In Illinois, the incidence of invasive H. influenzae disease increased from 1996 to 2004, and its epidemiological characteristics changed from a disease predominantly found in children and dominated by serotype b to a disease predominantly found in adults and dominated by nontypeable strains.

Objective Evaluate utility of MR in diagnosing structural injury in primiparous women with pelvic floor injury risks. Methods Observational study of 77 women with 3T MR imaging after delivery. Women (n=45) were operationally defined as High Risk for levator ani muscle tears (2nd stage labor> 150 minutes, anal sphincter tear, forceps, age> 35, birth weight > 4000 grams) or Low Risk (n=32): vaginally delivered without these risk factors (n=12); delivered by cesarean after 2nd stage labor >150 minutes (n=14), and cesarean without labor (n=6). All women were imaged using MR fluid sensitive sequences. Two musculoskeletal radiologists reviewed images for bone marrow edema, fracture, pubic symphysis measurements, and levator ani tear. Results MR imaging showed pubic bone fractures in 38% of women at High Risk and 13% of at Low Risk for pelvic floor injury (χ2(3)= 9.27, p=0.03). Levator ani muscle tears were present in 44% of the High Risk and 9% of Low Risk women (X2(3)=11.57, p=0.010). Bone marrow edema in the pubic bones was present in 61% of women studied across delivery categories. Complex patterns of injury included combinations of bone marrow edema, fractures, levator ani tears and pubic symphysis injuries. No MR documented injuries were present in 18% of women at High Risk and 44% at Low Risk (χ2(1)=6.2, p=.013). Conclusions Criteria identifying primiparous women at risk for pelvic floor injury can predict increased risk of bone and soft tissues changes at the pubic symphysis. Fluid sensitive MR imaging has utility for differential diagnosis of structural injury in postpartum women.

BackgroundAs of October 1, 2012, hospitals in the United States with excess readmissions based on the Centers for Medicare and Medicaid Services (CMS) risk-adjusted ratio began being penalized. Given the impact of high readmission rates to hospitals nationally, it is important for individual hospitals to identify which patients may be at highest risk of readmission. The objective of this study was to assess the association of institution specific factors with 30-day readmission.MethodsThe study is a retrospective observational study using administrative data from January 1, 2009 through December 31, 2010 conducted at a 257 bed community hospital in Massachusetts. The patients included inpatient medical discharges from the hospitalist service with the primary diagnoses of congestive heart failure, pneumonia or chronic obstructive pulmonary disease. The outcome was 30-day readmission rates. After adjusting for known factors that impact readmission, provider associated factors (i.e. hours worked and census on the day of discharge) and hospital associated factors (i.e. floor of discharge, season) were compared.ResultsOver the study time period, there were 3774 discharges by hospitalists, with 637 30-day readmissions (17% readmission rate). By condition, readmission rates were 19.6% (448/2284) for congestive heart failure, 13.0% (141/1083) for pneumonia, and 14.7% (200/1358) for chronic obstructive lung disease. After adjusting for known risk factors (gender, age, length of stay, Elixhauser sum score, admission in the previous year, insurance, disposition, primary diagnosis), we found that patients discharged in the winter remained significantly more likely to be readmitted compared to the summer (OR 1.54, p = 0.0008). Patients discharged from the cardiac floor had a trend toward decreased readmission compared a medical/oncology floor (OR 0.85, p = 0.08). Hospitalist work flow factors (census and hours on the day of discharge) were not associated with readmission.ConclusionsWe found that 30 day hospital readmissions may be associated with institution specific risk factors, even after adjustment for patient factors. These institution specific risk factors may be targets for interventions to prevent readmissions.