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Biomedical subjects

P Ginier

Publications and source records attributed to P Ginier.

7 recordsLinked to original sources
PubMed2000

Predicting non-elective hospital readmissions: a multi-site study. Department of Veterans Affairs Cooperative Study Group on Primary Care and Readmissions.

OBJECTIVE: To determine clinical and patient-centered factors predicting non-elective hospital readmissions. DESIGN: Secondary analysis from a randomized clinical trial. CLINICAL SETTING: Nine VA medical centers. PARTICIPANTS: Patients discharged from the medical service with diabetes mellitus, congestive heart failure, and/or chronic obstructive pulmonary disease (COPD). MAIN OUTCOME MEASUREMENT: Non-elective readmission within 90 days. RESULTS: Of 1378 patients discharged, 23.3% were readmitted. After controlling for hospital and intervention status, risk of readmission was increased if the patient had more hospitalizations and emergency room visits in the prior 6 months, higher blood urea nitrogen, lower mental health function, a diagnosis of COPD, and increased satisfaction with access to emergency care assessed on the index hospitalization. CONCLUSIONS: Both clinical and patient-centered factors identifiable at discharge are related to non-elective readmission. These factors identify high-risk patients and provide guidance for future interventions. The relationship of patient satisfaction measures to readmission deserves further study.

Diabetes Mellitus↗
PubMed1996

Classifying general medicine readmissions. Are they preventable? Veterans Affairs Cooperative Studies in Health Services Group on Primary Care and Hospital Readmissions.

OBJECTIVES: To describe a new quality assessment method used to classify the preventability of hospitalization in terms of patient, clinician, or system factors. DESIGN: The instrument was developed in two phases. Phase 1 was a prospective comparison of admitting residents' and their attending physicians' classifications of the perceived preventability of consecutive admissions to one Veterans Affairs Medical Center (VAMC) excluding admissions to the intensive care unit (ICU). In phase 2, a panel of 10 physicians rated 811 abstracted records of readmissions from nine VAMCs. SETTING: Nine VAMCs across the United States with varying degrees of university hospital affiliation. PATIENTS: Phase 1, 156 patients admitted to the general medicine service at the Durham VAMC. Phase 2, 514 patients accounting for 811 readmissions within 6 months of a general medicine service discharge at nine VAMCs. MEASUREMENTS AND MAIN RESULTS: Physicians used a checklist to record the reason for hospitalization, the preventability of the hospitalization, and, if preventable, a reason defining preventability, which was classified in terms of system, clinician, and patient factors. In phase 2, two physician panelists assessed preventability for each chart. When two panelists disagreed on the preventability of hospitalization, a third panelist, blind to the original assessments, rated the chart. In phase 1, residents and attending physicians rated 33% and 34% of admissions as preventable (kappa = 0.41), respectively. In phase 2, 277 (34%) of 811 readmissions were deemed preventable. Intraobserver accuracy for the assessment of preventability was 96% (kappa = 0.89). interobserver accuracy was 73% (kappa = 0.43). Hospital system factors accounted for 37% of preventable readmissions, clinician factors for 38%, and patient factors for 21%. The nine hospitals differed markedly in their profile of reasons for preventable readmissions (p = .005). CONCLUSIONS: Using a new method of determining the preventability of hospitalizations, we identified several factors that might avert hospitalizations. Focusing efforts to identify preventable hospitalizations may yield better methods for managing patients' total health care needs; however, the content of those efforts will vary by institution.

Adult↗
PubMed1992

Nosocomial transmission of hepatitis B virus associated with the use of a spring-loaded finger-stick device.

BACKGROUND AND METHODS: From June 1989 through March 1990, 26 patients, of whom 23 had diabetes, contracted acute hepatitis B virus (HBV) infection in a hospital in California. All 26 patients and one HBV carrier (also a diabetic) had been admitted to a single medical ward during the six months before the case patients became infected with HBV. To determine the source of the infection, we conducted a retrospective cohort study of the 72 patients with diabetes who had been admitted to the ward from January through December 1989 and a case-control study comparing the 3 nondiabetic patients who contracted hepatitis with 20 nondiabetic controls. RESULTS: The retrospective cohort study of all the patients with diabetes who were admitted to the ward during 1989 found that those who underwent capillary blood sampling by finger stick with a spring-loaded lancet device were more likely to contract HBV infection than those who did not have finger sticks (attack rate, 42 percent vs. 0 percent; P = 0.08). In addition, a dose-response relation was observed between the number of finger sticks received and the frequency of hepatitis B (P = 0.002). The case-control study found that all 3 of the nondiabetic patients who contracted hepatitis underwent finger-stick blood sampling with the device, as compared with none of the 20 nondiabetic controls (P = 0.0006). A review of nursing procedures indicated that the platform of the device was not routinely changed after each use; this finding suggested that contamination of the platform by HBV-infected blood was the mechanism of percutaneous transmission of HBV. CONCLUSIONS: Proper use of finger-stick devices as well as strict adherence to universal precautions to avoid contamination by blood are required to decrease the possibility of transmission of blood-borne pathogens among hospitalized patients.

Acute Disease↗
PubMed1985

Once-daily use of glyburide.

Ideally, metabolic control with sulfonylureas should be maintained for 24 hours. To determine an optimal glyburide dosage schedule, the effects of glyburide once (every morning) or twice daily and chlorpropamide once daily (every morning) were compared in 18 men with non-insulin-dependent diabetes mellitus in a randomized, double-blind fashion. After discontinuation of previous hypoglycemic agents for 10 days, patients were admitted to a metabolic ward for two weeks (Study A). Glycemic measurements were performed on Day 14. Subjects were readmitted after 12 weeks of outpatient therapy for another two weeks (Study B), and glycemic determinations were repeated. Weight was kept constant during and between Studies A and B. Effective hypoglycemic action of each drug regimen was demonstrated. When six glycemic parameters were compared, there was no significant difference between groups. Thus, over a 14-week period, both glyburide regimens were similar and as effective as chlorpropamide once daily.

Blood Glucose↗
PubMedDate not supplied

Clinical characteristics associated with microalbuminuria in an adult diabetic population.

A study was conducted to identify clinical characteristics which might distinguish individuals at risk for diabetic nephropathy. A cross-sectional survey measuring microalbuminuria in a population of 140 diabetic adults was performed and several clinical parameters among subgroups with different clinical types of diabetes, based upon age of onset and insulin treatment, were examined. In 67 insulin-treated patients with onset of diabetes at or after the age of 30 who had elevated albumin excretion rates, significantly greater duration of diabetes, age, blood pressure, serum creatinine, body mass index, and serum triglycerides were found. In this group of maturity onset insulin-treated diabetic patients, there was a significantly smaller proportion of smokers in the microalbuminuria group than in the group with normal excretion. No such distinctions were seen in 58 maturity onset patients with and without microalbuminuria who were not receiving insulin. In 15 insulin dependent patients with onset in early adulthood, only age and duration distinguished those with, or without, microalbuminuria. Analysis of microalbuminuria, taking into account diabetes therapy and other clinical and demographic data, may provide clues to the pathophysiology of renal disease in diabetes mellitus.

Albuminuria↗