Investigating the widely held belief that men and women with learning disabilities receive poor quality healthcare when admitted to hospital: a single-site study of 30-day readmission rates

BACKGROUND

This study aims to use 30-day readmission rates to investigate the presumption that men and women with learning disabilities (LDs, known internationally as intellectual disabilities) receive poorer quality hospital care than their non-disabled peers.

METHOD

A 12-month retrospective audit was conducted using Hospital Episode Statistics (HES) at a single acute hospital in the East of England. This identified all in-patient admissions; admissions where the person concerned was recognised as having a LD; and all emergency readmissions within 30 days of discharge. Additionally, the healthcare records of all patients identified as having a LD and readmitted within 30 days as a medical emergency were examined in order to determine whether or not these readmissions were potentially preventable.

RESULTS

Over the study period, a total of 66 870 adults were admitted as in-patients, among whom 7408 were readmitted as medical emergencies within 30 days of discharge: a readmission rate of 11%. Of these 66 870 patients, 256 were identified as having a LD, with 32 of them experiencing at least one emergency readmission within 30 days: a readmission rate of 13%. When examined, the healthcare records pertaining to these 32 patients who had a total of 39 unique 30-day readmissions revealed that 69% (n = 26) of these readmissions were potentially preventable.

CONCLUSION

Although overall readmission rates were similar for patients with LDs and those from the general population, patients with LDs had a much higher rate of potentially preventable readmissions when compared to a general population estimate from van Walraven et al. This suggests that there is still work to be done to ensure that this patient population receives hospital care that is both safe and of high quality.

In vitro self-assembly of human pericyte-supported endothelial microvessels in three-dimensional coculture: a simple model for interrogating endothelial-pericyte interactions

We describe a method for coculture of macro- or microvascular human endothelial cells (ECs) and pericytes (PCs) within a 3-dimensional (3-D) protein matrix resulting in lumenized EC cords invested by PCs. To prevent apoptotic cell death of ECs in 3-D culture, human umbilical vein or dermal microvascular ECs were transduced to express the antiapoptotic protein Bcl-2. To prevent PC-mediated gel contraction, the collagen-fibronectin gel was polymerized within a polyglycolic acid nonwoven matrix. Over the first 24-48 h, EC-only gels spontaneously formed cords that developed lumens via vacuolization; such vascular networks were maintained for up to 7 days. In EC-PC cocultures, PCs were recruited to the EC networks. PC investment of EC cords both limited the lumen diameter and increased the degree of vascular network arborization. Peg and socket junctions formed between ECs and PCs in this system, but dye transfer, indicative of gap junction formation, was not observed. This simple system can be used to analyze bidirectional signals between ECs and PCs in a 3-D geometry.

Direct optical-to-mechanical actuation

Performance data characterizing a direct optical activation device that operates either pneumatically or hydraulically are presented. This direct conversion device for optical signals offers immunity to electromagnetic interference and provides an alternative to electrooptic and electromechanical valves for actuation. The device uses a modified fluidic laminar proportional amplifier, employing laser induced deflection of the fluidic supply jet to perform the signal conversion. The pneumatic version operates at a supply pressure of 20.7 kPa having a gain of 15.5 kPa/W of optical power and a bandwidth of 140 Hz. The hydraulic version of the device operates with MIL-5606 hydraulic oil pressurized to a supply pressure of 1300 kPa. The hydraulic version has a gain of 170 kPa/W of input optical power and a bandwidth of 170 Hz. Experiments have determined that the laser induced deflection of the supply jet is a result of optical modulation of the fluid viscosity which creates an asymmetric jet flow.

Object motion compensation by speckle reference beam holography

A method is described for lessening the stringent vibration isolation requirements associated with conventional cw holography. This is accomplished by focusing a portion of the laser illuminating beam to a spot on the object, which then serves as a speckle reference beam for recording the object. In addition to the reduction of vibration isolation requirements, other features of the technique are as follows: Several holograms of the same scene, with different viewing directions, can be recorded simultaneously without additional reference beams, and vibration isolation requirements on the holographic plate are no greater than those associated with conventional photography. The method can also be used to determine relative phase between two points on a vibrating surface. In pulsed holography, the method can be used to eliminate residual fringes between recordings of pulsed holographic interferograms.