Taking care of the most vulnerable : a descriptive study of patients with 12 attendances or more at a Swiss university hospital emergency department in 2009

Introduction: Patients who repeatedly attend the Emergency Department (ED) often have a distinct and complex vulnerability profile that includes poor somatic, psychological, and social indicators. This profile has an impact on the patients' well-being as well as on hospital costs. The objective of the study was to specify the characteristics of hyper users (HU) and explore the connection with ED care and hospital costs. Methods: The study sample comprised all adult patients with 12 or more attendances at the ED of the Lausanne University Hospital in 2009. The data were collected by retrospectively searching internal databases to identify the patients concerned and then analysing the profiles of these patients. Information gathered included demographic, somatic, psychological, at-risk behaviour, and social indicators, and health system consumption including costs. Results: In 2009, 23 patients (0.1%) attended 12 times or more (425 attendances, 0.8%). The average age was about 43 years, 60.9% were female, and 47.8% single. Of these 95.7% had basic insurance, 87.0% had a general practitioner, and 30.4% were under legal guardianship. The majority attended in the evening or at night (67.1%), and almost one quarter of these attendances resulted in inpatient treatment (24.0%). Most HU had attended the ED in previous years too (95.7% in 2008). The most prevalent diagnoses concerned 'mental disorders' (87.0%). About 30.4% of patients had attempted suicide (all were female patients). Other frequent diagnoses concerned 'trauma' (65.2%), and the 'digestive' and the 'nervous system' (each 56.5%). At-risk behaviour such as severe alcohol consumption (34.8%), or excessive use of medicines (26.1%) was very frequent, and some patients used illicit drugs (21.7%). There was only a weak association between the number of ED attendances and the resulting costs. However, a reduction of one outpatient visit per patient would have decreased ED outpatient costs by 8.5%. Conclusions: HU often have a particularly vulnerable profile. Mental problems are prevalent among them, as are at-risk behaviour and severe somatic conditions. The complexity of the patients' profiles demands specific care that cannot be guaranteed within an everyday ED routine. The use of an interdisciplinary case management team might be a promising approach in diminishing the number of attendances and the associated costs, although the profiles of HU are such that they probably cannot completely give up ED attendance.

ABD e-News August 12, 2005

Weekly Newsletter

Acreage Living, December 2000, Vol.6, no.12

Monthly newsletter for people in Iowa that live on Acreages, produced by Iowa State University Copperative Extension.

Acreage Living, December 2001, Vol.7, no.12

Monthly newsletter for people in Iowa that live on Acreages, produced by Iowa State University Copperative Extension.

Acreage Living, December 2001, Vol.7, no.12

Monthly newsletter for people in Iowa that live on Acreages, produced by Iowa State University Copperative Extension.

Lottery Action, July 25-August 8, 2005, Vol. 12, no. 14

Iowa Lottery Authority Newsletter for Lottery retailers

Lottery Action, September 12-25, 2005, Vol. 12, no. 17

Iowa Lottery Newsletter for lottery retailers

Lottery Action, September 26-October 9, Vol. 12, no. 18

Iowa Lottery newsletter for lottery retailers

EPI Update, August 12 2005

Weekly newsletter for Center For Acute Disease Epidemiology of Iowa Department of Public Health.

Iowa Board of Nursing Annual Report, July 12, 2004-June 30,2005

Annual report of the Iowa Board of Nursing. Includes information on legislation, rule changes, and statistics related to all aspects of board business: education, continuing education, enforcement, administrative changes, financial report and general nursing demographics.

Wear of two artificial tooth materials in vivo: a 12-month pilot study.

STATEMENT OF PROBLEM: Wear of methacrylate artificial teeth resulting in vertical loss is a problem for both dentists and patients. PURPOSE: The purpose of this study was to quantify wear of artificial teeth in vivo and to relate it to subject and tooth variables. MATERIAL AND METHODS: Twenty-eight subjects treated with complete dentures received 2 artificial tooth materials (polymethyl methacrylate (PMMA)/double-cross linked PMMA fillers; 35%/59% (SR Antaris DCL, SR Postaris DCL); experimental 48%/46%). At baseline and after 12 months, impressions of the dentures were poured with improved stone. After laser scanning, the casts were superimposed and matched. Maximal vertical loss (mm) and volumetric loss (mm(3)) were calculated for each tooth and log-transformed to reduce variability. Volumetric loss was related to the occlusally active surface area. Linear mixed models were used to study the influence of the factors jaw, tooth, and material on adjusted (residual) wear values (alpha=.05). RESULTS: Due to drop outs (n=5) and unmatchable casts (n=3), 69% of all teeth were analyzed. Volumetric loss had a strong linear relationship to surface area (P<.001); this was less pronounced for vertical loss (P=.004). The factor showing the highest influence was the subject. Wear was tooth dependent (increasing from incisors to molars). However, these differences diminished once the wear rates were adjusted for occlusal area, and only a few remained significant (anterior versus posterior maxillary teeth). Another influencing factor was the age of the subject. CONCLUSIONS: Clinical wear of artificial teeth is higher than previously measured or expected. The presented method of analyzing wear of artificial teeth using a laser-scanning device seemed suitable.

Catalogue des vases, colonnes, tables de marbres rares, figures de bronze, porcelaines de choix, laques, meubles précieux, pendules, lustres... et autres effets importants qui composent le cabinet de feu M. le duc d'Aumont . Par P. F. Julliot fils, & A. J. Paillet. La vente se fera le 12 Décembre 1782...

[Vente. Art. 1782-12-12. Paris]