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Barra ME, Giulietti JM, DiCarlo JA, Erler KS, Krenz J, Roberts RJ, Lin DJ. Medication Profiles at Hospital Discharge Predict Poor Outcomes After Acute Ischemic Stroke. J Pharm Pract 2024; 37:600-606. [PMID: 36604314 DOI: 10.1177/08971900221150282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives: To examine the relationship between medications prescribed during the first 6-months post-stroke and functional outcome. Materials and Methods: A retrospective analysis of ischemic stroke survivors enrolled in an observational stroke recovery study from June-2017 to July-2019 was performed. Survivors with favorable outcomes (modified rankin scale (mRS) score 0-2) were compared to those with unfavorable outcomes (mRS ≥3) 6-months after stroke on the following: discharge medication classes prescribed, achievement of recommended targets for blood pressure control, glycemic control, and LDL ≤70 mg/dL, medication changes, medication interactions, and medication list discrepancies. Results: Unfavorable 6-month outcomes occurred in 36/78 (46.2%) of survivors. Survivors with unfavorable outcomes were more likely to be prescribed a central nervous system-acting agent (97.2% vs 71.4%; P = .0022) and/or an anti-hyperglycemic agent (25.0% vs 9.5%; P = .009) at discharge. After adjustment of baseline covariates, total number of medications prescribed was associated with unfavorable 6-month outcomes (OR 1.13, 95% CI 1.0-1.28). Secondary stroke prevention measures were not achieved in a high proportion of survivors. Medication changes during 6-month follow up were common and survivors with unfavorable outcomes were more likely to have clinically significant drug-drug interactions. Discussion: At 6-months, survivors with unfavorable outcomes were found to be prescribed more medications, particularly central nervous system-acting and anti-hyperglycemic agents. There were also more drug-drug interactions in the medications prescribed compared to those with favorable outcomes. Together, these data suggest the need for enhanced screening of high-risk stroke survivors focused on close monitoring of polypharmacy, drug-drug interactions, and adverse events with pharmacotherapy.
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Affiliation(s)
- Megan E Barra
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer M Giulietti
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
- School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Julie A DiCarlo
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kimberly S Erler
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - James Krenz
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Russel J Roberts
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - David J Lin
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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2
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Kroshus E, Steiner MK, Chrisman SPD, Lion KC, Rivara F, Lowry SJ, Strelitz B, Klein EJ. Improving post-concussion discharge education for families seeking emergency department care: intervention development. Brain Inj 2024; 38:479-488. [PMID: 38441083 DOI: 10.1080/02699052.2024.2318595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 02/09/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Pediatric emergency departments (ED) are where many families receive post-concussion medical care and thus an important context for helping parents build skills to support their child after discharge. OBJECTIVE Develop a strategy for increasing parent provision of emotional and instrumental support to their child after discharge and conduct a pilot test of this strategy's acceptability. METHODS In a large pediatric ED in the United States, we partnered with parents (n = 15) and clinicians (n = 15) to understand needs and constraints related to discharge education and to operationalize a strategy to feasibly address these needs. This produced a brief daily text message intervention for parents for 10 days post-discharge. We used a sequential cohort design to assess the acceptability this intervention and its efficacy in changing parenting practices in the 2-weeks post-discharge (n = 98 parents). RESULTS Parents who received the messaging intervention rated it as highly acceptable and had meaningfully higher scores for emotionally supportive communication with their child in the two weeks post-discharge than parents in the control condition (Cohen's d = 0.65, p = 0.021). CONCLUSIONS This brief messaging intervention is a promising strategy for enhancing discharge education post-concussion that warrants further evaluation.
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Affiliation(s)
- Emily Kroshus
- Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Mary Kathleen Steiner
- Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, WA, USA
| | - Sara P D Chrisman
- Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - K Casey Lion
- Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Frederick Rivara
- Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Sarah J Lowry
- Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, WA, USA
| | - Bonnie Strelitz
- Seattle Children's Research Institute, Center for Clinical and Translational Research, Seattle, WA, USA
| | - Eileen J Klein
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Seattle Children's Research Institute, Center for Clinical and Translational Research, Seattle, WA, USA
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Demagny-Warmoes A, Grimbert Y, Bouchard S. [Meleis theory: a tool for better understanding city-hospital transitions]. Soins 2024; 69:60-63. [PMID: 38614524 DOI: 10.1016/j.soin.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/15/2024]
Abstract
Meleis' theory: a tool for better understanding the hospital/town transitions. The purpose of this article is to provide a critique of the transition theory conceptualized by Afaf Meleis. A clinical vignette is used to highlight the strengths and limitations of the theory in the care of elderly people returning home after hospitalization for heart failure. The discussion is based on Peggy Chinn and Maeona Kramer's method of critical analysis.
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Affiliation(s)
- Aurélie Demagny-Warmoes
- Institut de formation aux métiers de la santé, CHU de Valenciennes, 116 avenue Desandrouin, 59300 Valenciennes, France; Unité de recherche EA 3279 CEReSS, Aix-Marseille Université, 27 boulevard Jean-Moulin, 13385 Marseille cedex 05, France.
| | - Yannick Grimbert
- Institut de formation aux métiers de la santé, CHU de Valenciennes, 116 avenue Desandrouin, 59300 Valenciennes, France
| | - Suzanne Bouchard
- Université Laval, 2325 rue de l'Université, Québec, G1V 0A6, Canada
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Petersen M, Nordlund HL, Koreska M, Brødsgaard A. Bridging the gap between healthcare sectors: Facilitating the transition from NICU to the municipality and home for families with premature infants. J SPEC PEDIATR NURS 2024; 29:e12426. [PMID: 38615233 DOI: 10.1111/jspn.12426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/27/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE The transition from hospital to home can be challenging for parents of prematurely born infants. The aim of this ethnographic study was to describe a multidisciplinary and cross-sectoral discharge conference for families with premature infants transitioning from a neonatal intensive care unit to municipal healthcare services. DESIGN AND METHODS An ethnographically/anthropologically inspired qualitative design was adopted. We conducted four participant observations of multidisciplinary and cross-sectoral discharge conferences and 12 semistructured interviews with four neonatologists, four nurses, and four health visitors who had attended one of the conferences. Salient themes were generated by two-part analysis consisting of a thematic analysis followed by Turner's ritual analysis. RESULTS This study illustrated how multidisciplinary and cross-sectoral discharge conferences improved the quality of care for premature infants and their families in their transition process which was perceived as complex. These conferences contributed to promoting a sense of coherence and continuity of care. The healthcare professionals experienced that this event may be characterized as a ritual, which created structures that promoted cross-sectoral cooperation and communication while increasing interdisciplinary knowledge sharing. Thus, the conferences triggered a sense that the participants were building bridges to unite healthcare sectors, ensuring a holistic and coordinated approach to meet the unique needs of the infants and their families. IMPLICATIONS FOR PRACTICE This study presented a unique holistic and family-centered approach to constructing multidisciplinary and cross-sectoral discharge conferences that seemed to underpin the quality of interdisciplinary and health-related knowledge sharing and establish a crucial starting point for early interventions, preventive measures, and health-promoting efforts. Hopefully, our findings will encourage others to rethink the discharge conference as a transitional ritual that may potentially bridge the gap between healthcare sectors. Specifically, our findings contribute to the mounting body of knowledge of family-centered care by showing how healthcare professionals may-in a meaningful and tangible manner-operate, develop, and implement this somewhat elusive theoretical foundation in their clinical practice.
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Affiliation(s)
- Mette Petersen
- Department of Paediatric and Adolescent Medicine, Neonatal Intensive Care Unit, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark
| | | | - Mai Koreska
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark
| | - Anne Brødsgaard
- Department of Paediatric and Adolescent Medicine, Neonatal Intensive Care Unit, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Amager Hvidovre, Copenhagen, Denmark
- Department of Public Health, Nursing and Health Care, University of Aarhus, Aarhus, Denmark
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Affiliation(s)
- Paul S Chan
- Saint Luke's Mid-America Heart Institute, University of Missouri, Kansas City
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Trivedi A, Bhatti A, Patel B, Patel M. What's age got to do with it? A study of the implementation of the discharge medicines service for paediatric patients. Int J Pharm Pract 2024:riae012. [PMID: 38554121 DOI: 10.1093/ijpp/riae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 03/26/2024] [Indexed: 04/01/2024]
Abstract
OBJECTIVES The discharge medicines service (DMS) was introduced as an essential service for all community pharmacies in England through the Community Pharmacy Contractual Framework (CPCF) in February 2021. This study aimed to describe the implementation of this service for paediatric patients and to identify any barriers to referrals. METHODS The study was undertaken in a 24-bed paediatric ward in a District General Hospital from September 2022 to February 2023. All paediatric inpatients on long-term medications were eligible for inclusion. Out of 169 eligible participants, 149 were referred. Community pharmacists accessed referrals through PharmOutcomes® and could accept, complete, or reject referrals on this platform. KEY FINDINGS Of the 149 referred patients, 24 (16.1%) were accepted but not yet actioned; 63 (42.3%) were fully or partially completed; 19 (12.8%) were rejected, and 43 (28.9%) there was no response (remained as referred). Younger children (<2 years) were more likely to have their referral rejected than older children (6 years and older). The feedback from parents was overwhelmingly positive (93.5%) and two families reported that they believed the DMS service prevented readmission to the hospital for their children. No children were involved in the community pharmacist consultation. Barriers to referrals included patients not having a nominated pharmacy and a lack of confidence in completing paediatric referrals. CONCLUSIONS This study demonstrates the value of completing referrals for paediatric patients. More research is required to explore how community pharmacists can be supported to complete paediatric DMS referrals.
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Affiliation(s)
- Ashifa Trivedi
- Pharmacy Department, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UB8 3NN, UK
| | - Afaq Bhatti
- Pharmacy Department, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UB8 3NN, UK
| | - Bhavisha Patel
- Pharmacy Department, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UB8 3NN, UK
| | - Monica Patel
- Pharmacy Department, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UB8 3NN, UK
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Erni-Cassola G, Dolf R, Burkhardt-Holm P. Microplastics in the Water Column of the Rhine River Near Basel: 22 Months of Sampling. Environ Sci Technol 2024; 58:5491-5499. [PMID: 38478875 DOI: 10.1021/acs.est.3c08364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Measured microplastic concentrations in river surface waters fluctuate greatly. This variability is affected by season and is codriven by factors, such as sampling methodologies, sampling site, or sampling position within site. Unfortunately, most studies comprise single-instance measurements, whereas extended sampling periods are better suited to assessing the relevance of such factors. Moreover, microplastic concentrations in riverine water column remain underexplored. Similar to the oceans, however, this compartment likely holds significant amounts of microplastics. By representatively sampling the entire Rhine River cross-section near Basel through five sampling points over 22 months, we found a median microplastic (50-3000 μm) concentration of 4.48 n m-3, and estimated a widely ranging load between 4.04 × 102 n s-1 and 3.57 × 105 n s-1. We also show that the microplastic concentration in the water column was not well explained by river discharge. This suggests that although high discharge events as observed here can over short time periods lead to peak microplastic concentrations (e.g., 1.23 × 102 n m-3), microplastic load variance was not dominated by discharge in the study area.
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Affiliation(s)
- Gabriel Erni-Cassola
- Man-Society-Environment (Programme MGU), Department of Environmental Sciences, University of Basel, Vesalgasse 1, Basel CH-4051, Switzerland
| | - Reto Dolf
- Abteilung Umweltlabor, Amt für Umwelt und Energie, Department für Wirtschaft, Soziales und Umwelt des Kantons Basel-Stadt, Spiegelgasse 15, Basel CH-4001, Switzerland
| | - Patricia Burkhardt-Holm
- Man-Society-Environment (Programme MGU), Department of Environmental Sciences, University of Basel, Vesalgasse 1, Basel CH-4051, Switzerland
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Gaskin KL, Barron D, Wray J. Parents' Journeys of Mastery and Knowledge Construction After Their Infant's First Stage of Surgery for Complex Congenital Heart Disease. Compr Child Adolesc Nurs 2024; 47:68-81. [PMID: 38090784 DOI: 10.1080/24694193.2023.2293993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/05/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND A growing body of conceptual evidence over the last decade has increased our understanding of parents' experiences of having an infant with complex congenital heart disease. These concepts include parents' feelings of uncertainty, fear, excitement, and mastery. However, little is known about parents' experiences, confidence, and knowledge acquisition during transition from hospital to home with their infant after the first stage of complex cardiac surgery. A theoretical framework to assess, plan and implement child and family centered care would assist children's cardiac nurses responsible for parental education, discharge planning and coordination. AIM To explore parents' experiences of the transition from hospital to home with their infant, following the first stage of cardiac surgery. DESIGN A prospective mixed methods longitudinal design. Semi-structured interviews were undertaken, including administration of the Maternal Confidence Questionnaire at four timepoints: before discharge following stage one cardiac surgery (T0), 2 weeks' post discharge (T1), 8 weeks' post discharge (T2) and after stage two surgery (T3). Qualitative data were thematically analyzed. Descriptive statistics were used to characterize the sample and non-parametric repeated measures analysis of variance was used to analyze changes over time in maternal confidence scores. RESULTS Sixteen parents of 12 infants participated. Four "patterns of transition experience" emerged, the fourth "Mastery", is discussed in this paper. Mastery can be contextualized in terms of the parents' journeys of knowledge construction, gaining confidence and reflection. Learning was dynamic and transformational, but successful learning and acquisition of knowledge was also dependent upon the parents' ability to absorb, integrate and adjust at any given time. Confidence at T0 was significantly lower than at T1 (p = .011), T2 (p = .018) and T3 (p = .012). There were no significant differences between scores at T1, T2 and T3. Liminality, as a concept, described the between and betwixt time that parents experienced as they were preparing for discharge from hospital; excitement to be going home balanced with the fear of being alone and confidence in looking after their fragile infant. CONCLUSION Parents of infants with complex congenital heart disease obtain knowledge, confidence, and mastery dependent upon their transition experience and their personal journey through pre-liminal, liminal, and post-liminal phases of discharge from hospital to home. A conceptual framework "Parenting through Transitions - hospital to home" emerged that could assist in structuring assessment of parents' knowledge and support needs within a coordinated discharge process. Identifying individualized support would promote adaptation and adjustment during transition from the pre to post liminal phase, following their infant's first stage of complex cardiac surgery.
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Affiliation(s)
- Kerry L Gaskin
- Children's Cardiac Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham Children's Hospital, Birmingham, UK
- Three Counties School of Nursing and Midwifery, University of Worcester, Worcester, UK
| | - David Barron
- Children's Cardiac Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham Children's Hospital, Birmingham, UK
- Division Head Cardiac Surgery, Hospital for Sick Children, Toronto, Canada
- CIT Endowed Chair, Professor of Surgery, University of Toronto, Toronto, Canada
| | - Jo Wray
- Health Psychology, Heart and Lung Directorate, Great Ormond Street Hospital for Children, London, UK
- Heart and Lung Directorate, NIHR Great Ormond Street Biomedical Research Centre, London, UK
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Sánchez-Martínez MP, Crisostomo MJ, Martín-San Agustín R, Montilla-Herrador J, Escolar-Reina MP, Valera-Novella E, Medina-Mirapeix F. Determination of Five Sit-to-Stand Test Performance at Discharge of Stroke Patients. Diagnostics (Basel) 2024; 14:521. [PMID: 38472993 DOI: 10.3390/diagnostics14050521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
The early identification of performance in the five-repetition sit-to-stand test (5-STS) at discharge in stroke patients could be of interest because it can determine independence for community-based activities. This study aimed to determine whether the initial measurement of the 5-STS test can be a determinant of the performance level prediction and amount of change in the 5-STS test at discharge in stroke patients. A prospective cohort study was conducted with a sample of 56 patients aged ≤60 d post-stroke. The 5-STS test results, as well as changes in patient condition, were measured at admission (T0) to an outpatient rehabilitation program, after the first month (T1), and at discharge (T2). The mean age was 62.7 (SD = 13.0), 58.9% of the subjects were male, and 75% had suffered an ischemic stroke. A multivariate linear regression model using the 5-STS test at T0 explained 57.7% of the variance in the performance at discharge. Using the 5-STS at T1 increased the variance to 75.5% (p < 0.001). Only the time from stroke onset at T0 significantly contributed to the two models. The measurement of the 5-STS at T0 and the amount of change in its performance at T2 explained 60.2% (p < 0.001) of the variance, while reassessment at T1 explained only 19.3% (p < 0.001). The level of patient performance on the 5-STS test at discharge, as well as any potential change, can be predicted by the admission measure of 5-STS in stroke patients.
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Affiliation(s)
| | | | - Rodrigo Martín-San Agustín
- Clinimetry and Technological Development in Therapeutic Exercise Research Group (CLIDET), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | | | | | | | - Francesc Medina-Mirapeix
- Department of Physiotherapy, University of Murcia, 30100 Murcia, Spain
- Clinimetry and Technological Development in Therapeutic Exercise Research Group (CLIDET), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
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Fernando JMG, Marçal MMG, Ferreira ÓR, Oliveira C, Pedreira L, Baixinho CL. Nursing Interventions for Client and Family Training in the Proper Use of Noninvasive Ventilation in the Transition from Hospital to Community: A Scoping Review. Healthcare (Basel) 2024; 12:545. [PMID: 38470656 PMCID: PMC10930648 DOI: 10.3390/healthcare12050545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/17/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Noninvasive ventilation is an increasingly disseminated therapeutic option, which is explained by increases in the prevalence of chronic respiratory diseases, life expectancy, and the effectiveness of this type of respiratory support. This literature review observes that upon returning home after hospital discharge, there are difficulties in adhering to and maintaining this therapy. The aim of this study is to identify nursing interventions for client and family training in the proper use of noninvasive ventilation in the transition from hospital to community. A scoping review was carried out by searching MEDLINE, CINAHL, Scopus, and Web of Science. The articles were selected by two independent reviewers by applying the predefined eligibility criteria. Regarding transitional care, the authors opted to include studies about interventions to train clients and families during hospital stay, hospital discharge, transition from hospital to home, and the first 30 days after returning home. The eight included publications allowed for identification of interventions related to masks or interfaces, prevention of complications associated with noninvasive ventilation, leakage control, maintenance and cleaning of ventilators and accessories, respiratory training, ventilator monitoring, communication, and behavioral strategies as transitional care priority interventions to guarantee proper training in the transition from hospital to community.
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Affiliation(s)
| | - Margarida Maria Gaio Marçal
- Department of Fundamentals of Nursing, Escola Superior de Enfermagem de Lisboa, Nursing School of Lisbon, 1600-190 Lisbon, Portugal; (M.M.G.M.); (Ó.R.F.)
| | - Óscar Ramos Ferreira
- Department of Fundamentals of Nursing, Escola Superior de Enfermagem de Lisboa, Nursing School of Lisbon, 1600-190 Lisbon, Portugal; (M.M.G.M.); (Ó.R.F.)
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal
| | - Cleoneide Oliveira
- Medical School Estácio Idomed Quixadá, University Center Estacio do Cearà, Fortaleza 60035-111, Brazil;
| | - Larissa Pedreira
- Nursing School, Federal University of Bahia, Salvador 40170-110, Brazil;
| | - Cristina Lavareda Baixinho
- Department of Fundamentals of Nursing, Escola Superior de Enfermagem de Lisboa, Nursing School of Lisbon, 1600-190 Lisbon, Portugal; (M.M.G.M.); (Ó.R.F.)
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal
- Center of Innovative Care and Health Technology (ciTechCare), 2414-016 Leiria, Portugal
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11
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Noland E, Virtanen S, Klötz Logan F, Chang Z, Strandh M. Post- discharge pharmacological treatment discontinuation of forensic psychiatric patients in Sweden. Front Psychiatry 2024; 15:1342722. [PMID: 38404465 PMCID: PMC10884161 DOI: 10.3389/fpsyt.2024.1342722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Most forensic psychiatric patients have chronic psychiatric disorders that require long-term pharmacological treatment even after discharge from care. However, the prevalence and correlates of post-discharge medication discontinuation in this patient group remain unclear. Objective The aim of this study was to investigate the prevalence and correlates of post-discharge discontinuation of pharmacological treatment in forensic psychiatric patients in Sweden. Methods Data on individuals discharged from forensic psychiatric care between 2009 and 2018 (n = 1,142) with ongoing pharmacological treatment at the time of discharge (n = 856) were identified from the Swedish National Forensic Psychiatric Register. Cox regression models were used to estimate the association between patient characteristics and medication discontinuation. Results Of the 856 individuals with pharmacological treatment at discharge, 488 (57%) discontinued treatment within 2 years of discharge. Factors associated with an increased risk of treatment discontinuation varied between different types of psychotropic medications: the most important correlate was comorbidity between psychosis and personality disorder. Higher age at discharge, longer length of stay, having a history of several psychiatric care episodes, having a trustee, having a limited guardian, and a residing in a supported living accommodation at the time of discharge were associated with a decreased rate of medication discontinuation. This applied for antipsychotics, antidepressants, antiepileptics, and any psychotropic medication, but not for psychostimulants or drugs used in addictive disorders. Conclusion For many former forensic psychiatric patients, there are situational factors associated with medication discontinuation. This insight holds significance for professionals who are involved in pre-discharge planning within forensic psychiatric care and those who interact with this cohort of former patients post-discharge.
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Affiliation(s)
- Ebba Noland
- Department of Social Work, Umeå University, Umeå, Sweden
- Sundsvall Forensic Psychiatric Centre, Region Västernorrland, Sundsvall, Sweden
| | - Suvi Virtanen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fia Klötz Logan
- Sundsvall Forensic Psychiatric Centre, Region Västernorrland, Sundsvall, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Jungdal A, Tousig CG, Christiansen TK, Birkelund L, Sørensen AN, Roskilde J, Birkelund R. Cross-sectoral exchange of nurses: An intervention study. Scand J Caring Sci 2024. [PMID: 38310602 DOI: 10.1111/scs.13238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/04/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND In health policy, much attention has been paid to collaboration between the primary and secondary health care sectors, especially in relation to hospitalisation and discharge. Despite ideal plans for collaboration, the research literature shows that inadequate communication is a well-known problem that can be a barrier to a safe trajectory for the citizen. Based on the assumption that better knowledge of each other's work will lead to better collaboration, a cross-sectoral exchange program with nurses was initiated. AIM The aim was to investigate which barriers to good patient trajectories the involved nurses attributed to cross-sectoral collaboration and what impact the exchange to the opposite sector had for them. METHODS Twenty-eight nurses were exchanged: 14 from a cardiology department and 14 from municipal home care. The nurses shadowed a colleague from the opposite sector in their daily work. Subsequently, six focus group interviews were conducted. The transcribed material was analysed based on Ricoeur's interpretation theory. RESULTS Two main themes, including sub-themes emerged: (1) Challenging communicative conditions: (a) Inadequate digital communication, (b) Inadequate care plans and discharge reports, (c) Conversation promotes understanding, and (d) Challenging collaboration and communication with the discharge coordinators. (2) Perceived importance of the exchange: (a) Cross-sectoral relationship, prejudice and gaining respect for each other and (b) Working in two different worlds. CONCLUSION Electronic communication is inadequate, and the IT systems do not support sufficient cross-sectoral communication. The organisational model in the municipal care sector is inflexible in terms of allocations for the current needs of citizens, and professionals feel that their professional judgements are not recognised. The nurses gained insight into each other's work and working conditions and respect for each other's professionalism. The exchange has the potential to both improve the relationship and communication between the sectors for the benefit of a better and more coherent patient course.
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Affiliation(s)
- Anni Jungdal
- Department of Cardiology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Charlotte Gad Tousig
- Department of Cardiology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | | | - Lisbeth Birkelund
- Odense University Hospital - University of Southern Denmark, Odense, Denmark
| | - Anette Nissen Sørensen
- Department of Cardiology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Jesper Roskilde
- Public Administration and Diploma of Leadership, Senior Healthcare, Vejle, Denmark
| | - Regner Birkelund
- Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle Kommune, Vejle, Denmark
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Ramanathan D, Bruckman D, Appachi S, Hopkins B. Association of Discharge Location Following Pediatric Tracheostomy with Social Determinants of Health: A National Analysis. Otolaryngol Head Neck Surg 2024; 170:522-534. [PMID: 37727943 DOI: 10.1002/ohn.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To evaluate the breakdown of discharge locations among pediatric tracheostomy patients and determine the impact of demographic variables and social determinants of health. STUDY DESIGN Retrospective review of the 2016 and 2019 Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP KID). SETTING A total of 4000 United States community hospitals, defined as short-term, non-Federal, general, and specialty hospitals. METHODS ICD-10-PCS, ICD-10 CM codes, and HCUP data elements were selected for patients and variables of interest. Bivariate comparisons were performed using Rao-Scott Chi-square tests; significance levels in post hoc pairwise testing were adjusted using Bonferroni adjustment. Multinomial generalized logistic regression models were used to determine the average annual odds ratio (OR) of 3 dispositions at discharge relative to discharge home for self-care. RESULTS Patients aged 11-17, patients from large metropolitan areas, and patients of "Other" race have an increased odds of discharge to a short- or long-term care facility (all P < .001). Weekend admissions, nonelective admissions, patients in Northeast hospitals, and patients at urban nonteaching hospitals are also more likely to be discharged to a short- or long-term care facility (all P < .001). Mean and median total costs of admission were $424,387 and $243,479, respectively, with a median total charge of $854,499. CONCLUSION Among pediatric tracheostomy patients, demographic factors that affect discharge disposition include age, community type, and race, and significant hospital factors include day and type of admission, geographic region, and hospital type. Hospitalizations are associated with high overall costs and charges to the patient, which are increasing over time.
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Affiliation(s)
- Diya Ramanathan
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - David Bruckman
- Center for Populations Health Research, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Swathi Appachi
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brandon Hopkins
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
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14
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Cochrane MM, Addis BR, Swartz LK, Lowe WH. Individual growth rates and size at metamorphosis increase with watershed area in a stream salamander. Ecology 2024; 105:e4217. [PMID: 38037284 DOI: 10.1002/ecy.4217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/20/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023]
Abstract
A fundamental goal of ecology is to understand how the physical environment influences intraspecific variability in life history and, consequently, fitness. In streams, discharge and associated habitat conditions change along a continuum from intermittency to permanence: Headwater streams typically have smaller watersheds and are thus more prone to drying than higher-order streams with larger watersheds and more consistent discharge. However, few empirical studies have assessed life history and associated population responses to this continuum in aquatic organisms. We tested the prediction that individual growth, rate of development, and population growth increase with watershed area in the long-lived stream salamander Gyrinophilus porphyriticus, where we use watershed area as a proxy for hydrologic intermittence. To address this hypothesis, we used 8 years of mark-recapture data from 53 reaches across 10 headwater streams in New Hampshire, USA. Individual growth rates and mean size at metamorphosis increased with watershed area for watersheds from 0.12 to 1.66 km2 . Population growth rates increased with watershed area; however, this result was not statistically significant at our sample size. Mean age of metamorphosis did not vary across watershed areas. Lower individual growth rates and smaller sizes at metamorphosis likely contributed to reduced lifetime fecundity and population growth in reaches with the smallest watershed areas and highest vulnerability to drought. These responses suggest that as droughts increase due to climate change, headwater specialists in hydrologically intermittent environments will experience a reduction in fitness due to smaller body sizes or other growth-related mechanisms.
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Affiliation(s)
- Madaline M Cochrane
- Division of Biological Sciences, University of Montana, Missoula, Montana, USA
| | - Brett R Addis
- Division of Biological Sciences, University of Montana, Missoula, Montana, USA
| | - Leah K Swartz
- Division of Biological Sciences, University of Montana, Missoula, Montana, USA
| | - Winsor H Lowe
- Division of Biological Sciences, University of Montana, Missoula, Montana, USA
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15
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Pierson SB, Dongarwar D, Bini T, Onwukwe JT, House K, Rosiji FO, Salihu HM. Factors Associated With Discharge Against Medical Advice in US Adolescents Hospitalized for Suicidal Ideation or Suicide Attempt. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00009-1. [PMID: 38280417 DOI: 10.1016/j.jaac.2023.09.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 09/19/2023] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVE Little is known about factors associated with discharge against medical advice (DAMA) in adolescent acute care hospitalization for suicidal ideation (SI) and suicide attempt (SA). Our study seeks to determine whether certain socioeconomic factors or hospital characteristics are associated with DAMA in this population. METHOD This retrospective cross-sectional study used data from the National Inpatient Sample from the 2015 fourth quarter to 2019. We included children 10 to 19 years of age hospitalized with a primary or secondary International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis of SI or SA. Exposures were patient socio-demographics and hospital characteristics. The outcome was DAMA. Logistic regression generated odds ratios (ORs) with 95% CIs to measure the association between each patient and hospital characteristics and DAMA. RESULTS Of 476,755 hospitalizations meeting inclusion criteria, 3,825 (0.8%) were DAMA. After adjusting for socio-demographics and hospital characteristics, predictive factors for DAMA were age 16 to 19 years (OR = 1.41; CI = 1.08-1.82), self-pay status (OR = 1.43; CI = 1.12-1.83), hospital region South and West (OR = 1.55; CI = 1.10-2.20 and OR = 1.79; CI = 1.26-2.54, respectively), and urban non-teaching status of the hospital (OR = 1.90; CI = 1.42-2.55). Hispanic patients were less likely to be DAMA (OR = 0.66; CI = 0.51-0.85). CONCLUSION Variations in DAMA probabilities by age, insurance status, hospital teaching status, and hospital regions suggest a need for a better understanding of this uncommon outcome.
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Jaberi E, Boussaha I, Dode X, Grenet G, Kassai B, Nguyen KA. Unlicensed/Off-Label Drug Prescriptions at Hospital Discharge in Children: An Observational Study Using Routinely Collected Health Data. Healthcare (Basel) 2024; 12:208. [PMID: 38255096 PMCID: PMC10815156 DOI: 10.3390/healthcare12020208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/23/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Unlicensed and off-label (UL/OL) prescriptions have been associated with an increased risk of drug-related problems. Data of their prevalence at hospital discharge remain insufficient. We aimed to describe the prevalence of UL/OL drugs in outpatient prescriptions at discharge in children. METHODS We conducted a retrospective study using the routinely collected health data of children at discharge from 2014 to 2016. The primary reference source for determining licensed labelling was the summaries of product characteristics (SPCs) in a French industry-independent formulary named Thériaque. We described the characteristics of UL/OL prescriptions at discharge and looked for predictors of UL/OL prescriptions. RESULTS We included 2536 prescriptions of 479 children. Licensed, OL, and UL prescriptions accounted for 58.6% (95% CI: 56.7-60.5), 39.2% (95% CI: 37.3-41.1), and 2.3% (95% CI: 1.7-2.9), respectively. A total of 323 (74%) children received at least one UL/OL drug. Among the licensed drugs, bronchodilators (8.8%) and analgesics (8.6%), and among the OL drugs, antibiotics (2.8%), were the most prescribed. The younger age of the children and higher number of drugs they received increased the probability of UL/OL prescriptions (unadjusted p-value of ≤0.05). CONCLUSION The prevalence of UL/OL prescriptions is about 40% at discharge from a pediatric university hospital in France.
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Affiliation(s)
- Elham Jaberi
- UMR CNRS 5558, Laboratoire de Biométrie et Biologie Humaine, Équipe Évaluation et Modélisation des Effets Thérapeutiques, rue Guillaume-Paradin, BP8071, CEDEX 08, F-69376 Lyon, France
| | - Inesse Boussaha
- Department of Clinical Epidemiology, Hospices Civils de Lyon, CIC 1407 de Lyon, Inserm, CHU-Lyon, F-69677 Bron, France
| | - Xavier Dode
- Pharmacy Department, Hospices Civils de Lyon University Hospital, F-69002 Lyon, France
| | - Guillaume Grenet
- UMR CNRS 5558, Laboratoire de Biométrie et Biologie Humaine, Équipe Évaluation et Modélisation des Effets Thérapeutiques, rue Guillaume-Paradin, BP8071, CEDEX 08, F-69376 Lyon, France
- Department of Pharmacotoxicology, Hospices Civils de Lyon, CHU-Lyon, F-69677 Bron, France
| | - Behrouz Kassai
- UMR CNRS 5558, Laboratoire de Biométrie et Biologie Humaine, Équipe Évaluation et Modélisation des Effets Thérapeutiques, rue Guillaume-Paradin, BP8071, CEDEX 08, F-69376 Lyon, France
| | - Kim An Nguyen
- UMR CNRS 5558, Laboratoire de Biométrie et Biologie Humaine, Équipe Évaluation et Modélisation des Effets Thérapeutiques, rue Guillaume-Paradin, BP8071, CEDEX 08, F-69376 Lyon, France
- Department of Pharmacotoxicology, Hospices Civils de Lyon, CHU-Lyon, F-69677 Bron, France
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Witt M, Domazet T, Dong A, Handler C, Nella K, Dilkas S, Campbell J, Guilcher SJT, MacKay C. Understanding transitions in care for persons with limb loss: a qualitative study exploring health care providers' perspectives. Disabil Rehabil 2024:1-8. [PMID: 38205588 DOI: 10.1080/09638288.2023.2301477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE To explore health care providers' (HCP) experiences related to transitions in care from inpatient rehabilitation to the community for patients with limb loss. MATERIALS AND METHODS A qualitative study was conducted using semi-structured interviews. Participants were eligible if they were HCPs currently working in amputation rehabilitation at a rehabilitation hospital in Ontario, Canada, with at least 1-year experience in this setting, and could speak and understand English. Data were analyzed thematically using the six-step process of the DEPICT model dynamic reading, engaged codebook development, participatory coding, inclusive reviewing and summarizing of categories, collaborative analyzing and translating. RESULTS Fourteen HCPs from a variety of health care professions participated in this study. Five key themes describe participants' perspectives on the factors impacting patients' transition in care following limb loss. Specifically, participants emphasized patient preparedness, HCP follow-up, finances and funding, patient self-management skills, and psychosocial support as factors that could influence the transition in care. CONCLUSION This study identified challenges to transitions in care for people with limb loss. Future research is needed to evaluate solutions to address these challenges in transitions in care.
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Affiliation(s)
- Micah Witt
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Teah Domazet
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Alexandra Dong
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Carly Handler
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Katrina Nella
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Steve Dilkas
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Janet Campbell
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Sara J T Guilcher
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Crystal MacKay
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
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Lomba GSB, da Silva PHA, do Rosário NF, Medeiros T, Alves LS, Silva AA, Almeida JR, Lugon JR. Post- discharge all-cause mortality in COVID-19 recovered patients hospitalized in 2020: the impact of chronic kidney disease. Rev Inst Med Trop Sao Paulo 2024; 66:e1. [PMID: 38198374 PMCID: PMC10768652 DOI: 10.1590/s1678-9946202466001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/16/2023] [Indexed: 01/12/2024] Open
Abstract
In Brazil, the COVID-19 burden was substantial, and risk factors associated with higher in-hospital mortality rates have been extensively studied. However, information on short-term all-cause mortality and the factors associated with death in patients who survived the hospitalization period of acute SARS-CoV-2 infection is limited. We analyzed the six-month post-hospitalization mortality rate and possible risk factors of COVID-19 patients in a single center in Brazil. This is a retrospective cohort study focused on a six-month follow-up. The exclusion criteria were death during hospitalization, transference to another hospital, and age under 18. We collected data from the charts of all hospitalized patients from March 2020 to December 2020 with a positive RT-PCR test for SARS-CoV-2, resulting in a sample size of 106 patients. The main outcome was death after hospitalization, whereas comorbidities and demographics were evaluated as risk factors. The crude post-hospitalization death rate was 16%. The first 30 days of follow-up had the highest mortality rate. In a Cox regression model for post-hospitalization mortality, previous chronic kidney disease (HR, 4.06, 95%CI 1.46 - 11.30) and longer hospital stay (HR 1.01, 95%CI 1.00 - 1.02) were the only factors statistically associated with death. In conclusion, a high six-month all-cause mortality was observed. Within the six-month follow-up, a higher risk of death was observed for patients who had prior CKD and longer hospital stay. These findings highlight the importance of more intensive medical surveillance during this period.
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Affiliation(s)
| | | | - Natalia Fonseca do Rosário
- Universidade Federal Fluminense, Faculdade de Medicina, Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Niterói, Rio de Janeiro, Brazil
| | - Thalia Medeiros
- Universidade Federal Fluminense, Faculdade de Medicina, Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Niterói, Rio de Janeiro, Brazil
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Patologia, Niterói, Rio de Janeiro, Brazil
| | - Lilian Santos Alves
- Universidade Federal Fluminense, Faculdade de Medicina, Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Niterói, Rio de Janeiro, Brazil
| | - Andrea Alice Silva
- Universidade Federal Fluminense, Faculdade de Medicina, Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Niterói, Rio de Janeiro, Brazil
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Patologia, Niterói, Rio de Janeiro, Brazil
| | - Jorge Reis Almeida
- Universidade Federal Fluminense, Faculdade de Medicina, Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Niterói, Rio de Janeiro, Brazil
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Medicina Clínica, Divisão de Nefrologia, Niterói, Rio de Janeiro, Brazil
| | - Jocemir Ronaldo Lugon
- Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Medicina Clínica, Divisão de Nefrologia, Niterói, Rio de Janeiro, Brazil
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Das A, Xi Tan J, Pillai A. The Efficacy of Virtual Fracture Clinics (VFCs) and the Impact of Physician Risk Appetite on Discharge Rates. Cureus 2024; 16:e51798. [PMID: 38187019 PMCID: PMC10771814 DOI: 10.7759/cureus.51798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 01/09/2024] Open
Abstract
Background and objectives Virtual fracture clinics (VFCs) allow the triage of emergency department referrals to identify those requiring further care and those that are suitable for discharge. Appropriate discharge from VFC benefits the patient and the healthcare provider by avoiding unnecessary face-to-face appointments. This study investigates factors associated with VFC discharge rates at our hospital and detects potential areas for improvement. Methodology A retrospective review was conducted on 4819 consecutive VFC referrals between March 17, 2021, and March 16, 2022, from a single hospital. Patient demographics, referral outcomes, and triaging consultant data were collected. Sixteen consultants conducted daily VFCs during the study period. Eleven consultants completed the DOSPERT psychometric test to measure their attitude toward risk. The data was analysed using Spearman's rho and Chi-square tests. Results The mean discharge from VFC was 35.4% (29.6-41.0%). The highest rates of discharge were for back pain (100%), followed by fractures of the pubic ramus (100%), the base of the fifth metatarsal (86.89%), the acetabulum (75%), and the proximal radius (73.03%). Consultant experience was significantly negatively correlated with discharge rate (p<0.05). The frequency of conducting a VFC was not associated with the discharge rate (p=0.758). In subspecialty analysis, 90% of lower limb consultants discharged more lower limb presentations from VFC, compared with upper limb consultants (p=0.001). There was no significant correlation between DOSPERT scores and discharge rates (p=0.65). Conclusions VFC remains an important tool for patient care. Consultant experience is associated with a more cautious approach to discharge; however, there was no relationship between a consultant's risk attitude and their VFC discharge rate in this study. Lower-limb consultants appear to discharge lower-limb injuries more readily when compared with their upper-limb colleagues. These insights could be used to improve emergency department and VFC efficiency.
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Affiliation(s)
- Abhirun Das
- Trauma and Orthopaedics, Wythenshawe Hospital, Manchester University National Health Service (NHS) Foundation Trust, Manchester, GBR
| | - Jie Xi Tan
- Trauma and Orthopaedics, University of Manchester, Manchester, GBR
| | - Anand Pillai
- Trauma and Orthopaedics, Wythenshawe Hospital, Manchester University National Health Service (NHS) Foundation Trust, Manchester, GBR
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Tian T, Aaron RE, Seley JJ, Longo R, Nayberg I, Umpierrez GE, Levy CJ, Klonoff DC. Use of Continuous Glucose Monitors Upon Hospital Discharge of People With Diabetes: Promise, Barriers, and Opportunity. J Diabetes Sci Technol 2024; 18:207-214. [PMID: 37784246 PMCID: PMC10899827 DOI: 10.1177/19322968231200847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Continuous glucose monitors (CGMs) have increasingly been used in ambulatory and inpatient or hospital settings to improve glycemic outcomes for people with diabetes. Given their capacity to aid individuals in avoiding hypo- and hyperglycemia, they may also be useful when transitioning from hospital to home by reducing rates of hospital readmissions and emergency department visits. Several types of barriers presently exist that make the deployment of CGMs at the time of hospital discharge problematic, including (1) regulatory, (2) behavioral, (3) logistical, (4) technical, (5) staffing, and (6) systemic issues. In this commentary, we review the literature, discuss these barriers, and propose possible solutions to facilitate the use of CGMs in people with diabetes at the time of hospital discharge.
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Affiliation(s)
- Tiffany Tian
- Diabetes Technology Society, Burlingame, CA, USA
| | | | - Jane Jeffrie Seley
- Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medicine, New York, NY, USA
| | - Rebecca Longo
- Lahey Hospital & Medical Center, Beth Israel Lahey Health, Burlington, MA, USA
| | - Irina Nayberg
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| | | | - Carol J. Levy
- Division of Endocrinology, Diabetes, and Metabolism, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
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21
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Hoffman AM, Walls JL, Prusch A, Roberts J. Prevented harm and cost avoidance with pharmacist intervention while utilizing a discharge medication reconciliation tool. Am J Health Syst Pharm 2024; 81:e37-e44. [PMID: 37813103 DOI: 10.1093/ajhp/zxad243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Indexed: 10/11/2023] Open
Abstract
PURPOSE The aim of this study was to determine prevented harm and cost avoidance following pharmacist intervention utilizing a discharge medication reconciliation tool. METHODS A retrospective chart review was conducted to identify patients with pharmacist-initiated, provider-accepted discharge medication reconciliation interventions completed at a community teaching hospital in January 2021. Investigators assigned the discrepancies targeted for intervention a National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) category, probability of harm, and calculated cost avoidance. The primary endpoint was the total cost avoidance associated with discharge medication reconciliation. RESULTS Pharmacists intervened 190 times in January 2021, avoiding an estimated $46,958 to $231,032 in cost. High-risk medications were associated with $33,920 to $147,203 in cost avoidance. The 3 high-risk therapeutic classes associated with the highest cost avoidance were insulin ($16,738-$70,793), antithrombotics ($13,884-$60,016), and opioids ($2,638-$11,834). CONCLUSION Targeted pharmacist discharge medication reconciliation and related interventions avoid significant cost and patient harm.
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Affiliation(s)
| | - Jennifer L Walls
- Department of Pharmacy, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Amanda Prusch
- Department of Pharmacy, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Justin Roberts
- Department of Patient Safety, Penn Medicine Lancaster General Health, Lancaster, PA, USA
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Han S, Kim YB, No JH, Suh DH, Kim K, Ahn S. Predicting Postoperative Hospital Stays Using Nursing Narratives and the Reverse Time Attention (RETAIN) Model: Retrospective Cohort Study. JMIR Med Inform 2023; 11:e45377. [PMID: 38131977 PMCID: PMC10763991 DOI: 10.2196/45377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 12/23/2023] Open
Abstract
Background Nursing narratives are an intriguing feature in the prediction of short-term clinical outcomes. However, it is unclear which nursing narratives significantly impact the prediction of postoperative length of stay (LOS) in deep learning models. Objective Therefore, we applied the Reverse Time Attention (RETAIN) model to predict LOS, entering nursing narratives as the main input. Methods A total of 354 patients who underwent ovarian cancer surgery at the Seoul National University Bundang Hospital from 2014 to 2020 were retrospectively enrolled. Nursing narratives collected within 3 postoperative days were used to predict prolonged LOS (≥10 days). The physician's assessment was conducted based on a retrospective review of the physician's note within the same period of the data model used. Results The model performed better than the physician's assessment (area under the receiver operating curve of 0.81 vs 0.58; P=.02). Nursing narratives entered on the first day were the most influential predictors in prolonged LOS. The likelihood of prolonged LOS increased if the physician had to check the patient often and if the patient received intravenous fluids or intravenous patient-controlled analgesia late. Conclusions The use of the RETAIN model on nursing narratives predicted postoperative LOS effectively for patients who underwent ovarian cancer surgery. These findings suggest that accurate and interpretable deep learning information obtained shortly after surgery may accurately predict prolonged LOS.
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Affiliation(s)
- Sungjoo Han
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yong Bum Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Soyeon Ahn
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Mao W, Shalaby R, Owusu E, Elgendy H, Shalaby N, Agyapong B, Nichols A, Eboreime E, Nkire N, Agyapong VIO. Status after Hospital Discharge: An Observational Study of the Progression of Patients' Mental Health Symptoms Six Weeks after Hospital Discharge. J Clin Med 2023; 12:7559. [PMID: 38137628 PMCID: PMC10744019 DOI: 10.3390/jcm12247559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Transitioning from mental health inpatient care to community care is often a vulnerable time in the treatment process where additional risks and anxiety may arise. We collected data for this study as part of a pragmatic cluster-randomized, longitudinal approach in Alberta. As the first phase of the ongoing innovative supportive program, this paper assessed the progression of mental health symptoms in patients six weeks after hospital discharge. Factors that may contribute to the presence or absence of anxiety and depression symptoms, as well as well-being, following return to the community were investigated. This provides evidence and baseline data for future phases of the project. (2) Methods: An observational study design was adopted for this study. Data on a variety of sociodemographic and clinical factors were collected at discharge and six weeks after via REDCap. Anxiety, depression, and well-being symptoms were assessed using the Generalized Anxiety Disorder (GAD-7) questionnaire, the Patient Health Questionnaire-9 (PHQ-9), and the World Health Organization-Five Well-Being Index (WHO-5), respectively. Descriptive, chi-square, independent t-tests, and multivariate regression analyses were conducted. (3) Result: The survey was completed by 88 out of 306 participants (28.8% response rate). The chi-square/Fisher exact test and independent t-test revealed no significant change in the mental health conditions from baseline to six weeks after discharge. It was found that the only significant factor predicting symptoms six weeks after discharge from inpatient treatment was the baseline symptoms in all three logistic regression models. It was four times more likely for those who experienced anxiety and depression at baseline to experience anxiety and depression symptoms six weeks after discharge (OR = 4.27; 95% CI: 1.38-13.20) (OR = 4.04; 95% CI: 1.25-13.05). Those with poor baseline well-being were almost 12 times more likely to experience poor well-being six weeks after discharge (OR = 11.75; 95% CI: 3.21-42.99). (4) Conclusions: Study results found no significant change in mental health conditions in the short term following hospital discharge. It is essential that researchers and policymakers collaborate in order to implement effective interventions to support and maintain the mental health conditions of patients following discharge.
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Affiliation(s)
- Wanying Mao
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Ernest Owusu
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Hossam Elgendy
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Nermin Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Angel Nichols
- Queen Elizabeth II Hospital, Alberta Health Services, Grande Prairie, AB T5J 3E4, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS B3H 2E2, Canada;
| | - Nnamdi Nkire
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Vincent I. O. Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS B3H 2E2, Canada;
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Kim E, Williams A, Chang J, Butala N, Firek M. Impact of traditional versus nontraditional initiation dosing schedule of paliperidone palmitate on 30-day readmission and safety. Ment Health Clin 2023; 13:311-316. [PMID: 38058597 PMCID: PMC10696170 DOI: 10.9740/mhc.2023.12.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 09/02/2023] [Indexed: 12/08/2023] Open
Abstract
Introduction Paliperidone palmitate (PP), a second-generation long-acting injectable antipsychotic, requires 2 injections upon initiation. Due to the fast-paced nature of the inpatient setting, the second dose may be administered earlier than recommended by labeled use despite the lack of evidence that evaluates this practice. Methods This was a retrospective chart review that investigated the outcomes associated with the timing of the second PP initiation dose with the aim of comparing patients who received the second PP dose fewer than 3 days after the first injection with those who received it between 3 and 11 days after the first injection. The primary outcomes included 30-day psychiatric readmission, index hospitalization length of stay, and time until the next psychiatric hospitalization. Secondary outcomes included 6-month readmission and the percentage of patients who experienced an adverse event after the second injection. Results No statistically significant differences were observed between groups for 30-day readmission. There was a statistically significant shortened index length of hospitalization (median, 2 vs 4 days; P < 0.001) and a non-statistically significant trend for time until the next psychiatric hospitalization (median, 25 vs 47 days) when comparing those who received the nontraditional loading regimen to those who received the traditional labeled loading regimen. No differences were observed in the secondary outcomes or safety/tolerability. Discussion The results of the study indicate that there are no significant differences in readmission rates and adverse drug reactions in those who received the second PP dose earlier than recommended per labeled use. Larger, controlled studies are needed to further investigate clinical and safety outcomes.
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Affiliation(s)
- Erika Kim
- Clinical Pharmacist, Riverside University Health System, Riverside, California
| | - Andrew Williams
- Clinical Pharmacist, Riverside University Health System, Riverside, California
- Clinical Pharmacist, Riverside University Health System, Riverside, California
- Clinical Pharmacist, Riverside University Health System, Riverside, California
- Research Specialist, Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, California
| | - Justin Chang
- Clinical Pharmacist, Riverside University Health System, Riverside, California
| | - Niyati Butala
- Clinical Pharmacist, Riverside University Health System, Riverside, California
| | - Matthew Firek
- Research Specialist, Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, California
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Murrell J, Khadabadi NA, Moores T, Hossain F. Identifying Preoperative Predictors for 24-Hour Discharge After Elective Hip and Knee Arthroplasties. Cureus 2023; 15:e50989. [PMID: 38143727 PMCID: PMC10748218 DOI: 10.7759/cureus.50989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction The resumption of elective medical services post-pandemic has brought to the forefront the importance of outpatient arthroplasty services in promoting efficiency and mitigating hospital-acquired infections. This study aimed to identify preoperative factors that predict the success of outpatient lower limb arthroplasty surgeries. Methods Our investigation involved a retrospective review of 606 patients who underwent elective hip and knee arthroplasty. We documented variables such as the hospital length of stay, patient demographics (age and gender), Oxford Joint Scores, body mass index, socioeconomic status, American Society of Anaesthesiologists' (ASA) physical status classification, comorbid conditions, the Functional Comorbidity Index (FCI), preoperative blood test results, implant types, scheduling details of the surgery, and rates of readmission within 30 days post-surgery. A two-step analysis using univariate and multivariate regression models was performed to pinpoint preoperative indicators that could predict same-day discharge following arthroplasty. Results Forty-five patients (7.4%) were discharged within 24 hours of surgery. Early discharge did not correlate with higher rates of readmission within 30 days (p>0.05). Neither weekend nor afternoon surgeries significantly extended the length of stay beyond 24 hours (p>0.05). No significant differences in the prevalence of comorbidities, FCI scores, socioeconomic status, or preoperative blood test results were found when comparing patients discharged within 24 hours to those who stayed longer. Multivariate analysis revealed that patients younger than 65 years (relative risk (RR) 2.41; 95% confidence interval (CI) 1.02-5.74) and those receiving partial knee arthroplasty (RR 8.91; 95% CI 3.05-26.04) were more likely to be discharged within 24 hours. Conclusions Outpatient arthroplasty is a viable option, especially for individuals younger than 65 years undergoing partial knee arthroplasty, independent of other patient-related factors, comorbidities, and specifics of the hospital episode.
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Affiliation(s)
- James Murrell
- Trauma and Orthopaedics, Walsall Manor Hospital, Walsall, GBR
| | | | - Thomas Moores
- Trauma and Orthopaedics, Walsall Manor Hospital, Walsall, GBR
| | - Fahad Hossain
- Trauma and Orthopaedics, Walsall Manor Hospital, Walsall, GBR
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Winqvist I, Näppä U, Rönning H, Häggström M. Reducing risks in complex care transitions in rural areas: a grounded theory. Int J Qual Stud Health Well-being 2023; 18:2185964. [PMID: 36866630 PMCID: PMC9987724 DOI: 10.1080/17482631.2023.2185964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
PURPOSE Although previous research indicates that care transitions differ between rural and urban areas, the knowledge of challenges related to care transitions in rural areas appears limited. This study aimed to provide a deeper understanding of what registered nurses' perceive as the main concerns in care transitions from hospital care to home healthcare in rural areas, and how they handle these during the care transition process. METHODS A Constructivist Grounded Theory method based on individual interviews with 21 registered nurses. RESULTS The main concern in the transition process was "Care coordination in a complex context". The complexity stemmed from several environmental and organizational factors, creating a messy and fragmented context for registered nurses to navigate. The core category "Actively communicating to reduce patient safety risks" was explained by the three categories- "Collaborating on expected care needs", "Anticipating obstacles" and "Timing the departure". CONCLUSIONS The study shows a very complex and stressed process that includes several organizations and actors. Reducing risks during the transition process can be facilitated by clear guidelines, tools for communication across organizations and sufficient staffing.
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Affiliation(s)
- Idun Winqvist
- Department of Health Sciences, Mid Sweden University, Östersund and Sundsvall, Sweden
| | - Ulla Näppä
- Department of Health Sciences, Mid Sweden University, Östersund and Sundsvall, Sweden
| | - Helén Rönning
- Department of Health Sciences, Mid Sweden University, Östersund and Sundsvall, Sweden
| | - Marie Häggström
- Department of Health Sciences, Mid Sweden University, Östersund and Sundsvall, Sweden
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Kealy-Bateman W. Working alongside next of kin to enhance discharge: A quality improvement collaboration to co-design discharge for mental health patients. Australas Psychiatry 2023; 31:782-785. [PMID: 37625817 PMCID: PMC10725611 DOI: 10.1177/10398562231198141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
OBJECTIVES Mental health (MH) patients seen in the emergency department (ED) setting are often viewed in isolation, outside of the context of their loved ones, the next of kin (NOK). This is especially problematic when a patient is detained under the mental health act. This project aimed to improve this engagement. METHODS A sense of urgency was created from a guiding coalition of the local MH and ED executive of a rural hospital. The vision was communicated to the team for action. This was then institutionally incorporated as best practice during a 3 month trial. RESULTS NOK were engaged more frequently as a result of this quality improvement strategy, rising to 90.8% (2021) from 63.2% (2020) compared to the previous year χ2 (1, N=166) =18.75, p = .000015. Admissions for all MH patients from the emergency department fell to 28.3% (2021) from 39% (2020) χ2 (1, N=652) =8.32, p = .0039. CONCLUSIONS Working with NOK is a best practice strategy that was embraced by clinicians when highlighted. This resulted in less restrictive practice and more community treatment. Creating a frame for the patient that is standardised, provides containment and co-designs future health care is beneficial.
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Affiliation(s)
- Warren Kealy-Bateman
- Warren Kealy-Bateman, Mental Health Drug and Alcohol, Dubbo Base Hospital, Myall Street, Dubbo 2839, NSW, Australia; The University of Sydney School of Rural Health – Dubbo Campus, 4 Moran Drive, Dubbo 2830, NSW, Australia; Graduate School of Medicine, University of Wollongong, PO Box 5029, Wollongong 2520, NSW, Australia.
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Wiens MO, Trawin J, Pillay Y, Nguyen V, Komugisha C, Kenya-Mugisha N, Namala A, Bebell LM, Ansermino JM, Kissoon N, Payne BA, Vidler M, Christoffersen-Deb A, Lavoie PM, Ngonzi J. Prognostic algorithms for post- discharge readmission and mortality among mother-infant dyads: an observational study protocol. Front Epidemiol 2023; 3:1233323. [PMID: 38455948 PMCID: PMC10911031 DOI: 10.3389/fepid.2023.1233323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/13/2023] [Indexed: 03/09/2024]
Abstract
Introduction In low-income country settings, the first six weeks after birth remain a critical period of vulnerability for both mother and newborn. Despite recommendations for routine follow-up after delivery and facility discharge, few mothers and newborns receive guideline recommended care during this period. Prediction modelling of post-delivery outcomes has the potential to improve outcomes for both mother and newborn by identifying high-risk dyads, improving risk communication, and informing a patient-centered approach to postnatal care interventions. This study aims to derive post-discharge risk prediction algorithms that identify mother-newborn dyads who are at risk of re-admission or death in the first six weeks after delivery at a health facility. Methods This prospective observational study will enroll 7,000 mother-newborn dyads from two regional referral hospitals in southwestern and eastern Uganda. Women and adolescent girls aged 12 and above delivering singletons and twins at the study hospitals will be eligible to participate. Candidate predictor variables will be collected prospectively by research nurses. Outcomes will be captured six weeks following delivery through a follow-up phone call, or an in-person visit if not reachable by phone. Two separate sets of prediction models will be built, one set of models for newborn outcomes and one set for maternal outcomes. Derivation of models will be based on optimization of the area under the receiver operator curve (AUROC) and specificity using an elastic net regression modelling approach. Internal validation will be conducted using 10-fold cross-validation. Our focus will be on the development of parsimonious models (5-10 predictor variables) with high sensitivity (>80%). AUROC, sensitivity, and specificity will be reported for each model, along with positive and negative predictive values. Discussion The current recommendations for routine postnatal care are largely absent of benefit to most mothers and newborns due to poor adherence. Data-driven improvements to postnatal care can facilitate a more patient-centered approach to such care. Increasing digitization of facility care across low-income settings can further facilitate the integration of prediction algorithms as decision support tools for routine care, leading to improved quality and efficiency. Such strategies are urgently required to improve newborn and maternal postnatal outcomes. Clinical trial registration https://clinicaltrials.gov/, identifier (NCT05730387).
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Affiliation(s)
- Matthew O. Wiens
- Institute for Global Health, BC Children’s and Women’s Hospitals, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
- WALIMU, Kampala, Uganda
| | - Jessica Trawin
- Institute for Global Health, BC Children’s and Women’s Hospitals, Vancouver, BC, Canada
| | - Yashodani Pillay
- Institute for Global Health, BC Children’s and Women’s Hospitals, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Vuong Nguyen
- Institute for Global Health, BC Children’s and Women’s Hospitals, Vancouver, BC, Canada
| | | | | | - Angella Namala
- Department of Obstetrics & Gynaecology, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Lisa M. Bebell
- Department of Medicine, Division of Infectious Diseases, Medical Practice Evaluation Center, Center for Global Health, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - J. Mark Ansermino
- Institute for Global Health, BC Children’s and Women’s Hospitals, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Niranjan Kissoon
- Institute for Global Health, BC Children’s and Women’s Hospitals, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Beth A. Payne
- Digital Health Research, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marianne Vidler
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Astrid Christoffersen-Deb
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Pascal M. Lavoie
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- Digital Health Research, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Joseph Ngonzi
- Department of Obstetrics and Gynaecology, Mbarara University of Science & Technology, Mbarara, Uganda
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Patel SV, Imburgio S, Johal AS, Ramirez C, DiSandro K, Mathur D, Walch B, Buccellato V, Hossain MA, Asif A. Improving Discharge Rates to Home With the Help of Mobility Technicians: A Step in the Right Direction. Cureus 2023; 15:e48298. [PMID: 38058341 PMCID: PMC10696277 DOI: 10.7759/cureus.48298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 12/08/2023] Open
Abstract
Background Early ambulation during acute hospitalization has been associated with improved clinical outcomes for patients. Despite the benefits of mobility in the hospital setting, physical therapists and nursing staff are often constrained by time. Mobility technicians (MTs) are individuals with specialized training who have emerged as a potential solution by providing safe ambulation for patients during their hospital stay. Objectives The purpose of this quality improvement project was to investigate the impact of MTs on clinical and financial outcomes for admitted patients at a high-volume tertiary institution. Methods A quality improvement project was implemented at Jersey Shore University Medical Center, Neptune City, from October 2022 to March 2023. The study was a prospective, single-institution cohort study and included patients admitted to two medical floors. Patients were divided into an experimental group that received services from MTs and a control group that did not receive this service but was eligible based on clinical status. The primary endpoint was the proportion of patients discharged to home. Secondary outcomes included the length of stay and financial impact. Results A total of 396 admitted patients were included, with 222 patients in the MT group and 174 in the non-MT group. Patients in the MT group were discharged home more frequently, at a rate of 79.7% compared to 66.1% for patients in the non-MT group (p = 0.002). MTs contributed to an average 2.4-day reduction in the length of hospital stay (7.8 days vs. 10.2 days, p = 0.007). The MT intervention led to an estimated net savings of $148,500 during the six-month study period. Additionally, 2.9 daily hospital beds were created. Conclusion Implementing an MT program significantly increased the discharge-to-home rates and decreased hospital length of stay. Preliminary analysis suggests that this intervention is cost-effective and can assist institutions in managing increased hospital capacity strain through the creation of additional hospital beds.
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Affiliation(s)
- Swapnil V Patel
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Steven Imburgio
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Anmol S Johal
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Claudia Ramirez
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Kristin DiSandro
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Divya Mathur
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Brian Walch
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Vito Buccellato
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Mohammad A Hossain
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Arif Asif
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
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Krebsbach MN, Alexander KM, Miller JJ, Doll EL, Lee YL, Simmons JD. Implementing a Discharge Opioid Bundle in Adult Trauma Patients Decreases the Amount of Opioids Prescribed at Discharge. Am Surg 2023; 89:4281-4287. [PMID: 35622969 DOI: 10.1177/00031348221101483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Opioids remain the mainstay treatment of acute pain caused by trauma. The lack of evidence driven prescribing creates a challenging situation for providers. We hypothesized that the implementation of a trauma discharge opioid bundle (TDOB) would decrease the total morphine milligram equivalents (MME) prescribed at discharge while maintaining pain control. METHODS This was a pre-post study of adult trauma patients before and after implementation of a TDOB to guide the prescription of opioids and discharge prescription education in patients discharged from a level one trauma center. The pre-group and post-group, included consecutively discharged patients from September through November in 2018 and 2019. The primary outcome was the total MME prescribed at discharge. RESULTS A total of 377 patients met inclusion criteria. One hundred and fifty-one patients were included in the pre-group and 226 in the post-group. The total MME prescribed at discharge (225 ± [150-300] pre vs 200 ± [100-225] post, P = < .001) and maximum MME/day (45 ± [30-45] vs 30 ± [20-45], P = .004) were significantly less in the post-group. Incidence of outpatient refills within fourteen days were similar. More non-opioid pain adjuncts were prescribed post-intervention and discharge pain education was provided more frequently. CONCLUSION The implementation of a TDOB significantly reduced the MME prescribed at discharge without increasing the number of opioid refills.
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Affiliation(s)
- Mackenzie N Krebsbach
- USA Health, Department of Surgery, Division of Trauma, Acute Care Surgery & Burns, Mobile, AL, USA
| | | | - Jennifer J Miller
- College of Nursing, Department of Adult Health Nursing, University of South Alabama, Mobile, AL, USA
| | - Elizabeth L Doll
- USA Health, Department of Surgery, Division of Trauma, Acute Care Surgery & Burns, Mobile, AL, USA
| | - Yann-Leei Lee
- USA Health, Department of Surgery, Division of Trauma, Acute Care Surgery & Burns, Mobile, AL, USA
| | - Jon D Simmons
- USA Health, Department of Surgery, Division of Trauma, Acute Care Surgery & Burns, Mobile, AL, USA
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Riveros C, Ranganathan S, Shah YB, Huang E, Xu J, Geng M, Melchiode Z, Hu S, Miles BJ, Esnaola N, Kaushik D, Jerath A, Wallis CJD, Satkunasivam R. Postoperative Discharge Destination Impacts 30-Day Outcomes: A National Surgical Quality Improvement Program Multi-Specialty Surgical Cohort Analysis. J Clin Med 2023; 12:6784. [PMID: 37959249 PMCID: PMC10650337 DOI: 10.3390/jcm12216784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/10/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Surgical patients can be discharged to a variety of facilities which vary widely in intensity of care. Postoperative readmissions have been found to be more strongly associated with post-discharge events than pre-discharge complications, indicating the importance of discharge destination. We sought to evaluate the association between discharge destination and 30-day outcomes. A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients were dichotomized based on discharge destination: home versus non-home. The main outcome of interest was 30-day unplanned readmission. The secondary outcomes included post-discharge pulmonary, infectious, thromboembolic, and bleeding complications, as well as death. In this cohort study of over 1.5 million patients undergoing common surgical procedures across eight surgical specialties, we found non-home discharge to be associated with adverse 30-day post-operative outcomes, namely, unplanned readmissions, post-discharge pulmonary, infectious, thromboembolic, and bleeding complications, as well as death. Non-home discharge is associated with worse 30-day outcomes among patients undergoing common surgical procedures. Patients and caregivers should be counseled regarding discharge destination, as non-home discharge is associated with adverse post-operative outcomes.
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Affiliation(s)
- Carlos Riveros
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA; (C.R.); (S.R.); (E.H.); (Z.M.); (S.H.); (B.J.M.); (D.K.)
| | - Sanjana Ranganathan
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA; (C.R.); (S.R.); (E.H.); (Z.M.); (S.H.); (B.J.M.); (D.K.)
| | - Yash B. Shah
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Emily Huang
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA; (C.R.); (S.R.); (E.H.); (Z.M.); (S.H.); (B.J.M.); (D.K.)
| | - Jiaqiong Xu
- Center for Health Data Science and Analytics, Houston Methodist Research Institute, Houston, TX 77030, USA;
| | - Michael Geng
- School of Engineering Medicine, Texas A&M University, Houston, TX 77030, USA;
| | - Zachary Melchiode
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA; (C.R.); (S.R.); (E.H.); (Z.M.); (S.H.); (B.J.M.); (D.K.)
| | - Siqi Hu
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA; (C.R.); (S.R.); (E.H.); (Z.M.); (S.H.); (B.J.M.); (D.K.)
| | - Brian J. Miles
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA; (C.R.); (S.R.); (E.H.); (Z.M.); (S.H.); (B.J.M.); (D.K.)
| | - Nestor Esnaola
- Department of Surgery, Houston Methodist Hospital, Houston, TX 77030, USA;
| | - Dharam Kaushik
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA; (C.R.); (S.R.); (E.H.); (Z.M.); (S.H.); (B.J.M.); (D.K.)
| | - Angela Jerath
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, ON M4N 3M5, Canada;
| | - Christopher J. D. Wallis
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5R 0A3, Canada;
- Division of Urology, University of Toronto, Toronto, ON M5R 0A3, Canada
- Division of Urology, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, TX 77030, USA; (C.R.); (S.R.); (E.H.); (Z.M.); (S.H.); (B.J.M.); (D.K.)
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Ng DHL, Koh FHX, Yeong HEL, Huey TCW, Chue KM, Foo FJ, Chew STH. Nutrition Care after Hospital Discharge in Singapore: Evidence-Based Best-Practice Recommendations. Nutrients 2023; 15:4492. [PMID: 37960145 PMCID: PMC10650134 DOI: 10.3390/nu15214492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023] Open
Abstract
The nutritional status of hospitalised patients is often at risk or compromised and predisposed to further deterioration after discharge, leading to poor clinical outcomes, high healthcare costs, and poor quality of life. This paper aims to provide evidence-based best-practice recommendations to address this, supported by a national survey of healthcare professionals in Singapore and reviewed by a multidisciplinary expert panel under the Sarcopenia Interest Group of Society of Parenteral and Enteral Nutrition Singapore (SingSPEN). We advocate screening all patients with a validated tool which includes a disease activity/burden component, an easily accessible dietitian referral pathway for patients at risk of malnutrition, and an individualised nutrition care plan formulated and delivered using a multidisciplinary team approach for patients at risk or with malnutrition. A comprehensive team would include not only dietitians but also physicians, nurses, physiotherapists, speech therapists, and medical social workers working together towards a common goal. Information on why nutrition is important for good health and how it can be achieved should also be provided to all patients and their caregivers before and after hospital discharge. With the above recommendations, we seek to improve upon the current nutrition care processes at discharge for healthcare institutions in Singapore.
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Affiliation(s)
- Doris Hui Lan Ng
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore;
| | - Frederick Hong Xiang Koh
- Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore; (F.H.X.K.); (K.M.C.)
| | - Hazel Ee Ling Yeong
- Department of Nutrition and Dietetics, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore;
| | - Terence Cheong Wei Huey
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore;
| | - Koy Min Chue
- Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore; (F.H.X.K.); (K.M.C.)
| | - Fung Joon Foo
- Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore; (F.H.X.K.); (K.M.C.)
| | - Samuel Teong Huang Chew
- Department of Geriatric Medicine, Changi General Hospital, 2 Simei St 3, Singapore 529889, Singapore;
- SingHealth Duke-NUS Medicine Academic Clinical Programme, 8 College Road, Singapore 169857, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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O’Donoghue B, Thompson A, McGorry P, Brown E. Discharge destinations for young people with a first episode of psychosis after attending an early intervention for psychosis service. Aust N Z J Psychiatry 2023; 57:1359-1366. [PMID: 37161277 PMCID: PMC10517580 DOI: 10.1177/00048674231172404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Early intervention for psychosis services result in superior outcomes in the domains of symptomatic and functional recovery, hospitalisation and employment compared to standard services; however, the optimal duration of care with these services is unknown. Knowledge on the discharge destinations, specifically the proportion discharged to high- and low-intensity services, could provide insights into the proportion of who may require a longer tenure of care. This study aimed to determine (1) the discharge destinations from early intervention for psychosis services and (2) baseline and intra-episode factors associated with discharge to the secondary care/adult mental health service. METHODOLOGY This study was conducted at the Early Psychosis Prevention and Intervention Centre in Melbourne and included all young people treated by the service with a first episode of psychosis over a 6-year period. Discharge destinations were categorised according to high-intensity services, namely, secondary mental health care, or lower intensity services, such as private practitioners or primary care. RESULTS A total of 1101 young people with a first episode of psychosis were included in the study, of whom 58.8% were male and the median age was 20.0 years (interquartile range: 17-22). After a median of 95.4 weeks (interquartile range: 66.7-105.7), 36.6% were discharged to the adult mental health services, which was associated with being not in employment, education or training at presentation (odds ratio = 1.71, 95% confidence interval [1.23, 2.37]); experiencing a relapse (odds ratio = 1.76, 95% confidence interval [1.24, 2.49]); and being admitted to a mental health unit (odds ratio = 3.98, 95% confidence interval [2.61, 6.09]). Young people who lived with their parents were less likely to be discharged to secondary care services (odds ratio = 0.52, 95% confidence interval [0.37, 0.73]), as were those who were achieving symptomatic remission within 12 weeks (odds ratio = 0.60, 95% confidence interval [0.43, 0.83]). Migrant status and the duration of untreated psychosis were not associated with discharge destination. CONCLUSION These findings indicate that there is a sizable, identifiable minority who may benefit from a longer episode of care with early intervention for psychosis services.
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Affiliation(s)
- Brian O’Donoghue
- Department of Psychiatry, University College Dublin, Dublin, Ireland
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Elm Mount Unit, St Vincent’s University Hospital, Dublin, Ireland
| | - Andrew Thompson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ellie Brown
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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Siddiqui S, Kelly L, Bosch N, Law A, Patel LA, Perkins N, Armaignac DL, Zabolotskikh I, Christie A, Krishna Mohan S, Deo N, Bansal V, Kumar VK, Gajic O, Kashyap R, Domecq JP, Boman K, Walkey A, Banner-Goodspeed V, Schaefer MS. Discharge Disposition and Loss of Independence Among Survivors of COVID-19 Admitted to Intensive Care: Results From the SCCM Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS). J Intensive Care Med 2023; 38:931-938. [PMID: 37157813 PMCID: PMC10183337 DOI: 10.1177/08850666231174375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES To describe incidence and risk factors of loss of previous independent living through nonhome discharge or discharge home with health assistance in survivors of intensive care unit (ICU) admission for coronavirus disease 2019 (COVID-19). DESIGN Multicenter observational study including patients admitted to the ICU from January 2020 till June 30, 2021. HYPOTHESIS We hypothesized that there is a high risk of nonhome discharge in patients surviving ICU admission due to COVID-19. SETTING Data were included from 306 hospitals in 28 countries participating in the SCCM Discovery Viral Infection and Respiratory Illness Universal Study COVID-19 registry. PATIENTS Previously independently living adult ICU survivors of COVID-19. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was nonhome discharge. Secondary outcome was the requirement of health assistance among patients who were discharged home. Out of 10 820 patients, 7101 (66%) were discharged alive; 3791 (53%) of these survivors lost their previous independent living status, out of those 2071 (29%) through nonhome discharge, and 1720 (24%) through discharge home requiring health assistance. In adjusted analyses, loss of independence on discharge among survivors was predicted by patient age ≥ 65 years (adjusted odds ratio [aOR] 2.78, 95% confidence interval [CI] 2.47-3.14, P < .0001), former and current smoking status (aOR 1.25, 95% CI 1.08-1.46, P = .003 and 1.60 (95% CI 1.18-2.16), P = .003, respectively), substance use disorder (aOR 1.52, 95% CI 1.12-2.06, P = .007), requirement for mechanical ventilation (aOR 4.17, 95% CI 3.69-4.71, P < .0001), prone positioning (aOR 1.19, 95% CI 1.03-1.38, P = .02), and requirement for extracorporeal membrane oxygenation (aOR 2.28, 95% CI 1.55-3.34, P < .0001). CONCLUSIONS More than half of ICU survivors hospitalized for COVID-19 are unable to return to independent living status, thereby imposing a significant secondary strain on health care systems worldwide.
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Affiliation(s)
- Shahla Siddiqui
- Center for Anesthesia Research
Excellence (CARE), Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical
Center, and Harvard Medical School, Boston, MA, USA
| | - Lauren Kelly
- Center for Anesthesia Research
Excellence (CARE), Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical
Center, and Harvard Medical School, Boston, MA, USA
| | | | - Anica Law
- Boston University School of
Medicine, Boston, MA, USA
| | - Love A Patel
- Allina Health (Abbott Northwestern
Hospital), Minneapolis, MN, USA
| | | | | | | | - Amy Christie
- Atrium Health Navicent the Medical
Center, Macon, GA, USA
| | | | - Neha Deo
- Mayo Clinic Rochester, Rochester, MN,
USA
| | | | | | | | | | | | - Karen Boman
- Society of Critical Care
Medicine, Mount Prospect, IL, USA
| | - Allan Walkey
- Boston University School of
Medicine, Boston, MA, USA
| | - Valerie Banner-Goodspeed
- Center for Anesthesia Research
Excellence (CARE), Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical
Center, and Harvard Medical School, Boston, MA, USA
| | - Maximilian Sebastian Schaefer
- Center for Anesthesia Research
Excellence (CARE), Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical
Center, and Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology,
Duesseldorf University Hospital, Duesseldorf, Germany
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Dassios T. On carbon dioxide and bronchopulmonary dysplasia. Acta Paediatr 2023; 112:2248-2249. [PMID: 37565373 DOI: 10.1111/apa.16947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/09/2023] [Indexed: 08/12/2023]
Affiliation(s)
- Theodore Dassios
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- University of Patras, Patras, Greece
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Hayanga JWA, Kakuturu J, Dhamija A, Asad F, McCarthy P, Sappington P, Badhwar V. Cannulate, extubate, ambulate approach for extracorporeal membrane oxygenation for COVID-19. J Thorac Cardiovasc Surg 2023; 166:1132-1142.e33. [PMID: 35396123 PMCID: PMC8915439 DOI: 10.1016/j.jtcvs.2022.02.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/07/2022] [Accepted: 02/23/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We compared outcomes in patients with severe COVID-19 versus non-COVID-19-related acute respiratory distress syndrome (ARDS) managed using a dynamic, goal-driven approach to venovenous extracorporeal membrane oxygenation (ECMO). METHODS We performed a retrospective, single-center analysis of our institutional ECMO registry using data from 2017 to 2021. We used Kaplan-Meier plots, Cox proportional hazard models, and propensity score analyses to evaluate the association of COVID-19 status (COVID-19-related ARDS vs non-COVID-19 ARDS) and survival to decannulation, discharge, tracheostomy, and extubation. We also conducted subgroup analyses to compare outcomes with the use of extracorporeal cytoreductive techniques (CytoSorb [CytoSorbents Corp] and plasmapheresis). RESULTS The sample comprised 128 patients, 50 with COVID-19 and 78 with non-COVID-19 ARDS. Advancing age was associated with decreased probability of survival to decannulation (P = .04). Compared with the non-COVID-19 ARDS group, patients with COVID-19 had a greater probability of survival to extubation (P < .01) and comparable survival to discharge (P = .14). CONCLUSIONS Patients with COVID-19 managed with ECMO had comparable outcomes as patients with non-COVID ARDS. A strategy of early extubation and ambulation might be a safe and effective strategy to improve outcomes and survival, even for patients with severe COVID-19.
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Affiliation(s)
- J W Awori Hayanga
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
| | - Jahnavi Kakuturu
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Ankit Dhamija
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Fatima Asad
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Paul McCarthy
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Penny Sappington
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
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Camazine MN, Rountree KM, Smith JB, Bath J, Vogel TR. Opioid utilization after lower extremity amputation for peripheral vascular disease and discharge prescribing recommendations. Vascular 2023; 31:954-960. [PMID: 35506989 DOI: 10.1177/17085381221097163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Opioids are commonly used for pain control after lower extremity amputations (LEA)-below the knee amputations (BKA) and above the knee amputations (AKA). Well-defined benchmarks for prescription requirements after amputation are deficient. This analysis evaluated opioid utilization after amputation to identify high-risk patients and provide recommendations for post-hospitalization opioid prescriptions at discharge. METHODS Patients undergoing LEA (2008-2016) with identified peripheral vascular disease were selected from Cerner's Health Facts® database using ICD-9 and 10 diagnosis and procedure codes. Patient demographics, disease severity, comorbidities, and hospital characteristics were evaluated. Post-operative opioid medications administered intravenously and orally during the hospital stay were identified from the data and converted to Morphine Milligram Equivalent per day (MME/d) for an evaluation and comparison during the index hospitalization. Descriptive statistics were used to report continuous and dichotomous variables. Dichotomous variables are reported as n (%) and continuous variables are reported as mean ± standard deviation (SD). Chi-square and T-tests were used as appropriate. RESULTS 2399 patients who underwent AKA or BKA with peripheral vascular disease were evaluated. Sixty-three percent of the cohort was male, 67% Caucasian, and 42% married, and 58% had a Charlson index >3. The majority of patients had an average length of hospital stay of 5.7 days (M = 5.72, SD = 4.56). Patient groups that used significantly higher MME/d in the early postop period included: BKA (29.2 vs 20.7, p = 0.006), males (62.6 vs 54.0, p < 0.0001), Caucasians (64.3 vs 44.7, p < 0.0001), younger patients (69.6 vs 54.0, p < 0.0001), and those at non-training institutions (66.7 vs 56.7, p < 0.0001). Patients whose hospital stay was greater than 6 days were found to have increased opioid utilization likely secondary to index complications. For those discharged by post-operative day 7, the mean MME utilized on postop day 1 was 59.5 and decreased to a mean MME/d utilization prior to discharge of 17.6. CONCLUSIONS This analysis demonstrates that younger patients, males, patients with BKAs, and those who receive amputations for vascular disease at non-training institutions have higher post-operative opioid utilization during the hospital stay. At the time of discharge, patients utilized an average of 17.6 MME/d which equates to approximately three hydrocodone/acetaminophen 5/325 mg tablets per day. Based on these findings, vascular surgeons are likely over prescribing opioids at discharge and must be cognizant of appropriate dosing quantities. Prescriptions at discharge should reflect the daily utilization described from this analysis and tapered to avoid chronic utilization, overdose, and possible death.
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Affiliation(s)
- Maraya N Camazine
- Division of Vascular Surgery, Department of Surgery, University of Missouri, School of Medicine, Columbia, MO, USA
| | - Kaitlyn M Rountree
- Division of Vascular Surgery, Department of Surgery, University of Missouri, School of Medicine, Columbia, MO, USA
| | - Jamie B Smith
- Department of Family and Community Medicine, University of Missouri, School of Medicine Columbia, MO, USA
| | - Jonathan Bath
- Division of Vascular Surgery, Department of Surgery, University of Missouri, School of Medicine, Columbia, MO, USA
| | - Todd R Vogel
- Division of Vascular Surgery, Department of Surgery, University of Missouri, School of Medicine, Columbia, MO, USA
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McMullen S, Panagioti M, Planner C, Giles S, Angelakis I, Keers RN, Robinson C, Fu Y, Johnson J, Tyler N. Supporting carers to improve patient safety and maintain their well-being in transitions from mental health hospitals to the community: A prioritisation nominal group technique. Health Expect 2023; 26:2064-2074. [PMID: 37421272 PMCID: PMC10485304 DOI: 10.1111/hex.13813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/10/2023] Open
Abstract
INTRODUCTION Carers of people with mental illness may face distinct challenges, including navigating fragmented health and social services during discharge from mental health hospitals. Currently, limited examples of interventions that support carers of people with mental illness in improving patient safety during transitions of care exist. We aimed to identify problems and solutions to inform future carer-led discharge interventions, which is imperative for ensuring patient safety and the well-being of carers. METHODS The nominal group technique was used which combines both qualitative and quantitative data collection methods in four distinct phases: (1) problem identification, (2) solution generation, (3) decision making and (4) prioritisation. The aim was to combine expertise from different stakeholder groups (patients, carers and academics with expertise in primary/secondary care, social care or public health) to identify problems and generate solutions. RESULTS Twenty-eight participants generated potential solutions that were grouped into four themes. The most acceptable solution for each was as follows: (1) 'Carer Involvement and Improving Carer Experience' a dedicated family liaison worker, (2) 'Patient Wellness and Education' adapting and implementing existing approaches to help implement the patient care plan, (3) 'Carer Wellness and Education' peer/social support interventions for carers and (4) 'Policy and System Improvements' understanding the co-ordination of care. CONCLUSION The stakeholder group concurred that the transition from mental health hospitals to the community is a distressing period, where patients and carers are particularly vulnerable to safety and well-being risks. We identified numerous feasible/acceptable solutions to enable carers to improve patient safety and maintain their own mental wellbeing. PATIENT AND PUBLIC CONTRIBUTION Patient and public contributors were represented in the workshop and the focus of the workshop was to identify the problems they faced and co-design potential solutions. Patient and public contributors were involved in the funding application and study design.
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Affiliation(s)
- Sarah McMullen
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
- NIHR School for Primary Care ResearchThe University of ManchesterManchesterUK
| | - Claire Planner
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
| | - Sally Giles
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
| | - Ioannis Angelakis
- Department of Primary Care and Mental HealthThe University of LiverpoolLiverpoolUK
| | - Richard N. Keers
- Division of Pharmacy and Optometry, Centre for Pharmacoepidemiology and Drug SafetyThe University of ManchesterManchesterUK
- NIHR Greater Manchester Patient Safety Translational Research CentreManchester Academic Health Science NetworkManchesterUK
- Suicide, Risk and Safety Research UnitGreater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Catherine Robinson
- Social Care and Society, School of Health SciencesThe University of ManchesterManchesterUK
| | - Yu Fu
- Population Health Sciences InstituteNewcastle UniversityNewcastleUK
| | | | - Natasha Tyler
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
- NIHR School for Primary Care ResearchThe University of ManchesterManchesterUK
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Smith AB, Davis KJ. Emergency short stay area improves access and flow in a rural hospital. Emerg Med Australas 2023; 35:771-776. [PMID: 37087104 DOI: 10.1111/1742-6723.14220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 04/24/2023]
Abstract
OBJECTIVES Shoalhaven District Memorial Hospital is a rural (MM3) 150-bed hospital in Nowra, New South Wales, whose ED has evolved to a FACEM-led model of care (MOC). It has never had an emergency short stay area (ESSA). The objective of the present study was to pilot an ESSA and determine whether this MOC would increase the operational performance of the ED. METHODS An ESSA was designed and delivered by emergency medicine medical, nursing and allied health practitioners. The study period was July-December 2021, with a seasonally matched retrospective cohort of records extracted for comparison (July-December 2020). Both took place within the context of the ongoing COVID-19 pandemic. The primary outcome measured was percentage of admitted patients meeting Emergency Treatment Performance (ETP). Secondary outcomes included discharge ETP, overall ED and inpatient length of stay (LOS), mortality and representation rates. RESULTS The admission ETP for patients after the implementation of the ESSA significantly increased, from 13.9% to 31.6% (χ2 = 288, P < 0.001). Discharge ETP significantly declined. There was no effect improvement on overall ETP. There was no change to mortality or representation rates. Average admission LOS decreased. CONCLUSIONS The introduction of the ESSA significantly improved the ETP of admitted patients. Ongoing refinement of the ESSA admission processes, as well as the lifting of certain COVID-19 restrictions, could show even greater improvements in this and other areas. Ongoing research in this field is necessary, as well as a more detailed cost-benefit analysis.
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Affiliation(s)
- Anne B Smith
- Emergency Department, Shoalhaven District Memorial Hospital, Illawarra Shoalhaven Local Health District, Nowra, New South Wales, Australia
| | - Kimberley J Davis
- Research Central, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
- Graduate Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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Sreepada RS, Chang AC, West NC, Sujan J, Lai B, Poznikoff AK, Munk R, Froese NR, Chen JC, Görges M. Dashboard of Short-Term Postoperative Patient Outcomes for Anesthesiologists: Development and Preliminary Evaluation. JMIR Perioper Med 2023; 6:e47398. [PMID: 37725426 PMCID: PMC10548316 DOI: 10.2196/47398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Anesthesiologists require an understanding of their patients' outcomes to evaluate their performance and improve their practice. Traditionally, anesthesiologists had limited information about their surgical outpatients' outcomes due to minimal contact post discharge. Leveraging digital health innovations for analyzing personal and population outcomes may improve perioperative care. BC Children's Hospital's postoperative follow-up registry for outpatient surgeries collects short-term outcomes such as pain, nausea, and vomiting. Yet, these data were previously not available to anesthesiologists. OBJECTIVE This quality improvement study aimed to visualize postoperative outcome data to allow anesthesiologists to reflect on their care and compare their performance with their peers. METHODS The postoperative follow-up registry contains nurse-reported postoperative outcomes, including opioid and antiemetic administration in the postanesthetic care unit (PACU), and family-reported outcomes, including pain, nausea, and vomiting, within 24 hours post discharge. Dashboards were iteratively co-designed with 5 anesthesiologists, and a department-wide usability survey gathered anesthesiologists' feedback on the dashboards, allowing further design improvements. A final dashboard version has been deployed, with data updated weekly. RESULTS The dashboard contains three sections: (1) 24-hour outcomes, (2) PACU outcomes, and (3) a practice profile containing individual anesthesiologist's case mix, grouped by age groups, sex, and surgical service. At the time of evaluation, the dashboard included 24-hour data from 7877 cases collected from September 2020 to February 2023 and PACU data from 8716 cases collected from April 2021 to February 2023. The co-design process and usability evaluation indicated that anesthesiologists preferred simpler designs for data summaries but also required the ability to explore details of specific outcomes and cases if needed. Anesthesiologists considered security and confidentiality to be key features of the design and most deemed the dashboard information useful and potentially beneficial for their practice. CONCLUSIONS We designed and deployed a dynamic, personalized dashboard for anesthesiologists to review their outpatients' short-term postoperative outcomes. This dashboard facilitates personal reflection on individual practice in the context of peer and departmental performance and, hence, the opportunity to evaluate iterative practice changes. Further work is required to establish their effect on improving individual and department performance and patient outcomes.
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Affiliation(s)
- Rama Syamala Sreepada
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Ai Ching Chang
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Nicholas C West
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Jonath Sujan
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Brendan Lai
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Andrew K Poznikoff
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
- Department of Anesthesia, BC Children's Hospital, Vancouver, BC, Canada
| | - Rebecca Munk
- Department of Anesthesiology, Kelowna General Hospital, Kelowna, BC, Canada
| | - Norbert R Froese
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
- Department of Anesthesia, BC Children's Hospital, Vancouver, BC, Canada
| | - James C Chen
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesia, BC Children's Hospital, Vancouver, BC, Canada
| | - Matthias Görges
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
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Lee K, Nixon G, Niemi K, Rose A. Improving inpatient discharge workflows through pharmacist pending discharge medication orders. Am J Health Syst Pharm 2023; 80:1264-1270. [PMID: 37343297 DOI: 10.1093/ajhp/zxad140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Indexed: 06/23/2023] Open
Abstract
PURPOSE Hospital discharge represents a difficult care transition for patients, with the potential for medication-related problems (MRPs) and adverse events. Medication reconciliation is widely accepted as a best practice to minimize MRPs at the time of discharge. Pharmacists can play a key role in identification and resolution of MRPs, although pharmacist reconciliation usually occurs after provider medication reconciliation. This workflow is often inefficient and results in duplication of work within the care team. A prospective pharmacist-led pilot program with preparation of discharge medication orders for provider review, also known as pended medication orders, was investigated to determine its impact on MRPs and discharge processing time. SUMMARY Patient discharges from February through April 2022 were compared for 2 hospital medicine services at a large academic medical center. One group participated in the pilot workflow, while the other used standard discharge workflows. The pilot group had a significant decrease in the average number of clinical interventions made by a pharmacist after provider orders were placed (52.4% decrease; P = 0.03) and a nonsignificant reduction in the time from provider order entry to completion of the final pharmacist medication reconciliation (47.6% reduction; P = 0.18) compared to the group using standard workflows. CONCLUSION Pharmacist-led, prospective discharge medication reconciliation with pending of medication orders for provider review increases overall discharge efficiency. Data from this project and previous studies support an expanded pharmacist role in the discharge process and continued high-level collaboration between pharmacists and providers.
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Affiliation(s)
- Kasheng Lee
- Department of Pharmacy, University of Wisconsin Health, Madison, WI, USA
| | - Grace Nixon
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristin Niemi
- Department of Pharmacy, University of Wisconsin Health, Madison, WI, USA
| | - Anne Rose
- Department of Pharmacy, University of Wisconsin Health, Madison, WI, USA
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Kovoor JG, Bacchi S, Gupta AK, Stretton B, Malycha J, Reddi BA, Liew D, O'Callaghan PG, Beltrame JF, Zannettino AC, Jones KL, Horowitz M, Dobbins C, Hewett PJ, Trochsler MI, Maddern GJ. The Adelaide Score: An artificial intelligence measure of readiness for discharge after general surgery. ANZ J Surg 2023; 93:2119-2124. [PMID: 37264548 DOI: 10.1111/ans.18546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND This study aimed to examine the performance of machine learning algorithms for the prediction of discharge within 12 and 24 h to produce a measure of readiness for discharge after general surgery. METHODS Consecutive general surgery patients at two tertiary hospitals, over a 2-year period, were included. Observation and laboratory parameter data were stratified into training, testing and validation datasets. Random forest, XGBoost and logistic regression models were evaluated. Each ward round note time was taken as a different event. Primary outcome was classification accuracy of the algorithmic model able to predict discharge within the next 12 h on the validation data set. RESULTS 42 572 ward round note timings were included from 8826 general surgery patients. Discharge occurred within 12 h for 8800 times (20.7%), and within 24 h for 9885 (23.2%). For predicting discharge within 12 h, model classification accuracies for derivation and validation data sets were: 0.84 and 0.85 random forest, 0.84 and 0.83 XGBoost, 0.80 and 0.81 logistic regression. For predicting discharge within 24 h, model classification accuracies for derivation and validation data sets were: 0.83 and 0.84 random forest, 0.82 and 0.81 XGBoost, 0.78 and 0.79 logistic regression. Algorithms generated a continuous number between 0 and 1 (or 0 and 100), representing readiness for discharge after general surgery. CONCLUSIONS A derived artificial intelligence measure (the Adelaide Score) successfully predicts discharge within the next 12 and 24 h in general surgery patients. This may be useful for both treating teams and allied health staff within surgical systems.
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Affiliation(s)
- Joshua G Kovoor
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders University, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Brandon Stretton
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- Flinders University, Adelaide, South Australia, Australia
| | - James Malycha
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Benjamin A Reddi
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Danny Liew
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Patrick G O'Callaghan
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - John F Beltrame
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Karen L Jones
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michael Horowitz
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher Dobbins
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Peter J Hewett
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Markus I Trochsler
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Guy J Maddern
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
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43
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Almawed R, Shiu J, Bungard T, Charrois T, Gill P. Pharmacist Prescribing at Inpatient Discharge in Alberta. Can J Hosp Pharm 2023; 76:275-281. [PMID: 37767376 PMCID: PMC10522341 DOI: 10.4212/cjhp.3346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Background Pharmacists in the province of Alberta may apply for additional prescribing authorization (APA), which allows them to independently prescribe medications. Currently, no literature exists about pharmacist prescribing for inpatients at the time of discharge. Objectives The primary objective was to report the proportion of patients for whom inpatient pharmacists with APA prescribed at discharge across Alberta, Canada. Secondary objectives were to describe discharge interventions other than prescribing that were provided, enablers of and barriers to discharge prescribing, and differences in discharge prescribing by facility or population type, clinical area, and health care charting system. Methods A descriptive, cross-sectional web-based survey of inpatient pharmacists with APA across Alberta was conducted over a 6-week period in early 2022. Results A total of 104 respondents met the inclusion criteria. Under half (45/102, 44.1%) of the participants reported prescribing at discharge. Those that reported prescribing at discharge did so for only a median 14.5% of their patients. The most common enabler of discharge prescribing was a supportive care team, and the most common barrier was the presence of other prescribers. Pharmacists who did not report prescribing at discharge selected "discomfort with being responsible for the prescription" and "fear of professional liability" as barriers more often than those who did report discharge prescribing (51.0% [26/51] vs 33.3% [13/39] and 43.1% [22/51] vs 25.6% [10/39], respectively). The proportion of pharmacists who reported prescribing at discharge was greater with increasing population/facility size (30% [6/20] of pharmacists in settings that served small populations vs 50% [29/58] of those in settings that served large populations). Conclusions Inpatient pharmacists who use APA at discharge reported prescribing for only a minority of patients, and discharge prescribing practices varied widely across the province. Future areas of research include how pharmacists can overcome barriers to prescribing at discharge.
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Affiliation(s)
- Reem Almawed
- , PharmD, ACPR, is with Pharmacy Services, Alberta Health Services, Edmonton, Alberta
| | - Jennifer Shiu
- , BScPharm, PharmD, ACPR, is with Pharmacy Services, Alberta Health Services, Edmonton, Alberta
| | - Tammy Bungard
- , BSP, PharmD, is with the Faculty of Medicine, University of Alberta, Edmonton, Alberta
| | - Theresa Charrois
- , BScPharm, ACPR, MSc, EdD, is with the Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta
| | - Pawandeep Gill
- , PharmD, ACPR, is with Pharmacy Services, Alberta Health Services, Edmonton, Alberta
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Nelson A, Stuckey H, Snyder B, Van Scoy LJ, Daymont C, Irvin C, Wasserman E, Beck M. Provider Perspectives of Transitions of Care at a Tertiary Care Children's Hospital With a Hospitalist-Run Discharge Clinic. Clin Pediatr (Phila) 2023; 62:926-934. [PMID: 36726290 PMCID: PMC10986183 DOI: 10.1177/00099228221149279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Children's hospitals are discharging patients to home with increasingly complex outpatient needs, making safe transitions of care (ToCs) of vital importance. Our study involved a survey of both outpatient providers and pediatric hospitalists associated with our medical center to better describe providers' views on the ToC process. The survey included questions assessing views on patient care responsibilities, resource availability, our hospitalist-run postdischarge clinic (PDC), and comfort with telemedicine. Our hospitalists generally believed that primary care providers (PCPs) did not have adequate access to important ToC elements, whereas PCPs felt their access was adequate. Both provider types felt it was the inpatient team's responsibility to manage patient events between discharge and PCP follow-up and that a hospitalist-run PDC may reduce interim emergency room visits. This study challenges perceptions about the ToC process in children and describes a generalizable approach to assessing provider perceptions surrounding the ToC within individual health systems.
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Affiliation(s)
- Abigail Nelson
- Penn State Children’s Hospital, Department of Pediatrics
| | - Heather Stuckey
- Penn State Hershey College of Medicine; Department of Medicine
| | - Bethany Snyder
- Penn State Hershey College of Medicine; Department of Medicine
| | | | - Carrie Daymont
- Penn State Children’s Hospital, Department of Pediatrics
- Penn State Hershey College of Medicine, Department of Public Health Sciences
| | | | - Emily Wasserman
- Penn State Hershey College of Medicine, Department of Public Health Sciences
| | - Michael Beck
- Penn State Children’s Hospital, Department of Pediatrics
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45
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Haroon H, Wolfe N, Feizi S, Barboriak P. Assessing Two Decades of Insanity Acquittee Release from the North Carolina Forensic Program. J Am Acad Psychiatry Law 2023; 51:342-352. [PMID: 37399257 DOI: 10.29158/jaapl.230024-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Over the past two decades, an increasing proportion of North Carolina state psychiatric hospital beds have been used to house forensic patients. Insanity acquittees occupy almost all forensic-designated beds in the state. Despite the effect insanity acquittees have on state hospital use in North Carolina, outcomes for acquittees after they are released from the state hospital are unknown because of a lack of previous research. This study evaluates postrelease outcomes for insanity acquittees discharged from the North Carolina Forensic Treatment Program between 1996 and 2020. The study also describes the association between the demographic, psychiatric, and criminological characteristics of insanity acquittees and outcomes of recidivism or rehospitalization. The results show that insanity acquittees in North Carolina have higher rates of criminal recidivism than acquittees in other states. There is also evidence of systemic bias against minority race acquittees in the insanity commitment and release process in North Carolina. Outcomes for insanity acquittees released from the state Forensic Treatment Program could be improved through the introduction of evidence-based practices widely used in other states.
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Affiliation(s)
- Haseeb Haroon
- Dr. Haroon is on the Adjunct Faculty at the Keck School of Medicine of University of Southern California, Los Angeles, CA. Dr. Wolfe is Forensic Psychiatrist, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC, and Forensic Psychiatry Fellowship Director, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Feizi is Adjunct Assistant Professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Barboriak was Director of Forensic Services, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC; he died March 29, 2023.
| | - Nicole Wolfe
- Dr. Haroon is on the Adjunct Faculty at the Keck School of Medicine of University of Southern California, Los Angeles, CA. Dr. Wolfe is Forensic Psychiatrist, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC, and Forensic Psychiatry Fellowship Director, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Feizi is Adjunct Assistant Professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Barboriak was Director of Forensic Services, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC; he died March 29, 2023
| | - Sara Feizi
- Dr. Haroon is on the Adjunct Faculty at the Keck School of Medicine of University of Southern California, Los Angeles, CA. Dr. Wolfe is Forensic Psychiatrist, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC, and Forensic Psychiatry Fellowship Director, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Feizi is Adjunct Assistant Professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Barboriak was Director of Forensic Services, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC; he died March 29, 2023
| | - Peter Barboriak
- Dr. Haroon is on the Adjunct Faculty at the Keck School of Medicine of University of Southern California, Los Angeles, CA. Dr. Wolfe is Forensic Psychiatrist, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC, and Forensic Psychiatry Fellowship Director, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Feizi is Adjunct Assistant Professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Barboriak was Director of Forensic Services, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC; he died March 29, 2023
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46
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Fong ISH, Yiu CH, Abelev MD, Allaf S, Begley DA, Bugeja BA, Khor KE, Rimington J, Penm J. Supply of opioids and information provided to patients after surgery in an Australian hospital: A cross-sectional study. Anaesth Intensive Care 2023; 51:340-347. [PMID: 37688434 PMCID: PMC10493037 DOI: 10.1177/0310057x231163890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Opioids are commonly prescribed to manage pain after surgery. However, excessive supply on discharge can increase patients' risk of persistent opioid use and contribute to the reservoir of unused opioids in the community that may be misused. This study aimed to evaluate the use of opioids in Australian surgical patients after discharge and patient satisfaction with the provision of opioid information after discharge. This prospective cohort study was conducted at a tertiary referral and teaching hospital. Surgical patients were called 7-28 days after discharge to identify their opioid use and the information that they received after discharge. In total, 66 patients responded. Most patients underwent orthopaedic surgery (45.5%; 30/66). The median days of opioids supplied on discharge was 5 (IQR 3-5). In total, 40.9% (27/66) of patients had >50% of their opioids remaining. Patients undergoing orthopaedic surgery were less likely to have >50% of their opioids remaining (P = 0.045), whilst patients undergoing urological or renal surgeries were significantly more likely (P = 0.009). Most patients recalled receiving information about their opioids (89.4%; 59/66). However, the majority (51.5%; 34/66) did not recall receiving any information about the signs of opioid toxicity and interactions between opioids and alcohol. In conclusion, around 40% of patients had more than half of their opioid supply remaining after they ceased taking their opioid. Although most patients recalled receiving information about their opioids, more than half did not recall receiving any information about the signs of opioid toxicity or interactions between opioids and alcohol.
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Affiliation(s)
- Ian SH Fong
- Department of Pharmacy, Prince of Wales Hospital, Randwick, Australia
| | - Chin Hang Yiu
- School of Pharmacy, The University of Sydney Faculty of Medicine and Health, Camperdown, Australia
| | - Matthew D Abelev
- School of Pharmacy, The University of Sydney Faculty of Medicine and Health, Camperdown, Australia
| | - Sara Allaf
- School of Pharmacy, The University of Sydney Faculty of Medicine and Health, Camperdown, Australia
| | - David A Begley
- Department of Pain Management. Prince of Wales Hospital, Randwick, Australia
| | - Bernadette A Bugeja
- Department of Pain Management. Prince of Wales Hospital, Randwick, Australia
| | - Kok Eng Khor
- Department of Pain Management. Prince of Wales Hospital, Randwick, Australia
| | - Joanne Rimington
- District Pharmacy Services, South Eastern Sydney Local Health District, Randwick, Australia
| | - Jonathan Penm
- Department of Pharmacy, Prince of Wales Hospital, Randwick, Australia
- School of Pharmacy, The University of Sydney Faculty of Medicine and Health, Camperdown, Australia
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47
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Pournajaf S, Pellicciari L, Proietti S, Agostini F, Gabbani D, Goffredo M, Damiani C, Franceschini M. Which items of the modified Barthel Index can predict functional independence at discharge from inpatient rehabilitation? A secondary analysis retrospective cohort study. Int J Rehabil Res 2023; 46:230-237. [PMID: 37334818 PMCID: PMC10396075 DOI: 10.1097/mrr.0000000000000584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/21/2023] [Indexed: 06/21/2023]
Abstract
The modified Barthel Index (mBI) is a well-established patient-centered outcome measure commonly administrated in rehabilitation settings to evaluate the functional status of patients at admission and discharge. This study aimed to detect which mBI items collected on admission can predict the total mBI at discharge from first inpatient rehabilitation in large cohorts of orthopedic (n = 1864) and neurological (n = 1684) patients. Demographic and clinical data (time since the acute event 11.8 ± 17.2 days) at patients' admission and mBI at discharge were collected. Univariate and multiple binary logistic regressions were performed to study the associations between independent and dependent variables for each cohort separately. In neurological patients, the shorter time between the acute event and rehabilitation admission, shorter length of stay, and being independent with feeding, personal hygiene, bladder, and transfers were independently associated with higher total mBI at discharge (R 2 = 0.636). In orthopedic patients, age, the shorter time between the acute event and rehabilitation admission, shorter length of stay, and being independent with personal hygiene, dressing, and bladder were independently associated with higher total mBI at discharge (R 2 = 0.622). Our results showed that different activities in neurological (i.e. feeding, personal hygiene, bladder, and transfer) and orthopedic sample (i.e. personal hygiene, dressing, and bladder) are positively associated with better function (measured by mBI) at the discharge. Clinicians have to take into account these predictors of functionality when they plan an appropriate rehabilitation treatment.
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Affiliation(s)
- Sanaz Pournajaf
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
| | | | | | - Francesco Agostini
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome
| | - Debora Gabbani
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
| | - Michela Goffredo
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
| | - Carlo Damiani
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
| | - Marco Franceschini
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele Roma, Rome
- San Raffaele University, Rome, Italy
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48
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Boerman GH, Haspels HN, de Hoog M, Joosten KF. Characteristics of Long-Stay Patients in a PICU and Healthcare Resource Utilization After Discharge. Crit Care Explor 2023; 5:e0971. [PMID: 37644970 PMCID: PMC10461958 DOI: 10.1097/cce.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES To examine the characteristics of long-stay patients (LSPs) admitted to a PICU and to investigate discharge characteristics of medical complexity among discharged LSP. DESIGN We performed a retrospective cohort study where clinical data were collected on all children admitted to our PICU between July 1, 2017, and January 1, 2020. SETTING A single-center study based at Erasmus MC Sophia Children's Hospital, a level III interdisciplinary PICU in The Netherlands, providing all pediatric and surgical subspecialties. PATIENTS LSP was defined as those admitted for at least 28 consecutive days. INTERVENTIONS None. MEASUREMENTS Length of PICU stay, diagnosis at admission, length of mechanical ventilation, need for extracorporeal membrane oxygenation, mortality, discharge location after PICU and hospital admission, medical technical support, medication use, and involvement of allied healthcare professionals after hospital discharge. MAIN RESULTS LSP represented a small proportion of total PICU patients (108 patients; 3.2%) but consumed 33% of the total admission days, 47% of all days on extracorporeal membrane oxygenation, and 38% of all days on mechanical ventilation. After discharge, most LSP could be classified as children with medical complexity (CMC) (76%); all patients received discharge medications (median 5.5; range 2-19), most patients suffered from a chronic disease (89%), leaving the hospital with one or more technological devices (82%) and required allied healthcare professional involvement after discharge (93%). CONCLUSIONS LSP consumes a considerable amount of resources in the PICU and its impact extends beyond the point of PICU discharge since the majority are CMC. This indicates complex care needs at home, high family needs, and a high burden on the healthcare system across hospital borders.
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Affiliation(s)
- Gerharda H Boerman
- Division of Pediatric Intensive Care, Department of Neonatology and Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Heleen N Haspels
- Division of Pediatric Intensive Care, Department of Neonatology and Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Pediatric Intensive Care Unit, Amsterdam Reproduction, and Development, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Transitional Care Unit Consortium, The Netherlands
| | - Matthijs de Hoog
- Division of Pediatric Intensive Care, Department of Neonatology and Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Transitional Care Unit Consortium, The Netherlands
| | - Koen F Joosten
- Division of Pediatric Intensive Care, Department of Neonatology and Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
- Transitional Care Unit Consortium, The Netherlands
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49
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Babaei Z, Alizadeh M, Shahsawari S, Jihoni‐Kalhori A, Cheraghbeigi R, Sotoudeh R, Mohammadi A. Analysis of factors affecting discharge with the personal consent of hospitalized patients: A cross-sectional study. Health Sci Rep 2023; 6:e1447. [PMID: 37534059 PMCID: PMC10391332 DOI: 10.1002/hsr2.1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
Background and Aims Discharge by personal satisfaction is a condition in which the patient leaves the hospital before completing the care period against medical advice. Thus, this study aims to identify and analyze the reasons for discharge with the personal satisfaction of hospitalized patients. Methods The study was descriptive-analytical being performed in 2021. The study population was 2869 discharged inpatients with personal satisfaction. Sampling was done by random and census. The data were collected using a checklist and a researcher-made questionnaire whose validity and reliability were confirmed. The data were analyzed using SPSS24 by K-Score test for qualitative and variance for quantitative variables. Results The discharge rate by personal satisfaction was 7.01%, the average age was 42 years, and the average length of stay was 4 days. Further, 57.1% of patients were female, 63.7% were married, and 21% were babies. A total of 22.77% of the patients were discharged with the father's consent, of which 13.2% were re-admitted. The most common reasons for the discharge were feeling of recovery (47.2%), the hospital being educational (30%), and dissatisfaction with the services of doctors (51.6%). Discharge with personal satisfaction had a significant relationship with the length of hospitalization (p < 0.001) and type of hospital (p = 0.04). Conclusion The feeling of recovery, the educational nature of the hospital, and dissatisfaction with the services of doctors were the most common reasons for discharge with personal satisfaction. Therefore, monitoring the provision of services, establishing proper patient-doctor communication, and increasing the awareness of patients and parents could reduce this type of discharge and its consequences.
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Affiliation(s)
- Zahra Babaei
- Department of Health Information ManagementMohamad Kermanshahi Hospital, Kermanshah University of Medical SciencesKermanshahIran
| | - Masoumeh Alizadeh
- Department of Health Information ManagementFarabi Hospital, Kermanshah University of Medical SciencesKermanshahIran
| | - Soodeh Shahsawari
- Department of Health Information Technology, Faculty of Paramedical SciencesKermanshah University of Medical SciencesKermanshahIran
| | - Azar Jihoni‐Kalhori
- Department of Health Information Technology, Faculty of Paramedical SciencesKermanshah University of Medical SciencesKermanshahIran
| | - Ramin Cheraghbeigi
- Strategic Purchase for Clinical ManagementSocial Security OrganizationKermanshahIran
| | - Rahman Sotoudeh
- Department of Administrative AffairsShohada Hospital, Social Security OrganizationKermanshahIran
| | - Ali Mohammadi
- Department of Health Information Technology, Faculty of Paramedical SciencesKermanshah University of Medical SciencesKermanshahIran
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50
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İnal S, Küçük Alemdar D, Bulut M. Comparison of Effect of Feeding Premature Infants with Either Cup, Bottle, and Syringe on Transition to Breastfeeding, Breastfeeding Success, Weight Gain, and Duration of Hospitalization. Breastfeed Med 2023; 18:586-595. [PMID: 37615568 DOI: 10.1089/bfm.2023.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Objective: This study was completed with the aim of determining the effect of cup feeding (CF), bottle feeding (BF), and syringe feeding (SF) methods on the transition to breastfeeding, breastfeeding success, physiological parameters, weight gain, and discharge duration for preterm neonates in the neonatal intensive care unit (NICU). Materials and Methods: The study was designed to be randomized, controlled, and single blinded. The study was completed with 102 premature neonates between 29-34 gestational weeks abiding by the case selection criteria receiving treatment and care in the NICU. The 1st group comprised premature neonates receiving CF, the second group received BF, and the third group received SF. For collection of data, the Premature Infant Descriptive Information and Monitoring Form, Bristol Breastfeeding Assessment Tool (BBAT), and Infant-Focused Feeding Scales (IFFS) were used. Results: Comparison of mean peak heart rate in the groups found that the BF group was significantly high (p = 0.047) and comparison of mean SO2 found that the SF group was significantly high (p = 0.000). Infants in the SF group were determined to have significantly higher BBAT scores compared to the infants in the BF and CF groups (p = 0.015). In addition, SF infants were determined to transition to full enteral feeding and breastfeeding in a shorter duration (p < 0.05). There were no significant differences between the groups for weight gain and discharge duration (p > 0.05). Conclusions: The SF method was determined to more positively affect breastfeeding success, transition to full breastfeeding duration, and vital signs compared to the CF and BF methods. In line with the results obtained in the study, the use of the SF method may be recommended to increase breastfeeding success of neonates, to shorten the transition to full breastfeeding and for stable physical parameters.
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Affiliation(s)
- Sevil İnal
- Department of Midwifery, İstanbul-Cerrah Paşa University Faculty of Health Sciences, İstanbul, Turkey
| | - Dilek Küçük Alemdar
- Department of Pediatric Nursing, Ordu University Faculty of Health Sciences, Ordu, Turkey
| | - Muhammet Bulut
- Department of Pediatrics, Giresun University Faculty of Medicine, Giresun, Turkey
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