If you measure it, it matters!: a survey of factors influencing implementation of physical activity promotion in cardiac and pulmonary rehabilitation in Australia.

OBJECTIVE: To identify factors related to the frequency of physical activity (PA) promotion by health professionals working in cardiac and/or pulmonary rehabilitation. METHODS: A cross-sectional online survey of health professionals working in cardiac and/or pulmonary rehabilitation in Australia was conducted between July and November 2022. RESULTS: A total of 71 health professionals from four disciplines (physiotherapy, nursing, exercise physiology, occupational therapy) completed the survey. The majority agreed that PA promotion was part of their role. Despite this, only half of the participants encouraged ≥ 10 patients per month to be more physically active. In logistic regression modelling, health professionals that measured patients' PA levels (odds ratio 8.04, 95% confidence level 1.45-44.19) and prioritised PA promotion regardless of other patient problems (odds ratio 3.3, 95% confidence level 0.74-14.82) were much more likely to frequently promote PA to patients. CONCLUSION: Measurement of patients' PA levels within cardiac and pulmonary rehabilitation and making PA promotion a priority may impact the implementation of PA promotion within these programs. PRACTICAL IMPLICATIONS: Physical activity measurement as a key performance indicator in cardiac and pulmonary rehabilitation is indicated. This may be an important strategy to increase physical activity promotion by cardiac and pulmonary rehabilitation health professionals.

Not All Falls Are Equal: Risk Factors for Unplanned Readmission in Older Patients After Moderate and Severe Injury-A National Cohort Study.

OBJECTIVES: Readmission after acute care is a significant contributor to health care costs, and has been proposed as a quality indicator. Our earlier studies showed that patients aged ≥55 years who are injured by falls from heights of ≤0.5 m were at increased risk for long-term mortality, compared to patients by high-velocity blunt trauma (higher fall heights, road injuries, and other blunt trauma). We hypothesized that these patients are also at higher risk of readmission, compared to patients injured by high-velocity mechanisms. DESIGN AND MEASURES: Competing risks regression (all-cause unplanned readmission or death) was performed. SETTING AND PARTICIPANTS: Data for 5671 patients from the Singapore National Trauma Registry data who were injured from 2011-2013 and aged 55 and over were matched to Ministry of Health admissions data. The registry uses standardized conversion metrics to convert patient histories to fall heights. RESULTS: Patients injured after a low fall were more likely to be readmitted to a hospital, compared to those sustaining injuries by high-velocity blunt trauma. On competing risks analysis, low fall [subdistribution hazard ratio (SHR) 1.52, 95% confidence interval (CI) 1.20-1.93, P < .01], Charlson Comorbidity Score (CCS≥3 relative to CCS = 0, SHR 1.46, 95% CI 1.04-2.04, P = .03), and Modified Frailty Index (MFI≥3 relative to MFI = 0, SHR 1.98, 95% CI 1.44-2.72, P < .001) were associated with higher risk of 30-day readmission. Rehabilitation was associated with reduced 30-day (SHR 0.64, 95% CI 0.48-0.86, P < .001) and 1-year (SHR 0.84, 95% CI 0.72-0.99, P = .04) readmission. CONCLUSIONS/IMPLICATIONS: Our study sheds light on the interpretation of trauma data in aging populations. The detailed fall height information in our registry makes it uniquely placed to facilitate understanding of the paradoxical finding that injuries sustained by low-energy falls are higher risk than those sustained by higher-velocity mechanisms. Low-fall patients should be prioritized for rehabilitation and postdischarge support. The proportion of low-fall patients in a trauma registry should be included in the factors considered for benchmarking.

Cancer patients as frequent attenders in emergency departments: A national cohort study.

BACKGROUND: Cancer patients contribute significantly to emergency department (ED) utilization. The objective of this study was to identify factors associated with patients becoming ED frequent attenders (FA) after a cancer-related hospitalization. METHODS: A retrospective cohort study was conducted using national administrative, billing, and death records of Singapore residents discharged alive from Singapore public hospitals from January 2012 to December 2015, with a primary discharge diagnosis of cancer. Patients with four or more ED visits within any 12-month period after discharge from their index hospitalization were classified as FA. Time to FA distribution was estimated using the Kaplan-Meier method, and factors associated with risk of FA were identified using multivariate Cox regression analyses. RESULTS: Records for 47 235 patients were analyzed, of whom 2980 patients were FA within the study period. Age (<17 years, hazard ratio [HR] 2.92, 95% CI 2.28-3.74; 75-84 years, HR 1.29, 95% CI 1.16-1.45; and ≥85 years, HR 1.71, 95% CI 1.45-2.02, relative to age 55-64), male gender (HR 1.26, 95% CI 1.16-1.37), Charlson comorbidity index (HR 1.21, 95% CI 1.19-1.23), and socioeconomic factors (Medifund use, HR 1.40, 95% CI 1.23-1.59; housing subsidy type, HR 2.12, 95% CI 1.77-2.54) were associated with increased risk of FA. Primary malignancies associated with FA included brain and spine (HR 2.51, 95% CI 1.67-3.75), head and neck cancers (tongue, HR 2.05, 95% CI 1.27-3.31; hypopharynx, HR 2.72, 95% CI 1.56-4.74), lung (trachea and lung, HR 1.57, 95% CI 1.13-2.18; pleural, HR 3.69, 95% CI 2.12-6.34), upper gastrointestinal (stomach, HR 1.93, 95% CI 1.26-2.74; esophagus, HR 4.13, 95% CI 2.78-6.13), hepato-pancreato-biliary (liver, HR 1.42, 95% CI 1.01-2.00, pancreas, HR 2.48, 95% CI 1.72-3.59), and certain hematological malignancies (diffuse non-Hodgkin's lymphoma, HR1.59, 95% CI 1.08-2.33, lymphoid leukemia, HR 1.86, 95% CI 1.21-2.86). Brain (HR 1.69, 95% CI 1.27-2.26), lung (HR 1.31, 95% CI 1.01-1.71), liver (HR 1.46, 95% CI 1.14-1.89), and bone (HR 1.35, 95% CI 1.04-1.76) metastases were also associated with FA. CONCLUSION: There are cancer-specific factors contributing to ED frequent attendance. Additional resources should be allocated to support high-risk groups and prevent unnecessary ED use.