Community factors and hospital readmission rates

OBJECTIVE

To examine the relationship between community factors and hospital readmission rates.

DATA SOURCES/STUDY SETTING

We examined all hospitals with publicly reported 30-day readmission rates for patients discharged during July 1, 2007, to June 30, 2010, with acute myocardial infarction (AMI), heart failure (HF), or pneumonia (PN). We linked these to publicly available county data from the Area Resource File, the Census, Nursing Home Compare, and the Neilsen PopFacts datasets.

STUDY DESIGN

We used hierarchical linear models to assess the effect of county demographic, access to care, and nursing home quality characteristics on the pooled 30-day risk-standardized readmission rate.

DATA COLLECTION/EXTRACTION METHODS

Not applicable.

PRINCIPAL FINDINGS

The study sample included 4,073 hospitals. Fifty-eight percent of national variation in hospital readmission rates was explained by the county in which the hospital was located. In multivariable analysis, a number of county characteristics were found to be independently associated with higher readmission rates, the strongest associations being for measures of access to care. These county characteristics explained almost half of the total variation across counties.

CONCLUSIONS

Community factors, as measured by county characteristics, explain a substantial amount of variation in hospital readmission rates.

Diagnostic accuracy studies in mild traumatic brain injury: a systematic review and descriptive analysis of published evidence

OBJECTIVES

To synthesize evidence and report findings from a systematic search and descriptive analysis of peer-reviewed published evidence of the accuracy of tests used for diagnosing mild traumatic brain injury (mTBI). The article also summarizes points of concurrence and divergence regarding case definitions of mTBI identified during the review. TYPE: Systematic review and descriptive analysis of published evidence.

LITERATURE SURVEY

A search of PubMed, PsychInfo, and the Cochrane Library for peer-reviewed publications between 1990 and July 6, 2011, identified 1218 abstracts; 277 articles were identified for full review, and 13 articles met the criteria for evaluation.

METHODOLOGY

Manuscript inclusion criteria were (1) reported sensitivity (Se) and specificity (Sp), or reported data were sufficient to compute Se and Sp; (2) >1 participant in the study; (3) at least 80% of the study cohort was ≥18 years of age; and (4) written in English. Articles describing clinical practice guidelines, opinions, theories, or clinical protocols were excluded. Seven investigators independently evaluated each article according to the Standards for Reporting of Diagnostic Accuracy (STARD) criteria.

SYNTHESIS

Findings indicate that all 13 studies involved civilian noncombat populations. In 7 studies, authors examined acute mTBI, and in 4 studies, historical remote mTBI was examined. In the 13 studies, Se ranged from 13%-92% and Sp ranged from 72%-99%, but confidence in these findings is problematic because the STARD review indicates opportunities for bias in each study.

CONCLUSIONS

Findings indicate that no well-defined definition or clinical diagnostic criteria exist for mTBI and that diagnostic accuracy is currently insufficient for discriminating between mTBI and co-occurring mental health conditions for acute and historic mTBI. Findings highlight the need for research examining the diagnostic accuracy for acute and historic mTBI.

Treatment of osteoarthritis of the knee (nonarthroplasty)

The clinical practice guideline was explicitly developed to include only treatments less invasive than knee replacement (ie, arthroplasty). Patients with symptomatic osteoarthritis of the knee are to be encouraged to participate in self-management educational programs and to engage in self-care, as well as to lose weight and engage in exercise and quadriceps strengthening. The guideline recommends taping for short-term relief of pain as well as analgesics and intra-articular corticosteroids, but not glucosamine and/or chondroitin. Patients need not undergo needle lavage or arthroscopy with débridement or lavage. Patients may consider partial meniscectomy or loose body removal or realignment osteotomy, as conditions warrant. Use of a free-floating interpositional device should not be considered for symptomatic unicompartmental osteoarthritis of the knee. Lateral heel wedges should not be prescribed for patients with symptomatic medial compartmental osteoarthritis of the knee. The work group was unable either to recommend or not recommend the use of braces with either valgus- or varus-directing forces for patients with medial unicompartmental osteoarthritis; the use of acupuncture or of hyaluronic acid; or osteotomy of the tibial tubercle for isolated symptomatic patellofemoral osteoarthritis.

Taste, olfactory and trigeminal neophobia in rats with forebrain lesions

The present study was designed to examine whether lesions of the insular cortex (IC; Experiment 1), the basolateral amygdala (BLA) or medial amygdala (MeA; Experiment 2) influence the neophobic reactions to orally consumed liquid stimuli. Three different types of stimuli were used: taste (0.5% saccharin), olfactory (0.1% amyl acetate), and trigeminal (0.01 mM capsaicin). Rats with IC, BLA and MeA lesions showed normal responses to the olfactory and trigeminal stimuli. Each type of lesion, however, disrupted the initial occurrence of neophobia to the taste stimulus. The significance of these findings to conditioned taste aversion is discussed.

Effects of central and basolateral amygdala lesions on conditioned taste aversion and latent inhibition

The present study examined the effects of neurotoxic lesions of the central nucleus (CNA) and basolateral complex (BLA) of the amygdala on conditioned taste aversion (CTA) in a latent inhibition design. In Experiment 1, lesions of the CNA were found to have no affect on CTA acquisition regardless of whether the taste conditioned stimulus (CS) was novel or familiar. Lesions of the BLA, although having no influence on performance when the CS was familiar, retarded CTA acquisition when the CS was novel in Experiment 2. The pattern of results suggests that the CTA deficit in rats with BLA lesions may be a secondary consequence of a disruption of perceived stimulus novelty.

C-fos expression in the rat brain following lithium chloride-induced illness

The present study examined c-Fos expression in selected brain areas consequent to administration of lithium chloride, the typical illness-inducing agent used in laboratory studies of conditioned taste aversion. The results replicated previous findings of significant c-Fos expression in the parabrachial nucleus, the central nucleus of the amygdala and the basolateral amygdala. New findings indicate significant lithium-induced c-Fos in the gustatory region of the thalamus and the bed nucleus of the stria terminalis but not in the insular cortex. The results are discussed with respect to the neural substrates of conditioned taste aversion.

Inhibition of estrous cyclicity in golden hamsters by melatonin administration on the day of proestrus

Single injections of melatonin (25 micrograms) were administered to female hamsters, 15 minutes before lights-out (14L:10D), during either the early diestrous (day 1) or proestrous (day 4) phase of the estrous cycle. Hamsters which received melatonin only on the evening of proestrus became anovulatory by three weeks of treatment, while those that were injected with melatonin during diestrus, or administered oil on either day 1 or 4, continued to exhibit normal estrous cycles. These results indicate that quartan injections of melatonin can suppress reproductive function in female hamsters, and that the effectiveness of the injections may be dependent upon the stage of the estrous cycle at which they are administered.