Influence of drugs, demographics and medical history on hospital readmission of elderly patients - A predictive model

Objective: To investigate factors that influence hospital readmissions of elderly patients and to construct a robust hospital readmissions predictive model.

Sleep complaints and risk factors for excessive daytime sleepiness in adult males in Northern Ireland

The prevalence of sleep complaints in Northern Ireland is unknown. Sleep disruption can result in excessive daytime sleepiness (EDS), with significant socioeconomic consequences. The aim of this study was to assess the prevalence of sleep complaints and to determine risk factors for EDS in a Northern Irish community. From an urban and rural community of 499 111 people, a random sample of 3391 adult men were sent a questionnaire by mail. Questions were asked regarding sleep, EDS and medical history. There were 2364 completed questionnaires returned (response rate 70%). The mean age of respondents was 46.0 years (range 18-91 years). 26.7% of men were not satisfied with their usual night's sleep and 68% of men woke up at least once during the night. Based on pre-defined criteria, 24.6% of the population had insomnia and 19.8% had EDS. The strongest risk factor identified for EDS was a history of snoring loudly (odds ratio 2.62; 95% CI 1.82-3.77). Other risk factors included ankle swelling, feeling sad or depressed stopping sleep, experiencing vivid dreams while falling asleep, waking up feeling unrefreshed and age > 35 years. The prevalence rates of sleep complaints and EDS in this community-based study is high, although this does depend directly on the criteria used to define insomnia and EDS. Recognition of risk factors for EDS may help to identify and treat those affected.

'"These schemes will win for themselves the confidence of the people": Irish independence, poor law reform and hospital provision'

This article examines hospital provision in Ireland during the early twentieth century. It examines attempts by the newly independent Irish Free State to reform and de-stigmatise medical relief in former workhouse infirmaries. Such reforms were designed to move away from nineteenth century welfare regimes which were underpinned by principles of deterrence. The reform initiated in independent Ireland - the first attempted break-up of the New Poor Law in Great Britain or Ireland - was partly successful. Many of the newly named County and District Hospitals provided solely for medical cases and managed to dissociate such health care provision from the relief of poverty. However, some hospitals continued to act as multifunctional institutions and provided for various categories including the sick, the aged and infirm, 'unmarried mothers' and 'harmless lunatics'. Such institutions often remained associated with the relief of poverty. This article also examines patient fee-payment and outlines how fresh terms of entitlement and means-testing were established. Such developments were even more pronounced in voluntary hospitals where the majority of patients made a financial contribution to their treatment. The article argues that the ability to pay at times determined the type of provision, either voluntary or rate-aided, available to the sick. However, it concludes that the clinical condition of patients often determined whether they entered a more prestigious voluntary hospital or the former workhouse. Although this article concentrates on two Irish case studies, County Kerry and Cork City; it is conceptualised within wider developments with particular reference to the British context.

Are early life factors considered when managing respiratory disease?:A British Thoracic Society survey of current practice

We hypothesised that early life events are not routinely considered by most respiratory specialists.

Preserving arteriovenous fistula outcomes during surgical training

PURPOSE: Arteriovenous fistulae (AVFs) are the preferred option for vascular access, as they are associated with lower mortality in hemodialysis patients than in those patients with arteriovenous grafts (AVGs) or central venous catheters (CVCs). We sought to assess whether vascular access outcomes for surgical trainees are comparable to fully trained surgeons.

METHODS: A prospectively collected database of patients was created and information recorded regarding patient demographics, past medical history, preoperative investigations, grade of operating surgeon, type of AVF formed, primary AVF function, cumulative AVF survival and functional patency.

RESULTS: One hundred and sixty-two patients were identified as having had vascular access procedures during the 6 month study period and 143 were included in the final analysis. Secondary AVF patency was established in 123 (86%) of these AVFs and 89 (62.2%) were used for dialysis. There was no significant difference in survival of AVFs according to training status of surgeon (log rank x2 0.506 p=0.477) or type of AVF (log rank x2 0.341 p=0.559). Patency rates of successful AVFs at 1 and 2 years were 60.9% and 47.9%, respectively.

CONCLUSION: We have demonstrated in this prospective study that there are no significant differences in outcomes of primary AVFs formed by fully trained surgeons versus surgical trainees. Creation of a primary AVF represents an excellent training platform for intermediate stage surgeons across general and vascular surgical specialties.

The association between myopia and various subtypes of lens opacity: SEE (Salisbury Eye Evaluation) project.

PURPOSE: To establish the relationship between myopia and lens opacity. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Two thousand five hundred twenty participants from the Salisbury Eye Evaluation aged 65 to 84 years. METHODS: Participants filled out questionnaires regarding medical history, social habits, and a detailed history of distance spectacle wear. They underwent a full ocular examination. Lens photographs were taken for assessment of lens opacity using the Wilmer grading system. Multivariate logistic regression models using generalized estimating equations were used to analyze the relationship between lens opacity type and degree of myopia, while accounting for potential confounders. MAIN OUTCOME MEASURES: Presence of posterior subcapsular opacity, cortical opacity, or nuclear opacity. RESULTS: Significant associations were found between myopia and both nuclear and posterior subcapsular opacities. For nuclear opacity, the odds ratios (ORs) were 2.25 for myopia between -0.50 diopters (D) and -1.99 D (P<0.001), 3.65 for myopia between -2.00 D and -3.99 D (P<0.001), 4.54 for myopia between -4.00 D and -5.99 D (P<0.001), and 3.61 for myopia -6.00 D or more (P = 0.002). For posterior subcapsular cataracts, ORs were 1.59 for myopia between -0.50 D and -1.99 D (P = 0.11), 3.22 for myopia between -2.00 D and -3.99 D (P = 0.002), 5.36 for myopia between -4.00 D and -5.99 D (P<0.001), and 12.34 for myopia -6.00 D or more (P<0.001). No association was found between myopia and cortical opacity. The association between posterior subcapsular opacity and myopia was equally strong for those wearing glasses by age 21 years and for those without glasses; for nuclear opacity, significantly higher ORs were found for myopes who started wearing glasses after age 21. CONCLUSIONS: These results confirm the previously reported association between myopia, posterior subcapsular opacity, and nuclear opacity. Furthermore, the strong association between early spectacle wear and posterior subcapsular opacity among myopes, absent for nuclear opacity, suggests that myopia may precede opacity in the case of posterior subcapsular opacity, but not nuclear opacity. Measures of association between posterior subcapsular opacity and myopia were stronger in the current study than have previously been found. Longitudinal studies to confirm the association are warranted.

Use of eye care services among diabetic patients in urban and rural China.

OBJECTIVE: To assess the use of eye care and its predictors among diabetic patients in China. DESIGN: Cross-sectional, clinic-based study. PARTICIPANTS: Diabetic patients 18 years of age or older were recruited consecutively from an urban tertiary and community hospitals and from a rural clinic in Guangdong, China. METHODS: Information obtained by questionnaire and chart review included: demographic and socioeconomic status, knowledge about diabetic retinopathy (DR), and ocular and medical history. MAIN OUTCOME MEASURES: Self-reported or chart history of an eye examination ever or within the preceding 12 months. RESULTS: The participation rate among 889 eligible subjects was 92.7%. Among 824 participants (mean age, 62.6+/-12.9 years; 58.8% female), 550 (66.7%) had not been examined in the last year as recommended by the American Academy of Ophthalmology, and 356 (43.2%) had never been examined. For the rural hospital, these figures were 81.1% and 68.7%, respectively. In regression analyses, factors associated with having an eye examination in the last year were: attendance at urban hospitals (odds ratio [OR], 3.46 [P<0.001] and 1.76 [P = 0.021] for the tertiary and community hospitals, respectively, compared with the rural clinic), higher DR knowledge score (OR, 1.24; P = 0.001), greater concern about vision loss (OR, 1.22; P = 0.007), and recommendation of regular eye examinations by the provider (OR, 2.36; P = 0.011). Predictors of ever having an eye examination were similar. Monthly income and health insurance status were not predictive of being examined. CONCLUSIONS: These results suggest that the low proportion of diabetic receiving recommended annual eye examinations in China may be improved through patient and physician education. Copyright © 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Use of eye care services among diabetic patients in urban Indonesia.

OBJECTIVES:

To assess the use of eye care and its predictors among diabetic patients in Indonesia.

METHODS:

Diabetic patients aged 18 years and older were recruited consecutively from a university clinic and 2 community clinics in Jakarta, Indonesia. Information obtained by questionnaire and record review included demographic and socioeconomic status, knowledge about diabetic retinopathy, and ocular and medical history. The main outcome was self-reported or record history of an eye examination by an eye care professional with dilation of the pupil within the preceding year.

RESULTS:

Among 196 participants (mean [SD] age, 58.4 [9.4] years; 61.5% female), 166 (84.7%) had not undergone ocular examination in the last year, including 100 of 119 patients (84.0%) at the university clinic. Fewer than half (82 of 166 [49.4%]) of all patients reported being told of the need for eye examinations by their physician. In regression analyses, factors associated with having an eye examination were higher diabetic retinopathy knowledge score (odds ratio = 1.52; P = .01) and years since being diagnosed as having diabetes (odds ratio = 1.71 for third vs first tertile; P = .02). Education, income, health insurance status, and diagnosis of diabetic retinopathy were not predictive of examination. The most common reasons given by subjects for not having had eye examinations concerned lack of knowledge about the need for care (97 of 160 subjects [60.6%]), while financial barriers were cited by only 22 of 160 subjects (13.8%).

CONCLUSION:

The low proportion of diabetic subjects receiving recommended annual eye examinations in Indonesia might be improved through patient and physician education.

Root caries development in older adults- a prospective cohort study

Objectives: To identify factors associated with root caries development during a two year period in a population of independently living older adults. Methods: A prospective cohort study was carried out with 334 independently living volunteers aged 65 and older. At baseline (t0), each participant completed a questionnaire which recorded age, gender, medical history, fluoride exposure, oral and denture hygiene practices, smoking and alcohol consumption, diet information, and socio economic information. Clinical examinations were performed and stimulated saliva samples were collected. Patients were reviewed 12(t1) and 24(t2) months later to determine the root caries increment. Results: 307 adults were assessed at t1 and 280 were assessed at t2 with 83.8% of participants examined at 24 months. Incidence of root caries in this cohort was 17.4% at t1 and 21.6% at t2. The mean root caries increment was 0.43 (SD 1.45) surfaces at t1 and 0.70 (SD 1.86) surfaces at t2. Age >70 years, completing education at primary level, poor oral hygiene, xerostomia, coronal decay at baseline, higher root caries index at baseline and number of exposed root surfaces showed a statistically significant association (P < 0.05) with root caries development. Conclusion: Root caries is a substantive dental health problem for our older population. Root caries prevention strategies should be targeted at older adults who have poor plaque control and high levels of caries experience. In particular patients with xerostomia should be targeted with preventive measures.

Risk factors (excluding hormone therapy) for endometrial hyperplasia: a systematic review.

Objective: To conduct a systematic review of risk factors associated with the development of Endometrial Hyperplasia (EH).

Data sources: Ovid MEDLINE, EMBASE and Web of Science databases were searched from inception to 30 June 2015.

Study eligibility: Fifteen observational studies that reported on EH risk in relation to lifestyle factors (n=14), medical history (n=11), reproductive and menstrual history (n=9) and measures of socio-economic status (n=2) were identified. Pooled relative risk estimates and corresponding 95% confidence intervals (CI) were able to be derived for EH and Body Mass Index (BMI), smoking, diabetes and hypertension, using random effects models comparing high versus low categories.

Results: The pooled relative risk for EH when comparing women with the highest versus lowest BMI was 1.82 (95% CI 1.22–2.71; n=7 studies, I2=90.4%). No significant associations were observed for EH risk for smokers compared with non-smokers (RR 0.88, 95% CI 0.66-1.17; n=3, I2=0.0%), hypertensive versus normotensive women (RR 1.51, 95% CI 0.72–3.15; n=5 studies, I2=79.1%), or diabetic versus non-diabetic women (RR 1.77, 95% CI 0.79–3.96; n=5 studies, I2=31.8%) respectively although the number of included studies was limited. There were mixed reports on the relationship between age and risk of EH. Too few studies reported on other factors to reach any conclusions in relation to EH risk.

Conclusions: A high BMI was associated with an increased risk of EH, providing additional rationale for women to maintain a normal body weight. No significant associations were detected for other factors and EH risk, however relatively few studies have been conducted and few of the available studies adequately adjusted for relevant confounders. Therefore, further aetiological studies of endometrial hyperplasia are warranted.

Life expectancy for community-based patients with heart failure from time of diagnosis

AIMS: Heart failure has been demonstrated in previous studies to have a dismal prognosis. However, the modern-day prognosis of patients with new onset heart failure diagnosed in the community managed within a disease management programme is not known. The purpose of this study is to report on prognosis of patients presenting with new onset heart failure in the community who are subsequently followed in a disease management program.

METHODS AND RESULTS: A review of patients referred to a rapid access heart failure diagnostic clinic between 2002 and 2012 was undertaken. Details of diagnosis, demographics, medical history, medications, investigations and mortality data were analysed. A total of 733 patients were seen in Rapid Access Clinic for potential new diagnosis of incident of heart failure. 38.9% (n=285) were diagnosed with heart failure, 40.7% (n=116) with HF-REF and 59.3% (n=169) with HF-PEF. There were 84 (29.5%) deaths in the group of patients diagnosed with heart failure; 41 deaths (35.3%) occurred in patients with HF-REF and 43 deaths (25.4%) occurred in patients with HF-PEF. In patients with heart failure, 52.4% (n=44) died from cardiovascular causes. 63.8% of HF patients were alive after 5 years resulting on average in a month per year loss of life expectancy over that period compared with aged matched simulated population.

CONCLUSIONS: In this community-based cohort, the prognosis of heart failure was better than reported in previous studies. This is likely due to the impact of prompt diagnosis, the improvement in therapies and care within a disease management structure.

Merely Birds of Passage: Lady Hariot Dufferin's Travel Writings and Medical Work in India, 1884-88

This article examines the travel writings and medical work in India of Lady Hariot Dufferin, Vicereine of India between 1884 and 1888. Lady Dufferin accompanied her husband, the Viceroy Lord Dufferin, through various social and political engagements in India, and carved her own niche in colonial and postcolonial history as a pioneer in the medical training of women in India. The article examines her travel writings on India and explores the nature of her complicity in the Raj, as well as the gendered nature of the separate public role she created for herself in relation to her 'zenana work' in providing medical care for the women of India. The author suggests that, through her work, Lady Dufferin challenges and extends the theoretical paradigms of postcolonialist and feminist critiques of empire.

The history of neurology in Belfast: the first hundred years.

No abstract