Search

Hospital readmissions with 30 days after vascular surgical interventions have been associated with increased morbidity, mortality, and cost. Readmission rates, now a Centers for Medicare and Medicaid Services quality measure, have been studied in databases that have excluded certain payer types and states and have not accounted for readmission to a hospital different from that of the index admission. More accurate and nationally representative data are needed, because this fragmentation of care could lead to flawed conclusions. The purpose of the present study was to examine the incidence and risk factors for readmission to a nonindex hospital for patients admitted for claudication or critical limb ischemia (CLI). We also examined how this disruption of patient care affects mortality. The 2013 to 2014 Nationwide Readmissions Database was queried for all patients admitted for claudication or CLI who had undergone angioplasty, lower extremity bypass, or aortobifemoral bypass. The outcomes of interest were 30- and 365-day readmission rates to any hospital, 30- and 365-day readmission rates to a nonindex hospital, and mortality rates. Multivariable logistic regression was used to identify risk factors for readmission to a nonindex hospital. The most common readmission diagnoses and diagnosis-related groups were identified. A total of 92,769 patients had been admitted with peripheral vascular disease (33,055 with claudication and 59,714 with CLI). The 30- and 365-day readmission rate was 8.97% and 21.49% and 19.26% and 40.36%, for claudication and CLI, respectively. Of the 30- and 365-day readmissions, 20.47% and 24.92% had occurred at a nonindex hospital, respectively. Significantly higher mortality rates were found for patients with 30- or 365-day readmissions to different hospitals (odds ratio, 1.4 and 1.8, respectively). Multivariable analysis revealed that procedural indication and angioplasty are not significant risk factors for readmission to a different hospital. However, female sex, length of stay >7 days, and Charlson Comorbidity Index >3 remained significant risk factors for nonindex readmissions. The most common disease groups for nonindex readmission were "septicemia and disseminated infections" (6.5%), "heart failure" (6.4%), "other vascular procedures" (6.1%), and "amputation of lower limb except toes" (4.0%). Previously unreported, ≥1 in 4 readmissions after lower extremity vascular procedures for peripheral vascular disease will occur at a nonindex hospital. This fragmentation of care is associated with increased mortality and has serious implications for guiding outcome and quality measures. With a sizeable portion of patients missed by current metrics, concern exists that providers are using flawed data. Further study into social- and patient-specific risk factors might provide methods to prevent these readmissions and improve outcomes in this difficult patient population. [ABSTRACT FROM AUTHOR]

Sport played a .special role in the political system of the GDR and was used to achieve political goals, especially in terms of diplomacy. The aim of the article is to show examples of the instrumen-talization of sport in the GDR in the context of competition within the Eastern Bloc countries. In the light of the attitude of East German authorities to sport competition and the so-called sporting policy the study points to examples oof competition between athletes from the GDR and the Soviet Union and other satellite states. The premise of the article is to point to the reactions of the GDR authorities to the intra-system rivalry of athletes, as well as its political foundations and attempts at instrumentalization. Politically declared friendship and close political cooperation usually did not reflect real competition, which - especially in sport and contrary to propaganda slogans - was usually extremely ruthless and uncompromising. The text is based on the research of thematic German literature and supported by analysis and interpretation of published source materials and archival research. [ABSTRACT FROM AUTHOR]

The German Democratic Republic, despite limited economic and demographic opportunities, achieved an incredible success in sports, becoming in the second half of the 20th century a real sports superpower. Competition at the international level, especially the Olympic Games were arenas for the presentation of the country's supremacy in sport, on account of which it began to be called "Sportwunderland". The article attempts to identify the most important components of the sport success of the GDR - institutional structures and implementation of the achievements of science in sport, together with the pathological use of prohibited pharmacological assistance, as well as methods of acquiring and selecting outstanding sportspersons. In addition, the article provides an analysis of the situation of East German sport after the unification of Germany and discusses ways of dealing with the dark sides of its past. [ABSTRACT FROM AUTHOR]

The article presents the development of German States 'fleets in the 20th century. It shows their evolution over the last one hundred years. The author focuses on the evolution of the place and role of the German Fleet from the Imperial Navy up to the contemporary Deutsche Marine, which concentrates on performing the tasks of joint forces within NATO. It also shows GDR and FRG fleets during the division of Germany. Contemporary German fleet and the FRG's armed forces in general are rather modest compared to the economic capacities of today's Germany. This situation coincides with an atmosphere of increasing pacifism that permeates the German society. [ABSTRACT FROM AUTHOR]

This article follows up on a thorough review and analysis of Polish and German literature on the subject matter of national anthems. The aim of the author was to familiarize readers with the origins of national anthems of the major European countries, notably that of Germany. Throughout this paper, the main focus is the origins of the Deutschlandlied as well as other popular songs such as ''Heil Dir im Siegenkranz, ''Wacht Am Rhein", "Horst-Wessel-Lied" of the Nazi era and ''Auferstanden aus Ruinen'', the national anthem of the German Democratic Republic. [ABSTRACT FROM AUTHOR]

Twenty-five years after the fall of the Berlin Wall, GDR did not become a relic of the past nor was it dumped on the garbage heap of history. Contrary to widespread expectations, the ''state of workers and peasants'' is still by all means a current topic, as attested by numerous scholarly and journalistic publications, as well as by memory, whose scope oversteps the borders of former Eastern Germany and enters into the difficult and complex context of German-German history. According Jürgen Fuchs (1950-1999), who until the breakthrough of 1989/90 was considered to be one of the most important writers living in forced emigration in the FRG, memory played a key role in the struggle against the communist regime, and it was memory that became instrumental for him in the process of creating engaged literature. The article highlights the person and achievements of this engaged and critical writer, who used to ''tell what it was really like'', and therefore struggled against forgetfulness. His work dealt largely with the second German dictatorship, which he exposed among others by the description of facts, documentation of the surrounding reality, presentation of the mechanisms of totalitarian violence, rejection of the postulate of a ''thick line" that closes the past without settling accounts, and above all by disclosing the truth hidden in the Stasi files. [ABSTRACT FROM AUTHOR]

Patients with inflammatory bowel diseases (IBDs) have a high risk of venous thromboembolism (VTE). We assessed the timing and risk factors associated with readmission to the hospital for VTE among patients with IBD. We collected data from the Nationwide Readmissions Database on IBD index admissions resulting in readmission to the hospital for VTE within 60 days, from 2010 through 2014. We used univariable and multivariable regression to assess risk factors associated with VTE readmission with unadjusted risk ratio (RR) and adjusted RR (aRR) as measures of effect. Time to VTE readmission was assessed in 10-day intervals, for up to 90 days. We identified 872,122 index admissions of patients with IBD; 1160 resulted in readmission with VTE. More than 90% of readmissions occurred within 60 days of discharge from the index admission. Factors associated with hospital readmission with VTE included prior VTE, longer length of hospital stay, comorbidities, having a flexible sigmoidoscopy or colonoscopy at index admission, and age older than 18 years. Additional risk factors included Clostridium difficile infection at index admission (aRR, 1.47; 95% CI, 1.17–1.85) and discharge to a skilled nursing facility or intermediate care facility (aRR, 1.39; 95% CI, 1.14-1.70) or discharge with home health services (aRR, 1.65; 95% CI, 1.41–1.94). Among patients admitted to the hospital with IBD, most readmissions with VTE occur within 60 days of discharge. Readmission with VTE is associated with C difficile infection and discharge to a skilled nursing facility, intermediate care facility, or with home health services. Studies are needed to evaluate the potential benefit of extending VTE prophylaxis for patients admitted to the hospital with IBD for up to 2 months after discharge, to minimize risk. [ABSTRACT FROM AUTHOR]

Background & Aims Approximately 15%–40% patients with inflammatory bowel diseases (IBD) are obese. There is an inconsistent association between obesity and IBD phenotype and course. We conducted a nationally representative cohort study to estimate and compare the burden, costs, and causes for hospitalization in obese vs non-obese patients with IBD. Methods Using the Nationwide Readmissions Database 2013, we identified obese (based on administrative claims code) and non-obese patients who had been hospitalized at least once, from January through June 2013, and followed them for re-hospitalization until December 2013. We compared annual burden (total days spent in hospital), costs, causes, and outcomes of hospitalization between obese and non-obese patients after 1:1 propensity score matching. Results We identified 42,285 patients with IBD, of which 12.4% were obese. After propensity score matching, we included 5128 obese and 5128 non-obese IBD patients in our analysis. Compared to non-obese patients, obese patients spent more days in hospital annually (median, 8 vs 5 days) (P <.01), with higher hospitalization-related costs (median, $17,277 vs $11,847) (P <.01); this pattern persisted in subsets of high-need and high-cost patients. Compared to non-obese patients, obese patients were more likely to be hospitalized with preventable admissions (19% vs 15%) or cardiopulmonary complications (16% vs 12%). Conclusions In an analysis of data on patients with IBD from the Nationwide Readmissions Database 2013, we found obesity to be independently associated with higher burden and costs of hospitalizations. Strategies should be considered to target obesity as adjunctive therapy for patients with IBD. [ABSTRACT FROM AUTHOR]