Abstract:
OBJECTIVES:Patients with cirrhosis have a high rate of 30-day hospital readmission that affects their quality of life and contributes to increased healthcare-related costs. The aim of our study was to identify frequency, predictors, and preventable causes of hospital readmissions among patients with decompensated cirrhosis. METHODS:We retrospectively reviewed electronic medical records of all patients with a confirmed diagnosis of decompensated cirrhosis admitted to Dayton VA Medical Center between 2009 and 2013. Demographics, clinical factors, laboratory values, and outcomes were recorded. Univariate analysis was performed using independent samples t tests and Wilcoxon rank sums tests for continuous variables and χ(2) or Fisher exact tests for categorical variables. A multiple logistic regression analysis was performed for variables found to be significant by univariate analysis to predict the risk factors for 30-day readmission. A detailed chart review was conducted for all patients readmitted within 30 days by a single gastroenterologist to identify the reason for readmission and to decide whether any of these readmissions were preventable. RESULTS:The 30-day readmission rate for decompensated cirrhotic patients was 27.03%. The risk factors for 30-day readmission were higher body mass index (BMI), lower body temperature, higher blood urea nitrogen, higher creatinine, more cirrhosis-related complications, and more readmissions per year per univariate analysis. Multivariable analysis revealed only BMI as a significant predictor of 30-day readmission (P = 0.023). A total of 36.7% of 30-day readmissions were possibly preventable. CONCLUSIONS:The independent variable that predicted 30-day readmission in patients with decompensated cirrhosis was higher BMI. Approximately one-third of 30-day readmissions were possibly preventable. These findings support the need to develop specific interventions for disease management to improve patient care and save on extraneous healthcare costs.
journal_name
South Med Jjournal_title
Southern medical journalauthors
Agrawal K,Kumar P,Markert R,Agrawal Sdoi
10.14423/SMJ.0000000000000371subject
Has Abstractpub_date
2015-11-01 00:00:00pages
682-7issue
11eissn
0038-4348issn
1541-8243pii
SMJ50099journal_volume
108pub_type
杂志文章abstract::Catheter emboli are a significant risk to patient well-being. With a 49% complication rate for indwelling catheter emboli, the consensus is that these foreign bodies should be removed. Preferably, the emboli are removed by percutaneous extraction; however, if the emboli are in the heart or central vasculature and perc...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199607000-00013
更新日期:1996-07-01 00:00:00
abstract::Treatment of major abdominal vascular injuries is a challenge. Since 1973, 93 patients have been treated at our institution for 147 abdominal vascular injuries. The majority of these injuries (67%) resulted from penetrating trauma in young men between 21 and 30 years of age. Upon admission 72% of the patients were in ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198510000-00003
更新日期:1985-10-01 00:00:00
abstract::A controlled trial of treatment of chronic osteomyelitis caused by Staphylococcus aureus compared nafcillin alone with nafcillin plus rifampin for a six-week period. Treatment was well tolerated, the only adverse effect being mild neutropenia in four of 18 patients; no toxicity was observed from rifampin. Eight of ten...
journal_title:Southern medical journal
pub_type: 临床试验,杂志文章
doi:10.1097/00007611-198608000-00008
更新日期:1986-08-01 00:00:00
abstract::We reviewed the cases of women admitted to LSU Medical Center in Shreveport with the diagnosis of "small bowel obstruction" from Jan 1, 1975 to June 30, 1981. Review of the charts of patients who had exploratory laparotomy for relief of the obstruction showed that 83% of them had had previous abdominal surgery. Furthe...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198311000-00005
更新日期:1983-11-01 00:00:00
abstract::One goal of primary care training programs is to provide "continuity experiences" for residents. Although programs funded by the Health Resources Administration are mandated to provide and evaluate such experiences, a wide variety may exist in both the concept and the evaluation of continuity in these training program...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198306000-00025
更新日期:1983-06-01 00:00:00
abstract::One hundred fifty patients underwent surgery for mitral valve disease between January 1974 and May 1981. There were 98 female and 52 male patients with a mean age of 57 years (+/- 18.6). One hundred forty-six patients were in New York Heart Association functional class III or IV. Pathologic diagnoses included 67% rheu...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198306000-00005
更新日期:1983-06-01 00:00:00
abstract::Significant increases in prevalence of resistance to antibiotics have been observed in common pathogens of humans in the United States and worldwide. The consequences of the appearance and spread of antibiotic resistance have included increasing morbidity, mortality, and cost of health care. The fundamental cause for ...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:
更新日期:2000-09-01 00:00:00
abstract::When patient records are to be auditied in a program designed to assess the quality of medical care rendered, careful consideration must be given to the cost of the system implemented. Structured data collection and a defined treatment plan are advantageous in facilitating the use of nonphysicians for the majority of ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197610000-00022
更新日期:1976-10-01 00:00:00
abstract::Since April 1975, 292 patients have had gastric operations for morbid obesity: gastric bypass with Roux-en-Y gastrojejunostomy (RY), 105 patients; gastric bypass with loop gastrojejunostomy (loop), 69 patients; greater curvature gastroplasty, 40 patients; and gastric partition with gastrogastrostomy, 78 patients. Foll...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198211000-00005
更新日期:1982-11-01 00:00:00
abstract:OBJECTIVES:Patient safety event (PSE) reporting is a critical element for healthcare organizations that are striving for continuous quality improvement. Although resident physicians routinely provide the majority of direct patient care, the level of their participation in PSE reporting historically has been low. In add...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.14423/SMJ.0000000000000486
更新日期:2016-07-01 00:00:00
abstract::Of 24 elderly patients with Streptococcus pneumoniae pneumonia confirmed by transtracheal aspiration, six had concomitant infection with gram-negative aerobic bacilli. All six patients were elderly men with underlying cardiopulmonary disease. Three had had recent prior episodes of gram-negative pneumonia and four had ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198102000-00004
更新日期:1981-02-01 00:00:00
abstract::This paper reports the case of a young woman with SLE whose paraspinous abscess due to Mycobacterium avium-intracellulare was metastatic to the breast. Surgical drainage and 18 months of treatment with rifampin, cycloserine, ethambutol, and streptomycin failed to eradicate the infection. This case illustrates that MAI...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199111000-00025
更新日期:1991-11-01 00:00:00
abstract::High fever occurred in a 30-year-old woman five weeks after transsphenoidal hypophysectomy for a pituitary adenoma. Extensive investigation failed to reveal any evidence of infection, and the clinical findings suggested the fever to be a manifestation of steroid withdrawal. Either suboptimal dosage of corticosteroid r...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198903000-00027
更新日期:1989-03-01 00:00:00
abstract::We evaluated the medical history, physical examination, and laboratory tests done on 245 patients with laparoscopically proven ectopic pregnancies. The absence of abdominal pain was the only clinically useful negative predictive value (91%) regarding tubal rupture. Although mean levels of serum human chorionic gonadot...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199112000-00014
更新日期:1991-12-01 00:00:00
abstract::We report the case of a 55-year-old woman who was thought to have systemic lupus erythematosus (SLE) for more than 13 years before Crohn's colitis was correctly diagnosed. The differentiation of Crohn's disease from SLE may be difficult, as illustrated by our case. Gastrointestinal symptoms, laboratory studies, and ra...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199510000-00018
更新日期:1995-10-01 00:00:00
abstract:OBJECTIVES:Pulmonary arterial hypertension (PAH) is a progressive disease that can be treated with several medications. Macitentan, an endothelin receptor antagonist (ERA), has received approval as a PAH therapy. We report our data regarding the tolerability in patients with PAH who were switched from bosentan to macit...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.14423/SMJ.0000000000000607
更新日期:2017-03-01 00:00:00
abstract::A "life stress" scale is applied to the antecedent events motivating 179 patients to seek outpatient psychiatric help. Intake evaluation reports of patients who kept their appointments at the Adult Psychiatric Outpatient Clinic of Vanderbilt University Hospital over a three-month period were reviewed. Almost half of t...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197602000-00016
更新日期:1976-02-01 00:00:00
abstract::An autopsy of a probable case of MCLS is described. After 10,000 cases have been recorded in Japan, the disease is being recognized in the United States. There may be an overlap with infantile periarteritis nodosa. Pathologic studies of fatal cases of MCLS diagnosed during life have not been reported in this country. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197809000-00040
更新日期:1978-09-01 00:00:00
abstract::Maffucci's syndrome in a 17-year-old girl is reported. Since the entity was first described in 1881 by Maffucci, 105 additional cases have been recorded. Several series have reported a small but significant percentage of cases (up to 18%) with malignant change. Our case, although not particularly unique in comparison ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197804000-00033
更新日期:1978-04-01 00:00:00
abstract::Primary sarcomatous arterial tumors are rare. We have reported a case of malignant fibrous histiocytoma in an elderly woman successfully treated by resection of the involved femoral vessel and reconstruction with a PTFE graft. The long-term result in this patient is presently uncertain. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199202000-00030
更新日期:1992-02-01 00:00:00
abstract::We have recently developed a Data Bank for Digestive Disorders, with primary data derived from the performance of upper gastrointestinal endoscopy. By using this system to analyze the clinical characteristics of patients with atypical chest pain, we found information from the patient's history (reflux, dysphagia, abdo...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198301000-00007
更新日期:1983-01-01 00:00:00
abstract:BACKGROUND:Mortality rates for hyperthermia and hypothermia are higher in Alabama than nationally, and Alabama has twice as many hypothermia deaths as hyperthermia deaths. These causes of death have not been studied in the southeastern United States. We describe the epidemiology of heat- and cold-related deaths in Alab...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:2000-08-01 00:00:00
abstract::The incidence of acute rheumatic fever in Mississippi was estimated by reviewing the hospital charts of Mississippi residents with a discharge diagnosis of acute rheumatic fever from 1964 through 1973. The average annual incidence was 1.5 cases/100,000 population for primary attacks and 0.4 cases/100,000 population fo...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198105000-00013
更新日期:1981-05-01 00:00:00
abstract::Castleman disease (CD) is a rare lymphoproliferative disorder that occurs in adults and rarely in the pediatric population. The disease is characterized by slowly enlarging masses that can form anywhere within the lymphatic system. It is an uncommon cause of a neck mass in both children and adults that presents insidi...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.14423/SMJ.0000000000000406
更新日期:2016-02-01 00:00:00
abstract::A woman with chronic hemoptysis as her only complaint had extensive testing and did not respond to antibiotic therapy. Radiologic examination of the sinuses identified a mass which, on surgical exploration, was found to be the result of a fungus, Pseudallescheria boydii. Although this fungus is known to be a cause of ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199507000-00021
更新日期:1995-07-01 00:00:00
abstract::The incidence of cocaine-induced psychosis has increased with the rise in popularity of cocaine as the recreational drug of choice. Neuroleptic agents have been used to control the hallucinations, paranoia, and hyperactivity of the acute psychotic episodes. Lithium has been suggested as an alternative therapeutic agen...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198112000-00015
更新日期:1981-12-01 00:00:00
abstract::Tramadol (Ultram) is a new analgesic agent with a dual mechanism of action that includes weak agonistic effects at the mu-opioid receptor as well as inhibition of neurotransmitter (serotonin, norepinephrine) re-uptake. Although it has proven to be a safe and effective agent for the control of pain, adverse effects can...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199708000-00010
更新日期:1997-08-01 00:00:00
abstract::Four patients, all sisters, presented a long-standing history of pain in the gallbladder region and no calculi. All were first thoroughly investigated and then relieved of their symptoms by cholecystectomy. This prompted an investigation of their family over three generations, which revealed a surprisingly large numbe...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-199302000-00008
更新日期:1993-02-01 00:00:00
abstract::A total of 37 physicians and other health care professionals have been accepted into a monitoring and advocacy program for an average of 24 months. Thirty-five are working in their profession, one is in treatment, and one has repeatedly relapsed and is no longer practicing medicine (an overall improvement rate of 97%)...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199409000-00003
更新日期:1994-09-01 00:00:00
abstract::Concurrent occurrence of carotid artery stenosis and intracerebral aneurysm is uncommon and poses a therapeutic dilemma. We report a patient with bilateral carotid artery stenosis and a 2.5 cm left middle cerebral artery aneurysm who simultaneously underwent a successful stent-assisted coiling for his intracerebral an...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.smj.0000217190.93989.c9
更新日期:2006-07-01 00:00:00