Hospital Room Lighting May Worsen Your Mood and Pain.


Story at-a-glance

  • Hospital patients are exposed to insufficient levels of light, disrupting both their circadian rhythms and sleep cycles
  • Light-deprived patients had fragmented and low levels of sleep, and those with the lowest exposures to light during the day reported more depressed mood and fatigue
  • Inadequate bright-light exposure has a far-reaching impact on your most critical bodily functions, including your ability to heal
  • Exposure to night-time light may also hinder the production of the hormone melatonin, which is very important for immune health
  • If you or a loved one is confined to a hospital room, move to areas with brighter natural light as much as possible, or bring in some full-spectrum light bulbs, and wear an eye mask at night to block night-time artificial light exposures

Hopefully you have never spent much time in a hospital, but if you have you likely experienced frequent disruptions to your sleep.

Aside from the beeping machines and nightly checks from hospital staff, your room was probably dimly lit with artificial light both day and night — a major impediment to proper sleep and well-being.

As a new study in the Journal of Advanced Nursing1 revealed, the lighting in many hospital rooms may be so bad that it actually worsens patients’ sleep, mood and pain levels.

Hospital-Room Lighting May Lead to Disrupted Sleep Cycles, Increased Pain and Fatigue

The study found that, on average, hospital patients in the study were exposed to about 105 lux (a measure of light emission) daily. This is a very low level of light; for comparison, an office would generally provide about 500 lux and being outdoors on a sunny day could provide 100,000 lux.2

The rooms were so dimly lit that many hospital patients had trouble sleeping. Your body requires a minimum of 1,500 lux for 15 minutes a day just to maintain a normal sleep-wake cycle, but ideally it should be closer to 4,000 for healthful sleep.3

Not surprisingly, the researchers found that the patients’ sleep time was “fragmented and low,” with most averaging just four hours of sleep a night.

Those with the lowest exposures to light during the day also reported more depressed mood and fatigue than those exposed to more light. The researchers noted:4 “Low light exposure significantly predicted fatigue and total mood disturbance.”

Why You Need Exposure to Bright Light During the Day

When full-spectrum light enters your eyes, it not only goes to your visual centers enabling you to see, it also goes to your brain’s hypothalamus where it affects your entire body.

Your hypothalamus controls body temperature, hunger and thirst, water balance and blood pressure. Additionally, it controls your body’s master gland, the pituitary, which secretes many essential hormones, including those that influence your mood.

Exposure to full-spectrum lighting is actually one effective therapy used for treating depression, infection, and much more – so it’s not surprising that hospital patients deprived of such exposures had poorer moods and fatigue.

Studies have also shown that poor lighting in the workplace triggers headaches, stress, fatigue and strained watery eyes, not to mention inferior work production.

Conversely, companies that have switched to full-spectrum lights report improved employee morale, greater productivity, reduced errors and decreased absenteeism. Some experts even believe that “malillumination” is to light what malnutrition is to food.

In a hospital setting, this has serious ramifications, as patients are already under profound stress due to illness and may be further stressed by a lack of natural bright light.

Your ‘body clock’ is also housed in tiny centers located in your hypothalamus, controlling your body’s circadian rhythm. This light-sensitive rhythm is dependent on Mother Nature, with its natural cycles of light and darkness, to function optimally.

Consequently, anything that disrupts these rhythms, like inadequate sunlight exposure to your body (including your eyes), has a far-reaching impact on your body’s ability to function and, certainly, also on its ability to heal.

Nighttime Light Exposure is Also Detrimental

While the featured study didn’t focus specifically on hospital patients’ nighttime light exposures, they’re likely to be significant. Most hospital room doors remain ajar all night, allowing artificial light from the hall to flood the room. There are also lights on medical equipment and monitors, and if your room is not private you may also be exposed to light from a roommates’ television or bathroom trips.

This is important because just as your body requires bright-light exposure during the day, it requires pitch-blackness at night to function optimally – which is all the more critical in the case of a hospital stay when bodily self-healing is most needed.

When you turn on a light at night, you immediately send your brain misinformation about the light-dark cycle. The only thing your brain interprets light to be is day. Believing daytime has arrived, your biological clock instructs your pineal gland to immediately cease its production of the hormone melatonin – a significant blow to your health, especially if you’re ill, as melatonin produces a number of health benefits in terms of your immune system. It’s a powerful antioxidant and free radical scavenger that helps combat inflammation.

In fact, melatonin is so integral to your immune system that a lack of it causes your thymus gland, a critically important part of your immune system, to atrophy.5 In addition, melatonin helps you fall asleep and bestows a feeling of overall comfort and well being, and it has proven to have an impressive array of anti-cancer benefits.6 So unnaturally suppressing this essential hormone is the last thing that a recovering hospital patient needs.

If a Loved One is In the Hospital, Let the Daylight Shine In

The best way to get exposure to healthy full-spectrum light is to do it the way nature intended, by going out in the sun with your bare skin – and ‘bare’ eyes — exposed on a regular basis. If you or a loved one is confined to a hospital room, however, the next best option is to move to areas with brighter natural light as much as possible, or alternatively bring in some full-spectrum light bulbs.

At night, the opposite holds true. You should turn off lights as much as possible, keep the door closed and close the blinds on the window. Wearing an eye mask is another simple trick that can help to keep unwanted light exposures to a minimum if you’re spending the night in a hospital. Taken together, these are simple ways to boost mood and improve sleep and fatigue levels among hospitalized patients.

The Other Major Risk of Spending Time in a Hospital

No matter how important it is, poor lighting may be the least of your worries if you find yourself hospitalized, as once you’re hospitalized you’re immediately at risk for medical errors, which is actually a leading cause of death in the US. According to the most recent research7 into the cost of medical mistakes in terms of lives lost, 210,000 Americans are killed by preventable hospital errors each year.

When deaths related to diagnostic errors, errors of omission, and failure to follow guidelines are included, the number skyrockets to an estimated 440,000 preventable hospital deaths each year!

One of the best safeguards is to have someone there with you. Dr. Andrew Saul has written an entire book on the issue of safeguarding your health while hospitalized. Frequently, you’re going to be relatively debilitated, especially post-op when you’re under the influence of anesthesia, and you won’t have the opportunity to see clearly the types of processes that are going on.

For every medication given in the hospital, ask, “What is this medication? What is it for? What’s the dose?” Take notes. Ask questions. Building a relationship with the nurses can go a long way. Also, when they realize they’re going to be questioned, they’re more likely to go through that extra step of due diligence to make sure they’re getting it right—that’s human nature. Of course, knowing how to prevent disease so you can avoid hospitals in the first place is clearly your best bet. One of the best strategies on that end is to optimize your diet. You can get up to speed on that by reviewing my comprehensive Nutrition Plan.

It’s Important for Virtually Everyone to Optimize Light Exposure: 5 Top Tips

Getting back to the issue of lighting, this isn’t only an issue for hospital patients. Virtually everyone requires exposure to bright light during the day and darkness at night for optimal health. Toward that end, here are my top tips to optimize your light exposure on a daily (and nightly) basis:

1.    Get some sun in the morning, if possible. Your circadian system needs bright light to reset itself. Ten to 15 minutes of morning sunlight will send a strong message to your internal clock that day has arrived, making it less likely to be confused by weaker light signals during the night. More sunlight exposure is required as you age.

2.    Make sure you get BRIGHT sun exposure regularly. Remember, your pineal gland produces melatonin roughly in approximation to the contrast of bright sun exposure in the day and complete darkness at night. If you work indoors, make a point to get outdoors during your breaks.

3.    Avoid watching TV or using your computer in the evening, at least an hour or so before going to bed.These devices emit blue light, which tricks your brain into thinking it’s still daytime. Normally your brain starts secreting melatonin between 9 and 10 pm, and these devices emit light that may stifle that process.

4.    Sleep in complete darkness, or as close to it as possible. Even the slightest bit of light in your bedroom can disrupt your biological clock and your pineal gland’s melatonin production. This means that even the tiny glow from your clock radio could be interfering with your sleep, so cover your alarm clock up at night or get rid of it altogether. You may want to cover your windows with drapes or blackout shades, or wear an eye mask while you sleep.

5.    Install a low-wattage yellow, orange or red light bulb if you need a source of light for navigation at night.Light in these bandwidths does not shut down melatonin production in the way that white and blue bandwidth light does. Salt lamps are handy for this purpose.

 

 

 

 

Diverse Sources of C. difficile Infection Identified on Whole-Genome Sequencing.


BACKGROUND

It has been thought that Clostridium difficile infection is transmitted predominantly within health care settings. However, endemic spread has hampered identification of precise sources of infection and the assessment of the efficacy of interventions.

METHODS

From September 2007 through March 2011, we performed whole-genome sequencing on isolates obtained from all symptomatic patients with C. difficile infection identified in health care settings or in the community in Oxfordshire, United Kingdom. We compared single-nucleotide variants (SNVs) between the isolates, using C. difficileevolution rates estimated on the basis of the first and last samples obtained from each of 145 patients, with 0 to 2 SNVs expected between transmitted isolates obtained less than 124 days apart, on the basis of a 95% prediction interval. We then identified plausible epidemiologic links among genetically related cases from data on hospital admissions and community location.

RESULTS

Of 1250 C. difficile cases that were evaluated, 1223 (98%) were successfully sequenced. In a comparison of 957 samples obtained from April 2008 through March 2011 with those obtained from September 2007 onward, a total of 333 isolates (35%) had no more than 2 SNVs from at least 1 earlier case, and 428 isolates (45%) had more than 10 SNVs from all previous cases. Reductions in incidence over time were similar in the two groups, a finding that suggests an effect of interventions targeting the transition from exposure to disease. Of the 333 patients with no more than 2 SNVs (consistent with transmission), 126 patients (38%) had close hospital contact with another patient, and 120 patients (36%) had no hospital or community contact with another patient. Distinct subtypes of infection continued to be identified throughout the study, which suggests a considerable reservoir of C. difficile.

CONCLUSIONS

Over a 3-year period, 45% of C. difficile cases in Oxfordshire were genetically distinct from all previous cases. Genetically diverse sources, in addition to symptomatic patients, play a major part in C. difficiletransmission.

Source: NEJM

 

Children’s hospital installs pirate-themed CT-scanner to make medical test a little less scary.


A New York children’s hospital recently purchased a a pirate-themed CT scanner to make the medical tests less of a ‘horrible, scary chore’. 

Child patients lay down on a mock plank which then slides into the scanner, a hoop in the shape of a ship’s wheel. Swash-buckling pirate animals decorate the walls to distract the children from the test.

GE provided the scanner to New York-Presbyterian Morgan Stanley Children’s Hospital, and gave the hospital two choices for a child theme – fish or pirates – sparking a heated debate among the staff. 

An exam adventure: A new CT scanner at a New York City children's hospital helps distract patients from the stressful test

An exam adventure: A new CT scanner at a New York City children’s hospital helps distract patients from the stressful test

Tough choice: The hospital was given two choices for a children's scanner by manufacturer GE, either pirates or fish

Tough choice: The hospital was given two choices for a children’s scanner by manufacturer GE, either pirates or fish

Dr Carrie Ruzal-Shapiro, the hospital’s chief of pediatric radiology, said the pirates won out because they ‘were cute’ and the scanner was installed in August.

And so far the reaction has been positive. Registered nurse Naomi Hawkins told Buzzfeed that the best response she’s gotten is a patient saying: ‘Hurry up and get out so I can play’.

Although the test only lasts a minute, it takes about 10 to 15 minutes to get children prepared for the test, which can be stressful. 

‘It allows children to imagine all sorts of things,’ Dr Ruzal-Shapiro told the New York Daily News. ‘So it doesn’t seem like a horrible scary chore.’

Decision: Dr Carrie Ruzal-Shapiro, head of the pediatric radiology department, said they chose the pirates because they were cute

Decision: Dr Carrie Ruzal-Shapiro, head of the pediatric radiology department, said they chose the pirates because they were cute

Not so bad: Dr Ruzal Shapiro said the decor helps make the test a little less of a 'horrible, scary chore'

Not so bad: Dr Ruzal Shapiro said the decor helps make the test a little less of a ‘horrible, scary chore’

Prep: The test only takes a minute, but around 10 to 15 minutes to prepare patients for

Prep: The test only takes a minute, but around 10 to 15 minutes to prepare patients for

Procedure: Patients are set up on the table which resembles a plank and are then pushed into scanner in the shape of a ship's wheel

Procedure: Patients are set up on the table which resembles a plank and are then pushed into scanner in the shape of a ship’s wheel

Before the test, nurses get kids settled onto the table and hooked up to an IV. The room’s decor helps kids take their mind off the IV and the anxiety of the test.

The children being scanned could be dealing with something as serious as cancer to checking on bone fractures.

The hospital’s radiology department conducts about five to 10 scans in the room every day, on patients ranging from infants to 21-year-olds. 

‘The teens roll their eyes at the cat with the eye-patch and the hippo mermaid,’ Dr Ruzal-Shapiro said. ‘But they like it as much as the kids.’

Entertained: Imagery of swash-buckling animals like monkeys and tigers adorn the walls to give patients something to look at

Entertained: Imagery of swash-buckling animals like monkeys and tigers adorn the walls to give patients something to look at

Patients: The hospital performs between five and 10 scans a day on patients as young as infants and as old as 21

Patients: The hospital performs between five and 10 scans a day on patients as young as infants and as old as 21

Different issues: Those getting scanned could be dealing with something as serious as cancer or just a fractured bone

Different issues: Those getting scanned could be dealing with something as serious as cancer or just a fractured bone

Never too old: While teens roll their eyes at the decorations, Dr Ruzal-Shapiro says that they like it just as much as the younger ones

Never too old: While teens roll their eyes at the decorations, Dr Ruzal-Shapiro says that they like it just as much as the younger ones

Source: Daily Mail.

Specialized Care Didn’t Affect Healthcare Use Among Confused Hospitalized EldersBut patients were happier, and their families were satisfied with their care..


 

 
Some hospitals have specialized units to care for older, cognitively impaired patients, but whether such units improve outcomes is unclear. In this randomized trial, investigators compared care in a specialized unit versus standard care (geriatric or general medical wards) in 600 patients (median age, 85) identified as “confused” on admission to a large U.K. hospital. Specialized unit staff were skilled in managing patients with delirium and dementia, and specialized care included regular psychiatrist visits, organized activities, a physical environment tailored to patients with cognitive impairment, and proactive involvement of family caregivers.

After adjusting for multiple variables, investigators found no significant differences between patients randomized to specialized care and those randomized to standard care in days spent at home during 90 days after randomization (51 and 45 days) or in median length of hospital stay (11 days in both groups). Rates of return home from the hospital, in-hospital mortality, 90-day survival, hospital readmission, and nursing home placement also were similar. However, specialized-unit patients were significantly more likely than standard-care patients to be in a positive mood (79% vs. 68%), and their family caregivers were significantly more likely to be satisfied with their care (91% vs. 83%).

COMMENT

In this trial, confused elders admitted to a specialized unit did not have superior healthcare-use outcomes or longer survival than those admitted to geriatric or general medical wards. Although patient mood and family caregivers’ satisfaction favored specialized care over standard care, the absolute differences were small. Based on these findings, justifying the costs associated with such specialized units would be difficult.

Source: NEJM

 

Prevalence of Polypharmacy Exposure Among Hospitalized Children in the United States.


ABSTRACT

Objective  To assess the prevalence and patterns of exposure to drugs and therapeutic agents among hospitalized pediatric patients.

Design  Retrospective cohort study.

Setting  A total of 411 general hospitals and 52 children’s hospitals throughout the United States.

Patients  A total of 587 427 patients younger than 18 years, excluding healthy newborns, hospitalized in 2006, representing one-fifth of all pediatric admissions in the United States.

Main Outcome Measures  Daily and cumulative exposure to drugs and therapeutic agents.

Results  The most common exposures varied by patient age and by hospital type, with acetaminophen, albuterol, various antibiotics, fentanyl, heparin, ibuprofen, morphine, ondansetron, propofol, and ranitidine being among the most prevalent exposures. A considerable fraction of patients were exposed to numerous medications: in children’s hospitals, on the first day of hospitalization, patients younger than 1 year at the 90th percentile of daily exposure to distinct medications received 11 drugs, and patients 1 year or older received 13 drugs; in general hospitals, 8 and 12 drugs, respectively. By hospital day 7, in children’s hospitals, patients younger than 1 year at the 90th percentile of cumulative exposure to distinct distinct medications had received 29 drugs, and patients 1 year or older had received 35; in general hospitals, 22 and 28 drugs, respectively. Patients with less common conditions were more likely to be exposed to more drugs (P = .001).

Conclusion  A large fraction of hospitalized pediatric patients are exposed to substantial polypharmacy, especially patients with rare conditions.

In the United States, for persons young and old, exposure to medications is essentially universal.1Over the past decade, the relatively neglected area of pediatric drug effectiveness and safety has received increasing attention. The 2002 Best Pharmaceuticals for Children Act (BPCA),2 building on the 1997 US Food and Drug Administration Modernization Act,3– 4 set forth the goal of reducing pharmaceutical errors in the dispensing of drugs to hospitalized children. In the hospital setting, the efficacy and safety of many pediatric medications have not been well established5; much of the use of medications is for off-label indications6; and medication errors occur.5,7– 10 Both the BPCA and the complementary Pediatric Research Equity Act of 200311 have underscored the need for pediatric studies regarding both on- and off-label drug treatments12– 14 and for improvements in pediatric drug labeling.15– 16

To advance this agenda, we need to refine our knowledge of the overall patterns of pediatric inpatient drug and therapeutic agent use, including what drugs and therapeutic agents are used most commonly, the number of different drugs and therapeutic agents that hospitalized children receive, and potential differences in drug and therapeutic agent exposures across different types of hospitals. This knowledge, especially if based on population-level data, would enhance efforts to prioritize and design research studies regarding the effectiveness and safety of pediatric inpatient medications.17– 19

To address these objectives, we combined hospital medication use data from 2 large databases, the first of which comprises data exclusively from children’s hospitals while the second data set comprises data from mostly general hospitals; together these data sets represent approximately 19.9% of all pediatric inpatient hospitalizations in the United States. In this report, we examine drug and therapeutic agent use patterns among hospitalized pediatric patients (excluding healthy newborns) evident in the combined data, focusing on exposure to polypharmacy, which has been shown to be associated with an increased risk of adverse drug reactions in adult patients in intensive care units and other settings.20– 21

Source: JAMA

 

Hospital-Specific Risk Factors for Filter Fever.


High Variation Between Hospitals in Vena Cava Filter Use for Venous Thromboembolism

Importance: The extent to which vena cava filter (VCF) use varies between hospitals in the management of acute venous thromboembolism (VTE) is not clear.

Methods: We conducted a retrospective observational study that compared the frequency of VCF use among California hospitals from January 1, 2006, through December 31, 2010. Using administrative hospital discharge data, we followed explicit criteria to identify nontrauma patients with acute VTE, and determined the frequency of VCF placement in each of the hospitals that admitted more than 55 VTE patients. Multivariable hierarchical regression models to predict VCF use included important clinical and demographic variables as fixed effects and hospital as a random effect.

Results: Among the 263 hospitals included, 130 643 acute VTE hospitalizations occurred with the placement of 19 537 VCFs (14.95%). Variation in the percentage of acute VTE hospitalizations that included VCF placement was very high, from 0% to 38.96% (interquartile range, 6.23%-18.14%), with 18.49% of the observed variation due to differences among the hospitals that provided care. Significant clinical predictors of VCF use included acute bleeding at the time of admission (odds ratio, 3.4 [95% CI, 3.2-3.6]), a major operation after admission for VTE (3.4 [3.3-3.5]), presence of metastatic cancer (1.7 [1.6-1.8]), and extreme severity of illness (2.5 [2.3-2.7] vs mild). Insertion of VCFs occurred more frequently than expected in 109 hospitals and less frequently in 59. Hospital characteristics associated with VCF use included a small number of beds (odds ratio, 0.2 [95% CI, 0.2-0.4], <100 vs >400 beds), a rural location (0.4 [0.2-0.5]), and other private vs Kaiser hospitals (1.5 [1.1-2.0]). Use of VCFs varied widely even in geographically proximate areas.

Conclusions and Relevance: The frequency of VCF use in patients with acute VTE varied widely and depended on which hospital provided the care, even after adjusting for clinical and socioeconomic factors. Further research is needed to determine whether this variation is associated with local cultural differences between hospitals or with differences in the availability of interventional radiologists or specialists, or whether it reflects the absence of high-quality evidence that VCFs are effective.

Source: JAMA

 

When It Comes to Stroke Treatment, Just 15 Minutes Can Make a Difference.


In patients with acute ischemic stroke, even small reductions in the time to thrombolytic therapy are associated with improved outcomes, according to a study in JAMA.

Using a national stroke registry, U.S. researchers examined outcomes among some 58,000 patients, at nearly 1400 hospitals, who received intravenous tissue plasminogen activator (tPA) within 4.5 hours after symptom onset. They found that with each 15-minute decrease in time to tPA therapy, patients were significantly less likely to die in the hospital or experience intracranial hemorrhage (odds ratio for each, 0.96). In addition, each 15-minute reduction was significantly associated with a greater likelihood to walk independently at discharge (OR, 1.04) and to be discharged home (OR, 1.03).

“These findings support intensive efforts to accelerate hospital presentation and thrombolytic treatment in patients with stroke,” the researchers conclude.

Source: JAMA

Intravenous or nebulised magnesium sulphate versus standard therapy for severe acute asthma (3Mg trial): a double-blind, randomised controlled trial.


Background

Previous studies suggested intravenous or nebulised magnesium sulphate (MgSO4) might improve respiratory function in patients with acute asthma. We aimed to determine whether intravenous or nebulised MgSO4 improve symptoms of breathlessness and reduce the need for hospital admission in adults with severe acute asthma.

Methods

In our double-blind, placebo-controlled trial, we enrolled adults (aged ≥16 years) with severe acute asthma at emergency departments of 34 hospitals in the UK. We excluded patients with life-threatening features or contraindication to study drugs. We used a central randomisation system to allocate participants to intravenous MgSO4 (2 g in 20 min) or nebulised MgSO4 (three 500 mg doses in 1 h) alongside standard therapy including salbutamol, or placebo control plus standard therapy alone. We assessed two primary outcome measures in all eligible participants who started treatment, according to assigned treatment group: the proportion of patients admitted to hospital within 7 days and breathlessness measured on a 100 mm visual analogue scale (VAS) in the 2 h after initiation of treatment. We adjusted for multiple testing using Simes’s method. The trial stopped before recruitment was completed because funding expired. This study is registered, number ISRCTN04417063.

Findings

Between July 30, 2008, and June 30, 2012, we recruited 1109 (92%) of 1200 patients proposed by the power calculation. 261 (79%) of 332 patients allocated nebulised MgSO4 were admitted to hospital before 7 days, as were 285 (72%) of 394 patients allocated intravenous MgSO4 and 281 (78%) of 358 controls. Breathlessness was assessed in 296 (89%) patients allocated nebulised MgSO4, 357 (91%) patients allocated intravenous MgSO4, and 323 (90%) controls. Rates of hospital admission did not differ between patients treated with either form of MgSO4 compared with controls or between those treated with nebulised MgSO4 and intravenous MgSO4. Change in VAS breathlessness did not differ between active treatments and control, but change in VAS was greater for patients in the intravenous MgSO4 group than it was in the nebulised MgSO4 group (5·1 mm, 0·8 to 9·4; p=0·019). Intravenous or nebulised MgSO4 did not significantly decrease rates of hospital admission and breathlessness compared with placebo: intravenous MgSO4 was associated with an odds ratio of 0·73 (95% CI 0·51 to 1·04; p=0·083) for hospital admission and a change in VAS breathlessness of 2·6 mm (—1·6 to 6·8; p=0·231) compared with placebo; nebulised MgSO4 was associated with an odds ratio of 0·96 (0·65 to 1·40; p=0·819) for hospital admission and a change in VAS breathlessness of −2·6 mm (—7·0 to 1·8; p=0·253) compared with placebo.

Source: lancet

 

 

Majority of children readmitted to hospital following transplant.


Nearly two-thirds of children receiving stem cell transplants returned to the hospital within six months for treatment of unexplained fevers, infections or other problems, according to a study performed at Dana-Farber/Children’s Hospital Cancer Center in Boston. Children who received donor cells were twice as likely to be readmitted as children who received their own stem cells.

“No one had ever looked at these data in children,” said Leslie E. Lehmann, MD, clinical director of pediatric stem cell transplantation at Dana-Farber/Children’s Hospital Cancer Center (DF/CHCC). “This is very important information and will allow us to counsel families appropriately, as well as try to devise interventions that reduce the rate of readmissions.”

The study by Lehmann and Harvard Medical School student David Shulman is being presented at the 26th annual meeting of the American Society of Pediatric Hematology Oncology in Miami, April 24-27.

A record review of 129 children from 2008 to 2011 revealed that 64 percent had at least one hospital readmission within 180 days of transplant. The source of the donor cells was a key predictor: 79 percent of patients receiving transplants from a related or unrelated donor were readmitted compared to 38 percent who received their own cells (autologous transplant). The mean number of readmissions was 2.4, indicating that for some children, discharge after transplant is just the beginning of a long process characterized by repeated hospital stays.

Fever without a documented source of infection accounted for 39 percent of the readmissions; 24 percent were for infections and 15 percent for gastrointestinal problems.

“Most of the patients went on to be successfully treated and ultimately did very well,” commented Lehmann.

“We hope these findings can eventually lead to identifying a group of low-risk children who could be managed at local hospitals rather than transplant centers, reducing costs and inconvenience to families.”

Lehmann said the goal is to identify which patients could be safely treated without requiring an admission to the hospital.

Source: Dana-Farber/Children’s Hospital Cancer Center

 

Featured in Journal Watch: More Studies from the San Francisco Cardiology Sessions.


Journal Watch Cardiology summarizes three New England Journal of Medicine studies that were presented at the American College of Cardiology conference:

Nonemergency PCI seems safe to perform at hospitals without on-site cardiac surgery facilities, according to a randomized study that included some 3700 patients. Three fourths underwent PCI at hospitals without on-site cardiac surgery, and the rest were transferred to hospitals with on-site facilities. The rate of a composite outcome (death, MI, repeat revascularization, or stroke) did not differ between the groups at either 30 days or 12 months.

In two studies of relatively high-risk patients undergoing CABG, use or nonuse of cardiopulmonary bypass had no significant effect on the rate of composite outcomes that included death, MI, stroke, repeat revascularization, or renal failure. Joel M. Gore comments that the choice regarding cardiopulmonary bypass “thus depends chiefly on operator expertise and individual patient characteristics and preferences.”

Source: Journal Watch Cardiology