CMAJ
News release embargoed until March 1, 2010
noon ET
Please credit CMAJ, not the Canadian Medical Association. CMAJ is an independent medical journal; views expressed here do not necessarily reflect those of its owner, the CMA.
Predicting early death or hospital readmission, breast lump aspiration, no more dithering on ehealth
CMAJ headlines:
- New tool to predict early death or hospital readmission
- A primer on aspirating breast lumps
- No more dithering on e-health – editorial
New tool to predict early death or hospital readmission
A new tool can help physicians predict the likelihood of death or readmission to hospital for patients within 30 days of discharge from hospital, according to a new study in CMAJ (Canadian Medical Association Journal).
The tool, called the LACE index, was developed by researchers at the Ottawa Hospital Research Institute, Institute for Clinical Evaluation Sciences, University of Toronto, University of Ottawa and University of Calgary. It was developed to help quantify the risk of early death or unplanned readmission after discharge from hospital to the community and can be useful in focusing post-discharge support on patients at highest risk of poor outcomes.
“We have derived and validated an easy-to-use index that is moderately discriminative and very accurate for predicting the risk of early death or unplanned readmission after discharge from hospital to the community,” write Dr. Carl Van Walraven, Ottawa Hospital Research Institute and coauthors.
The study followed 4812 patients admitted to 11 Ontario hospitals between October 2002 and July 2006. The participants were middle-aged, almost 95% were independent in daily living routines and most were free of comorbidities. None of the participants were residents of nursing homes. The most common reasons for hospitalization were acute coronary syndromes, cancer diagnoses and complications and heart failure.
During the first 30 days after discharge from hospital, 8% (385) patients died or were urgently readmitted. Of this number, 9.4% (36) died and 90.4% (349) had unplanned readmissions.
Key factors associated with these events were length of stay (“L”), acuity of admission (“A”), patient comorbidity (“C”) and number of visits to the emergency room (“E”). Called the LACE index for easy recall, the index has a potential score of 0 to 19. While easy to use, the system will be difficult to memorize and will need a computational aid.
“We believe that the LACE index can be used by clinicians, researchers and administrators to predict the risk of early death or unplanned readmission of cognitively intact medical or surgical patients after discharge from the hospital to the community,” they conclude. Further research is needed to determine if identifying the risk of poor death or readmissions changes patient care or outcomes.
MEDIA NOTE: Please use the following public links after the embargo lift:
http://www.cmaj.ca/cgi/doi/10.1503/cmaj.091117
Contact for research: Jenn Paterson, Director of Communications and Public Relations, Ottawa Hospital Research Institute, tel: 613 798-5555, ext. 73325, jpaterson{at}ohri.ca for Dr. Carl Van Walraven
A primer on aspirating breast lumps
A patient with a breast lump that has no features suggesting cancer should still be immediately evaluated, according to a primer for physicians in CMAJ (Canadian Medical Association Journal).
This article provides an “in office” approach for immediate evaluation of women who present to their family physician with a breast lump.
“As a family physician and a GP Oncologist who specializes in breast disease, I know how important it is to quickly evaluate breast lumps and reassure women who have benign cysts,” says author Dr. Ruth Heisey, Women’s College Hospital.
Aspiration, the removal of fluid with a needle, is a fast first approach for patients with a breast lump that does not have cancerous features. The fluid removed from the lump can determine the type of lesion. This procedure, which does not need an anesthetic, can be done in a doctor’s office on women who do not have breast implants and who are not on anticoagulants.
“Our suggested approach enables family physicians to follow the same evaluation pathway using needle aspiration to determine at that visit which women need referral for further investigation and which women may be reassured that their lump is benign,” write the authors.
The patient should have a follow-up if the lump is a cyst or referred for further tests or possible surgery if the lump is solid.
MEDIA NOTE: Please use the following public links after the embargo lift:
http://www.cmaj.ca/cgi/doi/10.1503/cmaj.090416
Media Contact: Jane Finlayson, Senior Public Affairs Advisor
Princess Margaret Hospital, University Health Network, tel: 416-946-2846
jane.finlayson{at}uhn.on.ca for Dr. Ruth Heisey
No more dithering on e-health
Editorial
Canada is lagging behind many countries in the use of electronic health records and it is critical that the country’s medical and political leaders set targets for universal adoption, states an editorial in CMAJ (Canadian Medical Association Journal).
While Canada has invested more than $1.6 billion in federal funds to develop integrated electronic health records, only 37% of general practitioners use electronic records compared with 97% in New Zealand and 95% in Australia.
Canada Health Infoway, the organization created to build a national infrastructure for electronic health records, has set a goal to have all health records “available” to their health care providers, although this does not mean that they will be used or compatible across the country.
“So after billions of dollars and nearly a decade of by Infoway and the provinces, Canada is well back of the electronic records pack,” write Dr. Paul Hebert, CMAJ Editor-in-Chief and coauthors Kimberlyn McGrail and Michael Law of the University of British Columbia.
The lack of electronic health records also threatens patient safety and the authors recommend mandating use of the system.
“Given the ongoing threats to patient safety, it is critical that our medical and political leaders set timely targets for the universal adoption of electronic health records for all professionals, especially in primary care, write the authors. “Unfortunately, mandating the use of electronic health records may be the only way to avoid long delays.”
Media contact: Kim Barnhardt, Senior Strategist, Communications and Partnerships, CMAJ, tel: 613-520-7116 x2224, kim.barnhardt{at}cmaj.ca or Alexandra Schlesiger, Alexandra.schlesiger{at}cmaj.ca, CMAJ, tel: 613-520-7116 x 2041
Also in the March 1 issue: Practice
Lactating male
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