: Reasons for unplanned presentations (infection, trauma, others) and the history of any previous admissions at PCH were analysed. Results: Dental infection and trauma were the main reasons for the unplanned dental presentations. More than half of those who presented due to dental infection had at least once previous admission at PCH due to other reasons. Patients who presented with dental infection were more likely to have previous visits by community nurse or social worker, while those who presented due to trauma, were more likely to have had previous visits at orthopaedic or fracture wards of the same hospital. Conclusions: Community nurses and social workers can possibly play a role in informing patients about dental care options in the primary care sector.

Extended-spectrum β-lactamase blaCTX-M-1 group in gram-negative bacteria colonizing patients admitted at Mazimbu hospital and Morogoro Regional hospital in Morogoro, Tanzania

Objective The objective of this study was to determine the proportion of extended spectrum β-lactamase producing gram-negative bacteria (ESBL-GNB) colonizing patients admitted at Mazimbu hospital and Morogoro Regional hospital, in Morogoro, Tanzania. Rectal colonization with ESBL-GNB increases the risks of developing bacterial infections by extra-intestinal pathogenic ESBL-GNB. Results Of the 285 patients investigated, 123 (43.2%) carried ESBL-GNB in their intestines. Five of the 123 ESBL positive patients were colonized with two different bacteria, making a total of 128 ESBL producing isolates. Escherichia coli (n = 95, 74.2%) formed the majority of ESBL isolates. The proportion of CTX-M-1 group genes among ESBL isolates tested was 94.9% (93/98). History of antibiotic use (OR: 1.83, 95% CI: 1.1–3.2, P = 0.03), being on antibiotic treatment (OR: 2.61, 95% CI: 1.5–4.53, P = 0.001), duration of hospital stay (OR: 1.2, 95% CI: 1.1–1.3, P < 0.001) and history of previous admission (OR: 2.24, 95% CI: 1.2–4.1, P = 0.009) independently predicted ESBL-GNB carriage.

Comparison of inpatients who were readmitted within 28 days of discharge with those not readmitted: an audit at an Australian private psychiatric hospital

Objective: To compare inpatients who had been readmitted within 28 days of discharge with patients not readmitted within the same period in a private psychiatric hospital. Method: Of 118 readmissions within 28 days in 2017 (7% of admissions), 50 were randomly selected and matched by age and gender with control patients who had not been readmitted within 28 days. Differences in demographics, diagnosis, length of stay and number of admissions in the previous 12 months were examined. Results: Readmitted cases were 64% female, were aged 49.8 ± 18.2 years (range 19–89), 40% were in relationships and 24% were receiving disability support. Most patients were suffering an episode of depression. Cases had higher rates of multiple psychiatric diagnoses ( p < .001) and physical disorders ( p < .05). There were no significant differences between cases and controls on psychiatric diagnoses. Cases had a longer length of stay in their previous admission ( p < .01) and a higher number of admissions in the preceding 12 months ( p < .05) compared to controls. Conclusion: This study indicates that inpatients readmitted within 28 days of discharge were more likely to have multiple diagnoses, physical co-morbidity and relapsing conditions than patients who were not readmitted.

365. Characteristics and outcomes of COVID-19 patients admitted to a regional health system in the southeast

Background COVID-19, first described in Wuhan, China, is now a global pandemic. We describe a cohort of patients (pts) admitted to our academic health system (HS) in the southeast, where demographics and comorbidities differ significantly from other regions in the U.S. Methods This was a retrospective review of 161 consecutive pts admitted with COVID-19 from 3/12/20 to 6/1/20. We assessed demographics, comorbidities, presenting symptoms, treatments and outcomes and compared pts who died during hospitalization to those who survived to discharge (EpiInfo 7.2, Atlanta, GA). Results Mean age was 60.5 years, 51.6% were female, 72% African American (AA) and 69.6% admitted from home. 54.5% had a BMI &gt;30, 72% had HTN, 47.2% diabetes, and 33.6% COPD or asthma. The majority (68.8%) presented with fever (&gt;38.0) and required supplemental oxygen within 8 hours of admission (63.4%). Cough (65.6%), dyspnea (57.5%), myalgias (30.6%) and diarrhea (23.8%) were also common. 40.4% received hydroxychloroquine, 23.6% steroids and 19.9% convalescent plasma. 42.9% required ICU care, 27.3% were intubated, and 19.3% died. Characteristics associated with death included older age, male sex, HTN, ESRD on HD, and cancer. Symptoms associated with death included absence of cough, absence of myalgias, previous admission for COVID-19, tachypnea, need for supplemental oxygen, elevated BUN and creatinine, and elevated ferritin. Interventions associated with death included use of steroids, receipt of ICU care, intubation, delay to intubation, and use of vasopressors or inotropes. Complications associated with death included development of a new arrhythmia, bacteremia, pneumonia, ARDS, thrombosis, and new renal failure requiring HD (Table). Table 1. Patient Characteristics by Death Table 2. Patient Characteristics by Death Table 3. Patient Characteristics by Death Conclusion COVID-19 pts admitted to our southeast U.S. HS had significant comorbidities, most commonly obesity, HTN, and diabetes. Additionally, AA comprised a disproportionate share (72%) of our cohort compared to the general population of our state (30%), those tested in our region (32.9%), and those found to be positive for COVID-19 (35.8%). In-hospital mortality was 19.3% and intubation, particularly if delayed, was associated with death as were several complications, most notably arrhythmia, ARDS, and renal failure with HD. Disclosures All Authors: No reported disclosures

Patient satisfaction and associated factors among in-patients in Primary Hospitals of North Shoa Zone, Amhara Regional State, Ethiopia

Satisfaction of patient is the preferred item for the consumption of care. It is related to health services consumption. The objective of the study was to determine the level of patient satisfaction and associated factors among patients Primary Hospitals of North Shoa Zone. Institutional-based cross-sectional study design were implemented from March 15-April 25, 2019. Sample sizes of 422 inpatients were included. Participants were selected by lottery method. Factor analysis was used in order to generate factor scores for further analysis. Variables P&lt;0.25 on the bivariate analysis were included in the multiple linear regression and variables with p&lt;0.05 with 95% confidence interval were considered as statistically significant. There was 59.1% inpatient was satisfied. Sex, religion, place of residence, previous admission and occupational status of a housewife, ggovernment employee and educational status of primary school were associated with patient satisfaction.

Olmesartan-Induced Enteropathy: A Case of Recurrent Diarrhoea

A 77-year-old man with arterial hypertension and dyslipidaemia, treated with olmesartan/hydrochlorothiazide and simvastatin, was admitted with a 3-week history of anorexia, nausea, vomiting, profuse diarrhoea and weight loss. He was dehydrated and blood tests showed acute kidney injury. The aetiological study was inconclusive. The patient had a favourable clinical evolution during hospitalization and was discharged. However, after about 10 days at home, he was re-admitted to hospital with the same clinical presentation. It was noticed that olmesartan had not been prescribed during the previous admission but had been restarted on an outpatient basis. Biopsy examination showed duodenal mucosa with villous atrophy and polymorphic inflammatory infiltrate. Antibody testing for coeliac disease was negative. Based on these facts, it was hypothesized that the patient had olmesartan-induced enteropathy, which was subsequently confirmed.

Hyponatraemia: the importance of obtaining a detailed history and corroborating point-of-care analysis with laboratory testing

We describe a 67-year-old man admitted from a mental health unit with an incidental finding of hyponatraemia on routine blood tests. Laboratory investigations were in keeping with syndrome of inappropriate antidiuretic hormone secretion (SIADH). He had been recently commenced on mirtazapine. During his inpatient stay, he became increasingly confused. Review of a previous admission with hyponatraemia raised the possibility of voltage-gated potassium channel antibody-associated limbic encephalitis, although subsequent investigations deemed this unlikely as a cause of hyponatraemia. Although his sodium levels improved with fluid restriction, serial point-of-care testing proved misleading in monitoring the efficacy of treatment as inconsistencies were seen in comparison with laboratory testing. The cause of hyponatraemia may have been medication-induced SIADH and/or polydipsia. This case highlights the importance of collating detailed histories and laboratory blood testing to guide management in cases of hyponatraemia of unknown aetiology.