Chronic obstructive pulmonary disease (COPD) accounts for a large number of hospital admissions and numerous interventions have attempted to reduce exacerbations requiring hospitalization. This paper describes the implementation of a community based COPD management programme led by a respiratory physiotherapist to improve home management of COPD and its effect on reducing readmissions and/or length of stay in hospital. One-hundred and twenty-five patients (median age 73) referred with COPD exacerbations met the criteria for the service; 95 received the intervention and data were available for 80. Median FEV1 was 0.86 L. Admission data, length of stay and total hospitalization days with COPD were compared for one year before and after the intervention. Overall there was no reduction in length of stay, admission frequency, or adjusted total hospitalization days with COPD, but median time interval to next exacerbation increased by 29%. In those who had had previous admissions (mean FEV1 0.58 L) total hospitalization days fell by 27%, length of stay fell by 58% despite an increase in admission frequency from one to two per year, and there was no change in median time interval to next hospitalized exacerbation. In our patients implementation of a Chronic Disease Management programme increased the time to next hospitalized exacerbation. Benefit was seen in the more severe patients however, with a significant reduction in both length of stay and total hospitalization days.

Background/Aims The aim of this study was to evaluate the association of fluid balance with outcomes in patients hospitalized with acute pancreatitis (AP). Methods This was a retrospective study of patients hospitalized between May 2008 and June 2016 with AP and a clinical order for strict recording of intake and output. Data collected included various types of fluid intake and output at 24 and 48 hours after admission. The primary outcome was length of stay (LOS). Analysis was performed using single-variable and multivariable negative binomial regression models. Results Of 1256 patients hospitalized for AP during the study period, only 71 patients (5.6%) had a clinical order for strict recording of intake and output. Increased urine output was associated with a decreased LOS at 24 and 48 hours in univariable analysis. An increasingly positive fluid balance (total intake minus urine output) at 24 hours was associated with a longer LOS in multivariable analysis. Conclusions Few patients hospitalized for AP had a documented order for strict monitoring of fluid intake and output, despite the importance of monitoring fluid balance in these patients. Our study suggests an association between urine output and fluid balance with LOS in AP.

Idiopathic intracranial hypertension (IIH) is a poorly understood phenomenon and its presentation can both mimic and co-exist with other intra-cranial processes. Accurate diagnosis is imperative as ongoing advancements in treatment can yield dramatic positive results. Here we present the case of an individual with signs and symptoms of obstructive hydrocephalus who was ultimately found to have IIH secondary to venous sinus stenosis. After correction of the venous sinus stenosis, resolution in the patient's symptoms was noted. The case highlights some of the unique considerations in approaching patients with IIH and provides a framework for review of current literature related to IIH and venous sinus stenosis.

Our findings suggest that in patients hospitalized with encephalopathy, serum electrolyte measurements are not strong predictors of patient outcome.