Background: hospital level healthcare in the home guided by comprehensive geriatric assessment (CGA) might provide a less costly alternative to hospitalisation for older people.
Objective: to determine the cost-effectiveness of CGA admission avoidance hospital at home (HAH) compared with hospital admission.
Design/intervention: a cost-effectiveness study alongside a randomised trial of CGA in an admission avoidance HAH setting, compared with admission to hospital.
Participants/setting: older people considered for a hospital admission in nine locations across the UK were randomised using a 2:1 randomisation schedule to admission avoidance HAH with CGA (N = 700), or admission to hospital with CGA when available (N = 355).
Measurements: quality adjusted life years, resource use and costs at baseline and 6 months; incremental cost-effectiveness ratios were calculated. The main analysis used complete cases.
Results: adjusting for baseline covariates, HAH was less costly than admission to hospital from a health and social care perspective (mean -£2,265, 95% CI: -4,279 to -252), and remained less costly with the addition of informal care costs (mean difference -£2,840, 95% CI: -5,495 to -185). There was no difference in quality adjusted survival. Using multiple imputation for missing data, the mean difference in health and social care costs widened to -£2,458 (95% CI: -4,977 to 61) and societal costs remained significantly lower (-£3,083, 95% CI: -5,880 to -287). There was little change to quality adjusted survival.
Conclusions: CGA HAH is a cost-effective alternative to admission to hospital for selected older people.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8753046 | PMC |
http://dx.doi.org/10.1093/ageing/afab220 | DOI Listing |
Eur Ann Allergy Clin Immunol
January 2025
Division of Allergy and Immunology, Department of Pediatrics, Marmara University, School of Medicine, Istanbul, Turkey.
Children with milk and egg allergies have outcomes in which, three-quarters are tolerant to baked forms of the allergenic food. Identifying predictors of tolerance to baked foods for IgE-mediated immediate-type reactions may guide the early introduction of baked allergens to diet and tolerance development. This study explores factors associated with early tolerance to baked foods.
View Article and Find Full Text PDFEur Eat Disord Rev
January 2025
ACUTE Center for Eating Disorders and Severe Malnutrition at Denver Health, Denver, Colorado, USA.
Objective: Refeeding oedema, believed to result from the effects of insulin on renal sodium retention and subsequent oedema formation, typically occurs during the first 2 weeks after reintroduction of nutrition in individuals with severe malnutrition and can intensify body image distress in patients with eating disorders (EDs). Phosphate supplements have been found to increase insulin sensitivity, and it is hypothesised that they may also contribute to refeeding oedema in patients with EDs.
Method: In this retrospective cohort study of 633 patients with severe malnutrition due to anorexia nervosa (AN) or avoidant restrictive food intake disorder (ARFID), the impact of phosphate supplementation on the rate of weight gain was investigated.
BMJ Open Qual
December 2024
Neurology Same Day Emergency Care, University College London Hospitals NHS Foundation Trust, London, UK.
There are various models for acute neurology services in the UK, with considerable variation in practice. Patients are often admitted unnecessarily for neurology review, leading to delay in diagnosis and treatment. Alternative models, such as the Neurology Same Day Emergency Care service (Neuro-SDEC) at University College London Hospital provide a pathway that can prevent admissions and streamline patient care.
View Article and Find Full Text PDFJ Med Case Rep
December 2024
Department of Internal Medicine, Woldia Comprehensive Specialized Hospital, Woldia, Ethiopia.
Introduction: Aluminum phosphide is a cheap and commonly used rodenticide that is also an effective solid fumigant and frequently used for grain preservation. The pill contains around 44% inert elements (ammonium carbonate) to avoid disintegration of the tablet, while the rest (about 56%) is aluminum phosphide. Because it is freely available on the market, it is one of the commonly used agents for self-poisoning in different parts of the developing world.
View Article and Find Full Text PDFCEN Case Rep
December 2024
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
Neuron-derived neurotrophic factor (NDNF) was discovered as a target antigen in membranous nephropathy (MN) caused by syphilis. However, there have been few reports of NDNF-positive MN in Japan. A 19-year-old female patient was admitted to our hospital with nephrotic syndrome and acute kidney injury.
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