Immediate post-discharge care among US adults hospitalized with respiratory syncytial virus infection.

BACKGROUND: Respiratory Syncytial Virus (RSV) is an important pathogen causing acute respiratory illnesses in adults. RSV infection can lead to severe outcomes, including hospitalizations and even death. Despite the increased recognition of the burden in older adults, immediate post-discharge care needs among adults hospitalized with RSV are not well characterized and have not been compared to other serious medical conditions (such as influenza, acute myocardial infarction (MI), and stroke) for which there have been long-standing disease prevention efforts. OBJECTIVES: This study aims to describe the immediate post-discharge care needs among adults hospitalized with RSV in the United States and descriptively compare it to those hospitalized with influenza, acute MI, or stroke. DESIGN: Retrospective observational cohort study. PATIENTS: Adults aged ≥ 18 years, hospitalized with a primary diagnosis of RSV, influenza, acute MI, or stroke from January 01, 2016, to December 31, 2019, were identified from the Premier Healthcare Database using the International Classification of Diseases (ICD-10) codes. MAIN MEASURES: Immediate post-discharge care was categorized into three different levels of care based on the discharge dispositions. Descriptive analyses were performed. KEY RESULTS: In total, 3,629 RSV, 303,577 influenza, 388,682 acute MI, and 416,750 stroke hospitalizations were identified, the majority occurred among patients aged ≥ 65 years. Professional home care needs were the highest for RSV hospitalizations (19.1%), followed by influenza (17.7%), stroke (15.4%), and acute MI (9.8%). Additionally, institutional care needs immediately following discharge were similar for RSV, influenza, and acute MI hospitalizations (14.2%, 15.8%, and 14.1%, respectively). CONCLUSIONS: Immediate post-discharge care needs among adults hospitalized with RSV, especially in older adults, can be considerable and comparable to influenza and acute MI discharges. With recently approved RSV vaccines, efforts to increase vaccination in older adults are needed to prevent RSV and associated healthcare consequences.

The effect of legal representation on clinical measures in involuntarily admitted psychiatric patients: a retrospective study.

BACKGROUND: Most western countries provide funded legal representation (LR) for involuntarily admitted psychiatric patients appearing before judicial committees. In 2004, an amendment to the Israeli Mental Health Act granted this right to involuntarily committed psychiatric patients. Psychiatrists then voiced concerns that LR may increase rates of premature discharge and compromise patients' safety and well-being. These worries have not been sufficiently addressed to date. This study aimed to provide answers to their concerns. METHODS: This study included 3124 and 3434 inpatients involuntarily admitted to psychiatric facilities in 2000 and in 2010 (respectively), prior to and after the introduction of LR in Israel. Data were acquired from the Israeli National Psychiatric Hospitalization Registry. Clinical measures included percentage of discharges by the District Psychiatric Board (DPB), duration of involuntary hospitalization and rates of readmissions within thirty days and six months of discharge by treating psychiatrists (TP) or DPB. RESULTS: The odds ratio (OR) of discharge by a DPB in 2010 (n = 221) compared to 2000 (n = 93) was 2.2 [95%CI 1.72-2.82]. The OR was similar for readmissions within thirty days or six months among patients discharged by TP and a DPB (OR = 1.08, p = 0.697 and OR = 0.92, p = 0.603, respectively) as well as between the two time points (p = 0.486 and p = 0.618). The duration of hospitalizations terminated by a DPB was significantly shorter than those terminated by TP, with no difference between the study time points. The mean hospitalization duration in 2010 was 21% shorter compared to 2000 among patients discharged by TP. CONCLUSIONS: The number of DPB proceedings and the number of involuntarily hospitalized psychiatric patients discharged by DPBs increased considerably after the advent of state-funded legal representation in 2004. We found that this did not compromise beneficence and non-malfeasance of patient care. Our results emphasize the feasibility of affording even the most severely mentally ill patients the rights to due process. These findings may relieve concerns about state-funded LR procedures in involuntary psychiatric hospitalizations.

Post-discharge Outcomes of COVID-19 Patients in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Understanding the post-discharge outcomes of COVID-19 patients is essential for informed healthcare planning and support services. This study aimed to assess the physical health status of COVID-19 patients three months after discharge from a tertiary care hospital in Kathmandu, Nepal. METHODS: A descriptive follow-up study design was used, involving 200 COVID-19 discharged patients. Data were collected from healthcare facilities and participants through structured questionnaires and telephonic interviews. The study duration was between November 2020 to April 2021. RESULTS: Persistence of COVID-19-related symptoms was reported by 49 (24.50%) of participants reported at follow-up, while 41 (20.50%) indicated previous symptoms from discharge. CONCLUSIONS: After discharge, most of patient returned to normal activities within three months.Persistence of symptoms and test positive rate was less in those patients.

Exploring the factors affecting the readiness for hospital discharge after total knee arthroplasty: A structural equation model approach.

AIM: To investigate the factors that influence readiness for hospital discharge in Chinese patients after total knee arthroplasty and to identify priorities for nursing interventions. DESIGN: A cross-sectional study. METHODS: From January to August 2022, data were collected from 339 patients at two tertiary A-level hospitals in Jinan, Shandong Province. SPSS 26.0 and Mplus 8.3 software were used for statistical analysis. RESULTS: Results from multiple linear regression showed that patients' age, residence status, education level, knee pain during sleep, quality of discharge teaching, self-efficacy for rehabilitation, pain control knowledge, and social support were factors influencing their readiness for hospital discharge. The results of the structural equation model had shown that there were also indirect effects of the education level, knee pain during sleep, quality of discharge teaching, and pain control knowledge. CONCLUSION: Patients' readiness for hospital discharge needs further improvement, hence physicians and nurses should judiciously allocate medical resources and concentrate their efforts on high-risk groups characterized by low readiness for hospital discharge. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: This study underscores the importance of physicians and nurses prioritizing key factors such as age, residency status, education level, and social support in total knee arthroplasty patients to enhance their readiness for hospital discharge. By implementing targeted discharge planning, effective pain management, and comprehensive rehabilitation education, healthcare providers can improve patient outcomes. IMPACT: This study identified key factors influencing readiness for hospital discharge in total knee arthroplasty patients, guiding targeted nursing interventions to improve post-operative care. REPORTING METHOD: STROBE. PATIENT OR PUBLIC CONTRIBUTION: The participants recruited for this study were actively engaged in the data collection process.

Standardized therapies after ECMO program (STEP); a novel approach to pediatric post-ECMO care.

BACKGROUND: The study objective was to characterize compliance with Standardized Therapy after ECMO Program (STEP), an intentional discharge pathway for extracorporeal membrane oxygenation (ECMO) survivors in a US pediatric hospital. METHODS: The program identified pediatric ECMO survivors before discharge, appropriate consultations were reviewed and requested, families were educated on ECMO sequelae, and ECMO summaries were sent to pediatricians. Compliance with institutional post-ECMO guidelines was evaluated before and after STEP implementation. RESULTS: We identified 77 ECMO survivors to hospital discharge (36 [46.8%] before and 41 [53.2%] after STEP implementation). There was a significant increase in complete (38.8% vs. 74.2%, p < 0.001) and time-appropriate neurodevelopmental testing (71.4% vs. 95.6%, p = 0.03). Significant increase in inpatient evaluations by neurology (52.7% vs. 75.6%, p = 0.03) and audiology (66.7% vs. 87.8%, p = 0.02), and in referrals for outpatient audiology (66.6 vs. 95.1%, p = 0.002), physical therapy (P.T.) (63.8% vs. 95.1%, p = 0.001), occupational therapy (O.T.) (63.8% vs. 95.1%, p = 0.001) and speech-language pathology (S.L.P.) (55.5% vs. 95.1%, p < 0.001) were noted. CONCLUSION: Implementing an intentional discharge pathway for pediatric ECMO survivors (STEP) successfully increases inpatient and outpatient compliance with hospital and Extracorporeal life support organization (ELSO) follow-up guidelines. It leads to timely and complete neurodevelopmental evaluation.

Efficacy of Remote Health Monitoring in Reducing Hospital Readmissions Among High-Risk Postdischarge Patients: Prospective Cohort Study.

BACKGROUND: Patients with respiratory or cardiovascular diseases often experience higher rates of hospital readmission due to compromised heart-lung function and significant clinical symptoms. Effective measures such as discharge planning, case management, home telemonitoring follow-up, and patient education can significantly mitigate hospital readmissions. OBJECTIVE: This study aimed to determine the efficacy of home telemonitoring follow-up in reducing hospital readmissions, emergency department (ED) visits, and total hospital days for high-risk postdischarge patients. METHODS: This prospective cohort study was conducted between July and October 2021. High-risk patients were screened for eligibility and enrolled in the study. The intervention involved implementing home digital monitoring to track patient health metrics after discharge, with the aim of reducing hospital readmissions and ED visits. High-risk patients or their primary caregivers received education on using communication measurement tools and recording and uploading data. Before discharge, patients were familiarized with these tools, which they continued to use for 4 weeks after discharge. A project manager monitored the daily uploaded health data, while a weekly video appointment with the program coordinator monitored the heart and breathing sounds of the patients, tracked health status changes, and gathered relevant data. Care guidance and medical advice were provided based on symptoms and physiological signals. The primary outcomes of this study were the number of hospital readmissions and ED visits within 3 and 6 months after intervention. The secondary outcomes included the total number of hospital days and patient adherence to the home monitoring protocol. RESULTS: Among 41 eligible patients, 93% (n=38) were male, and 46% (n=19) were aged 41-60 years, while 46% (n=19) were aged 60 years or older. The study revealed that home digital monitoring significantly reduced hospitalizations, ED visits, and total hospital stay days at 3 and 6 months after intervention. At 3 months after intervention, average hospitalizations decreased from 0.45 (SD 0.09) to 0.19 (SD 0.09; P=.03), and average ED visits decreased from 0.48 (SD 0.09) to 0.06 (SD 0.04; P<.001). Average hospital days decreased from 6.61 (SD 2.25) to 1.94 (SD 1.15; P=.08). At 6 months after intervention, average hospitalizations decreased from 0.55 (SD 0.11) to 0.23 (SD 0.09; P=.01), and average ED visits decreased from 0.55 (SD 0.11) to 0.23 (SD 0.09; P=.02). Average hospital days decreased from 7.48 (SD 2.32) to 6.03 (SD 3.12; P=.73). CONCLUSIONS: By integrating home telemonitoring with regular follow-up, our research demonstrates a viable approach to reducing hospital readmissions and ED visits, ultimately improving patient outcomes and reducing health care costs. The practical application of telemonitoring in a real-world setting showcases its potential as a scalable solution for chronic disease management.

Usability Evaluation Methods Used in Electronic Discharge Summaries: Literature Review.

BACKGROUND: With the widespread adoption of digital health records, including electronic discharge summaries (eDS), it is important to assess their usability in order to understand whether they meet the needs of the end users. While there are established approaches for evaluating the usability of electronic health records, there is a lack of knowledge regarding suitable evaluation methods specifically for eDS. OBJECTIVE: This literature review aims to identify the usability evaluation approaches used in eDS. METHODS: We conducted a comprehensive search of PubMed, CINAHL, Web of Science, ACM Digital Library, MEDLINE, and ProQuest databases from their inception until July 2023. The study information was extracted and reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). We included studies that assessed the usability of eDS, and the systems used to display eDS. RESULTS: A total of 12 records, including 11 studies and 1 thesis, met the inclusion criteria. The included studies used qualitative, quantitative, or mixed methods approaches and reported the use of various usability evaluation methods. Heuristic evaluation was the most used method to assess the usability of eDS systems (n=7), followed by the think-aloud approach (n=5) and laboratory testing (n=3). These methods were used either individually or in combination with usability questionnaires (n=3) and qualitative semistructured interviews (n=4) for evaluating eDS usability issues. The evaluation processes incorporated usability metrics such as user performance, satisfaction, efficiency, and impact rating. CONCLUSIONS: There are a limited number of studies focusing on usability evaluations of eDS. The identified studies used expert-based and user-centered approaches, which can be used either individually or in combination to identify usability issues. However, further research is needed to determine the most appropriate evaluation method which can assess the fitness for purpose of discharge summaries.

Improving the secondary diagnoses capture rate in SingHealth Community Hospital discharge summaries: a quality improvement project made successful by change management principles.

High-quality discharge summaries are essential for promoting patient safety during transitions between care settings. When the diagnosis list in the discharge summary is not accurate, the subsequent care provider will not have the latest medical history list and the care and safety of the patient will be compromised. Discrepancies in the secondary diagnosis capture rates have been identified in close to 30% of patients admitted to Sengkang Community Hospital (SKCH) during internal audits. Our project aimed to improve the rates of secondary diagnoses coding in the discharge summaries of patients who were admitted to SKCH using skills of change management in our interventions. Plan-Do-Study-Act cycles used in combination with change management skills led to the success of our quality improvement project. Remarkably, we managed to achieve close to 100% of the secondary diagnoses capture rate after a 5-month period.

Telenursing with elderly people in home care service during the COVID-19 pandemic: quasi-experimental study.

OBJECTIVE: to evaluate telenursing as a support technology in the transition of care for elderly people and their caregivers in the context of home care during the COVID-19 pandemic. METHOD: quasi-experimental before-after, non-randomized study, with 219 elderly people and caregivers from the home care service, divided into 131 in the intervention groups and 88 in the control group. Analytical treatment, descriptive and inferential statistics were carried out. RESULTS: 1691 calls were made, 1515 to the intervention group and 176 to the control group. It was observed that in the first call there is a greater need for interventions to promote health and this quantity decreases throughout the calls with a significant result (p-value < 0.001). The outcomes analyzed were hospitalization, death, discharge or continuation of the home care service and it was observed that the chance of discharge from the service was nine times greater in the intervention group. Continuity of care from the home care service and discharge after the end of the calls were also significant (p-value < 0.001). CONCLUSION: telenursing was a technology to support care, mainly for health promotion and discharge from home care services.

Are Primary Health Care Visits Associated With Reduced Risk of Hospital Readmissions After Discharge From Geriatric Inpatient Departments? Evidence From Stockholm County.

INTRODUCTION/OBJECTIVES: Primary health care visits post-discharge could potentially play an important role in efforts of reducing hospital readmission. Focusing on a single or a particular type of visit obscures nuances in types of primary care contacts over time and fails to quantify the intensity of primary health care visits during the follow-up period. The aim of this study was to explore associations between the number and type of primary health care visits post-discharge and the risk of hospital readmission within 30 days. METHODS: A register-based closed cohort study. The study population of 6135 individuals were residents of Stockholm who were discharged home from any of the 3 geriatric inpatient departments, excluding those who were readmitted within the next 24 h. The dependent variable was hospital readmission within 30 days of discharge. The key independent variable was the number and type of primary health care visits in 30 days post-discharge. Cox-regression with time-varying covariates was employed for data analyses. RESULTS: Approximately, 12% of the participants were readmitted to hospital within 30 days. There was no statistically significant association between number of primary care visits post-discharge and readmission (HR 1.00; 95% CI 1.00-1.01). Compared to no primary health care visit, no statistically significant association were found for administrative care related visits (HR 0.33, 95%CI 0.08-1.33), clinic visits (HR 0.93, 95%CI 0.71-1.21), home visits (HR 1.03, 95%CI 0.84-1.27), or team visits (HR 0.76, 95%CI 0.54-1.07). CONCLUSIONS: There were no associations between primary health care visits post-discharge and hospital readmission after geriatric inpatient care. Further studies using survey or qualitative approaches can provide insights into the factors that are relevant to post-discharge care but are unavailable in this type of register data studies.

Re-Exposure to Culprit Medication Following Adverse Drug Event Diagnosis in Canadian Emergency Department Patients: A Cohort Study.

PURPOSE: The magnitude of repeat exposures to culprit medications after hospital discharge is not well studied. We combined prospective cohort data with administrative health data to understand the frequency of repeat exposures to culprit medications after discharge and the risk factors for their occurrence. METHODS: This was a retrospective analysis of three prospective cohorts of patients who presented to the hospital with an adverse drug event in British Columbia, from 2008 to 2015 (n = 849). We linked prospectively identified adverse drug events to administrative data to examine patterns of redispensing of culprit medications. We used Cox regression to assess risk factors for re-exposure, and conducted subgroup analyses for essential vs. nonessential medications. RESULTS: Among 849 diagnosed adverse drug events, 45.2% had subsequent culprit medication redispensing within a year of hospital discharge. The factors associated with re-exposures included atrial fibrillation, adverse drug event type (e.g. adverse reaction), culprit medication type, and longer historical duration of medication use. CONCLUSIONS: Re-exposures to culprit medications occurred in almost half of the adverse drug events diagnosed in emergency departments. Many of these were appropriate re-exposures to essential medications for indications in which the risk of uncontrolled disease likely outweighed the risk of a repeat adverse event. More research is needed to understand re-exposures to nonessential medications or medications with safer alternatives.

Care transition management and patient outcomes in hospitalized Medicare beneficiaries.

OBJECTIVES: To assess whether discharging hospitals' self-reported care transition activities (CTAs) were associated with transitional care management (TCM) claims following discharge to the community and whether CTAs and TCM were associated with better patient outcomes. STUDY DESIGN: Cross-sectional study of 424,115 hospitalized Medicare fee-for-service beneficiaries 66 years and older who were discharged to the community in 2017 and attributed to 659 hospitals in the 2017-2018 National Survey of Healthcare Organizations and Systems (response rate, 46.5%). Of these beneficiaries, 76,156 were categorized into a Hospital Readmissions Reduction Program (HRRP) cohort based on admission principal diagnoses. METHODS: Using logistic regression, we examined the association between survey-based hospital-reported CTAs and an attributed beneficiary's TCM claim. We assessed the associations between hospital CTAs and TCM and beneficiary spending, utilization, and mortality in linear (continuous outcomes) and logistic (binary outcomes) regressions. RESULTS: Beneficiaries attributed to hospitals reporting high (top tertile vs bottom tertile) CTA had a higher probability of TCM after discharge by 3 percentage points. TCM was associated with lower 90-day episode spending (-$2803; P < .001) and improved quality (-28.7 30-day readmissions/1000 beneficiaries; P < .001; -29.7 deaths/1000 beneficiaries; P < .001), and greater use of evaluation and management visits (491/1000 beneficiaries; P = .001). Billing for TCM was associated with significantly lower spending, emergency department visits, hospitalizations, readmissions, and 90-day mortality in the HRRP cohort. Significant utilization reductions were estimated for beneficiaries attributed to high-CTA hospitals. CONCLUSIONS: Beyond recent increases in provider TCM compensation and relaxed billing restrictions, hospitals should be encouraged to increase CTA and to enhance care transitions to improve patient outcomes and lower spending.

Outcomes by Race and Ethnicity Following a Medicare Bundled Payment Program for Joint Replacement.

Importance: The Comprehensive Care for Joint Replacement (CJR) model, a traditional Medicare bundled payment program for lower-extremity joint replacement, is associated with care for patients outside traditional Medicare. Whether CJR model outcomes have differed by patient race or ethnicity outside of traditional Medicare is unclear. Objective: To evaluate outcomes associated with the CJR model among Hispanic patients not enrolled in traditional Medicare. Design, Setting, and Participants: This cohort study used hospitalization data from California's Patient Discharge Dataset for all patients who underwent lower-extremity joint replacement in California between January 1, 2014, and December 31, 2017. In California, 3 metropolitan statistical areas (MSAs) were randomly selected to participate in CJR in April 2016. Hospitals not participating in other Medicare Alternative Payment Models were included in the treated group if they were in these 3 MSAs and in the control group if they were in the remaining 23 MSAs. The data analysis was performed between October 1 and December 31, 2023. Exposure: Comprehensive Care for Joint Replacement program implementation. Main Outcomes and Measures: The main outcomes were hospital length of stay and home discharge rates by race and ethnicity. Home discharge status included self-care, the use of home health services, and hospice care at home. Event study, difference-in-differences, and triple differences models were used to estimate differential changes in health care service use by race and ethnicity for patients in the treated MSAs compared with the control MSAs before vs after CJR implementation. Results: Of 309 834 hospitalizations (patient mean [SD] age, 68.3 [11.3] years; 60.6% women; 14.8% Hispanic; 72.4% non-Hispanic White), 48.0% were in treated MSAs and 52.0% in control MSAs. The CJR program was associated with an increase in home discharge rates for patients without traditional Medicare coverage; however, the increase differed by patient race and ethnicity. The increase was 0.05 (95% CI, 0.02-0.08) percentage points higher for Hispanic patients with Medicare Advantage and 0.03 (95% CI, 0.01-0.04) percentage points higher for Hispanic patients without Medicare compared with their non-Hispanic White counterparts. Conclusions and Relevance: This cohort study shows that CJR program outcomes differed by race and ethnicity for patients covered outside traditional Medicare, with home discharge rates increasing more for Hispanic compared with non-Hispanic White patients. These findings suggest the importance of considering differential outcomes of Medicare payment policies for racial and ethnic minority patient populations beyond the initially targeted groups.

Interventions to minimise hospital winter pressures related to discharge planning and integrated care: a rapid mapping review of UK evidence.

Background: Winter pressures are a familiar phenomenon within the National Health Service and represent the most extreme of many regular demands placed on health and social care service provision. This review focuses on a part of the pathway that is particularly problematic: the discharge process from hospital to social care and the community. Although studies of discharge are plentiful, we identified a need to focus on identifying interventions and initiatives that are a specific response to 'winter pressures'. This mapping review focuses on interventions or initiatives in relation to hospital winter pressures in the United Kingdom with either discharge planning to increase smart discharge (both a reduction in patients waiting to be discharged and patients being discharged to the most appropriate place) and/or integrated care. Methods: We conducted a mapping review of United Kingdom evidence published 2018-22. Initially, we searched MEDLINE, Health Management Information Consortium, Social Care Online, Social Sciences Citation Index and the King's Fund Library to find relevant interventions in conjunction with winter pressures. From these interventions we created a taxonomy of intervention types and a draft map. A second broader stage of searching was then undertaken for named candidate interventions on Google Scholar (Google Inc., Mountain View, CA, USA). For each taxonomy heading, we produced a table with definitions, findings from research studies, local initiatives and systematic reviews and evidence gaps. Results: The taxonomy developed was split into structural, changing staff behaviour, changing community provision, integrated care, targeting carers, modelling and workforce planning. The last two categories were excluded from the scope. Within the different taxonomy sections we generated a total of 41 headings. These headings were further organised into the different stages of the patient pathway: hospital avoidance, alternative delivery site, facilitated discharge and cross-cutting. The evidence for each heading was summarised in tables and evidence gaps were identified. Conclusions: Few initiatives identified were specifically identified as a response to winter pressures. Discharge to assess and hospital at home interventions are heavily used and well supported by the evidence but other responses, while also heavily used, were based on limited evidence. There is a lack of studies considering patient, family and provider needs when developing interventions aimed at improving delayed discharge. Additionally, there is a shortage of studies that measure the longer-term impact of interventions. Hospital avoidance and discharge planning are whole-system approaches. Considering the whole health and social care system is imperative to ensure that implementing an initiative in one setting does not just move the problem to another setting. Limitations: Time limitations for completing the review constrained the period available for additional searches. This may carry implications for the completeness of the evidence base identified. Future work: Further research to consider a realist review that views approaches across the different sectors within a whole system evaluation frame. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130588) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 31. See the NIHR Funding and Awards website for further award information.

Every year, the National Health Service struggles with huge care demands from people with heart and lung problems. This 'mapping review' aimed to chart the evidence around what has been done to minimise winter pressures related to discharge planning, by helping people leaving hospital sooner, and by optimising integrated care (also known as 'collaborative care') and to make suggestions for future research. Good research evidence was identified for three specific approaches: Acute medical units: these units provide rapid assessment, diagnosis and treatment for adults referred by their general practitioner or the emergency department. Discharge to assess: this involves discharging patients who need care services but not an acute hospital bed. Patients are either discharged home or are transferred to an appropriate community setting with short-term funded support while their future care needs are assessed. Hospital at home: this approach provides patients with the care they need at home instead of in hospital (also known as virtual wards). The evidence for many other activities to reduce winter pressures was weaker, coming from case studies, conference presentations or small, low methodological quality (poorly designed or executed) research studies. The review identified many different initiatives with diverse names or labels and it is also important to consider how implementing an initiative in one setting might affect another setting. Further research is recommended around what works best for which patient groups, under what circumstances and why, based on common processes within the different initiatives and across the whole health and social care system.

Vaginal natural orifice transvaginal endoscopic surgery (vNOTES) for benign ovarian cysts is safe and feasible in same-day discharge: a retrospective cohort study.

BACKGROUND: Advances in minimally invasive surgery and the development of Enhanced Recovery After Surgery (ERAS) have favored the spread of day-surgery programs. Even though Vaginal natural orifice transvaginal endoscopic surgery (vNOTES) is accepted as an innovative treatment for benign ovarian cysts that is rapidly gaining recognition worldwide, the safety and feasibility of same-day surgery (SDS) have yet to be established. OBJECTIVE: This study aimed to evaluate the safety and feasibility of day surgery compared to inpatient surgery of patients undergoing vNOTES for benign ovarian cysts by determining perioperative outcomes. MATERIALS AND METHODS: The study consisted of 213 patients who underwent vNOTES for ovarian cystectomy at a single institution from January 2020 to November 2022. Based on the hospital stay, patients were classified into the same-day surgery group (SDSG) and the inpatient surgery group (ISG); after data processing and screening considering the balance of the two groups, SDSG has 83 samples(n = 83), and ISG has 113 samples(n = 113). The patient's demographic characteristics and follow-up data were collected during the perioperative period by doctors and nurses for medical tracking and analysis purposes and 1-month postoperatively by doctors in charge of their operation. Independent sample t-tests were performed to verify if there was any major difference between these two groups for continuous data like age, BMI, and cyst diameter, and Pearson's chi-squared tests were used to test whether there was a major difference between these two groups for categorical data like cyst count, abdominal surgery history and whether their cyst is bilateral ovarian cysts or not. The association between exhaust time and postoperative characteristics and the association between levels of pain and postoperative characteristics were further analyzed to unveil the confounding factors contributing to the same-day discharge method's quick recovery nature. RESULTS: Upon performing propensity score matching, 196 patients were finally enrolled in this study for the matched comparison, including 83(42.3%) patients in the SDSG and 113(57.7%) patients in the ISG. There was no statistical difference between the two groups in terms of duration of operation (85.0 ± 41.5 min vs. 80.5 ± 33.5 min), estimated blood loss (27.7 ± 28.0 ml vs. 36.3 ± 33.2 ml), preoperative hemoglobin levels (128.8 ± 13.2 g/L vs. 128.6 ± 14.0 g/L), postoperative hemoglobin difference at 24 h (16.5 ± 15.4 g/L vs. 19.3 ± 9.1 g/L), pelvic adhesions (42 (50.6%) vs. 47 (41.6%)), and postoperative complications (7(8.4%) vs. 4(3.5%)). The SDSG group showed less time of feeding/off-bed/exhaust/urination after surgery, shorter hospitalization duration, a lower postoperative 6-hour pain score, and a lower incidence of analgesic drug use. Multiple linear regression analysis showed that advancing the time of postoperative off-bed activity and feeding reduced the postoperative exhaust time by 0.34 (95% CI: 0.185-0.496, 0.34 h, p < 0.001) and 0.299(95% CI: 0.158-0.443, 0.229 h, p = 0.036) hours. In addition, Ordinal logistic regression revealed a correlation between pain scores and bilaterality of cyst, increasing about 25.98 times the risk of pain levels when ovarian cysts are bilateral (OR: 26.98, 95% CI: 1.071-679.859, P = 0.045). CONCLUSION: In this pilot study, same-day discharge after vaginal natural orifice transvaginal endoscopic ovarian cystectomy is safe and feasible. The vNOTES for ovarian cystectomy combined with the same-day discharge shorten the exhaust time and duration of hospitalization, reduce postoperative pain, and lower the use incidence of analgesic drugs.

Hospital and post-discharge mortality in COVID-19 patients with a preexisting cancer diagnosis in Iran.

BACKGROUND: Despite the severe impact of COVID-19 on cancer patients, data on COVID-19 outcomes in cancer patients from low- and middle-income countries is limited. We conducted a large study about the mortality rate of COVID-19 in cancer patients in Iran. METHODS: We analyzed data from 1,079 cancer (average age: 58.2 years) and 5,514 non-cancer patients (average age: 57.2 years) who were admitted for COVID-19 in two referral hospitals between March 2019 and August 2021. Patients were followed up until death or 31st August 2021. Multiple logistic regression models estimated the odds ratio (OR) and 95% confidence intervals (CI) of factors associated with ICU admission and intubation. The Cox regression model estimated hazard ratios (HRs) and 95% CI of factors associated with hospital and post-discharge 60-day mortalities. RESULTS: The cancer patients had higher ICU admission (OR = 1.65, 95% CI: 1.42-1.91; P-value 0.03) and intubation (OR = 3.13, 95% CI = 2.63-3.73, P-value < 0.001) than non-cancer patients. Moreover, hospital mortality was significantly higher in cancer patients than in non-cancer patients (HR = 2.12, 95% CI: 1.89-2.41, P-value < 0.001). HR for the post-discharge mortality was higher in these patients (HR = 2.79, 95% CI: 2.49-3.11, < 0.001). The hospital, comorbidities, low oxygen saturation, being on active treatment, and non-solid tumor were significantly associated with ICU admission (P-value < 0.05) in cancer patients, while only low oxygen saturation was associated with intubation. In addition, we found that old age, females, low oxygen saturation level, active treatment, and having a metastatic tumor were associated with death due to COVID-19 (P-value < 0.05). Only lung cancer patients had a significantly higher risk of death compared to other cancer types (HR = 1.50, 95% CI: 1.06-2.10, P-value = 0.02). CONCLUSION: Cancer patients are at a higher risk of ICU admission, intubation, and death due to COVID-19 than non-cancer patients. Therefore, cancer patients who are infected with COVID-19 require intensive care in the hospital and active monitoring after their discharge from the hospital.

What happened to the patients? Care trajectories for persons with a delayed hospital discharge during wave 1 of COVID-19 in Ontario, Canada; a population-based retrospective cohort study.

During the initial wave of coronavirus disease of 2019 (COVID-19), patients were rapidly discharged from acute hospitals in anticipation of an expected influx of patients with COVID-19. Patients that were no longer receiving acute medical care but were waiting for their next destination (i.e., delayed hospital discharge) were particularly affected. The objectives of this study were to examine the impact of COVID-19 onset on healthcare utilization and mortality among those who experienced delayed discharge from acute care. We conducted a population-based retrospective cohort study using linked administrative data. We included persons discharged from acute care who experienced a delayed hospital stay between April 1, 2019 and September 30, 2020. The onset of COVID-19 was the exposure (March 1, 2020), while the period of April 1, 2019 to February 29, 2020 was considered as a comparator. Primary outcomes included healthcare utilization and mortality following discharge, stratified by care setting (homecare, inpatient rehabilitation or long-term care). Multivariable logistic, zero-inflated Poisson regressions, and Cox proportional hazard models were used to examine the impact of COVID-19 on outcomes while adjusting for covariates. Those discharged home were more likely to receive homecare and physician visits within 30 days during COVID-19. The type of visits examined included both in-person as well as virtual visits. Individuals discharged to inpatient rehabilitation experienced lower rates of general physician visits but higher rates of specialist and homecare visits. Patients discharged to long-term care were significantly less likely to receive a physician visit following COVID-19, and significantly more likely to be readmitted within 7-days. There were no significant differences in mortality irrespective of discharge destination during the two time periods. Overall, the onset of the initial wave of COVID-19 significantly impacted healthcare utilization among those with a delayed discharge but varied depending on destination, with those in long-term care being most impacted.

Turkish adaptation of the Neonatal Eating Assessment Tool-Bottle-Feeding in preterm infants discharged to home.

Background/aim: Preterm infants often continue to have feeding difficulties after hospital discharge. Parental use of assessment tools and collaboration with health professionals are important for the early diagnosis of postdischarge feeding difficulties. This methodological study examined the validity and reliability of the Turkish version of the Neonatal Eating Assessment Tool (NeoEAT)-Bottle-feeding in postdischarge preterm infants in Türkiye. Materials and methods: A Turkish version of the NeoEAT-Bottle-feeding was developed and applied to 321 mothers of preterm infants younger than 7 months of corrected age between August 2021 and December 2022. Cronbach's alpha, exploratory factor, confirmatory factor, item-total correlation, test-retest, and known-groups validity analyses were performed. Results: The Turkish NeoEAT-Bottle-feeding has 60 items in five factors explaining 55.785% of the total variance. Exploratory factor analysis indicated that the item factor loading ranged from 0.320 to 0.792. The known-group validity analysis confirmed that preterm infants with diagnosed feeding problems had higher total and subscale scores than those without (p = 0.001). The Cronbach's alpha (α) of the entire scale was 0.96. The item-total correlation coefficients were between 0.31 and 0.77 (p = 0.001). There was excellent agreement between test values and retest values obtained after a 2-week interval (intraclass correlation coefficient: 0.930-1.000). Conclusion: The Turkish NeoEAT-Bottle-feeding was shown to be a reliable and valid parent-reported assessment tool for oral feeding skills and difficulties after neonatal intensive care unit discharge in bottle-fed preterm infants younger than 7 months of corrected age. Healthcare professionals can use this assessment tool during the initial evaluation of risk factors contributing to problematic feeding and to determine the effectiveness of planned interventions in preterm infants.

Clinical course in older patients diagnosed with syncope treated in Spanish emergency departments: results from the Emergency Department and Elder Needs-17 study. / Evolución clínica de los pacientes mayores diagnosticados de síncope en servicios de urgencias en España: resultados del estudio EDEN-17.

OBJECTIVE: To study factors associated with hospitalization in an unselected population of patients aged 65 years or older treated for syncope in Spanish hospital emergency departments (EDs). To determine the prevalence of adverse events at 30 days in patients discharged home and the factors associated with such events. METHODS: We included all patients aged 65 years or older who were diagnosed with syncope during a single week in 52 Spanish EDs, recording patient clinical and ED case management data. We compared the findings between hospitalized patients and those discharged home, following the latter for 30 days. In discharged patients, we explored predictors of a composite adverse-event outcome (occurrence of any of the following: ED revisits, hospitalization related to the index visit, or any-cause death). RESULTS: A total of 477 patients with syncope were identified; 67 (14%) were admitted, and 5 (7.5%) died. The median (interquartile range) length of hospital stay was 6 days (3-11 days). Comorbidity increased the probability of hospitalization (odds ratio, 2.172; 95% CI, 1.013-4.655). Among the 410 patients (86%) discharged home from the ED, 9.2% experienced an adverse event within 30 days (ED revisits, 8.,1%; hospitalization, 2.2%; death, 1.5%). No factors were associated with the 30-day composite outcome. CONCLUSIONS: The majority of patients aged 65 years or older are discharged home from EDs, and 30-day adverse events, while infrequent, are difficult to predict. Hospitalization was related to comorbidity and an absence of cognitive decline.

OBJETIVO: Investigar en una muestra no seleccionada de población mayor (65 o más años) atendida en servicios de urgencias hospitalarios (SUH) españoles por síncope los factores que se asociaron con la hospitalización, prevalencia de eventos adversos (EA) a 30 días y los factores asociados a estos entre los pacientes dados de alta desde urgencias. METODO: Se incluyeron todos pacientes con 65 o más años diagnosticados de síncope durante una semana en 52 SUH españoles. Se recogieron datos de la situación clínica y el manejo en urgencias, que se compararon entre los pacientes hospitalizados y los dados de alta directamente desde urgencias. Estos últimos fueron seguidos durante 30 días y se identificaron aquellos que presentaron un EA combinado (reconsulta en urgencias u hospitalización relacionada con el evento índice y muerte por cualquier causa), y se investigaron los factores que predecían dicho EA combinado. RESULTADOS: Se identificaron 477 pacientes con síncope. Hospitalizaron 67 (14%), de los que fallecieron 5 (7,5%) y la estancia mediana fue de 6 días (RIC 3-11). La comorbilidad incrementó la probabilidad de ingreso (OR: 2,172, IC 95%: 1,013-4,655). Entre los 410 pacientes dados de alta de urgencias (86%), el 9,2% tuvo un EA durante los 30 días siguientes (reconsulta a urgencias: 8,1%; hospitalización: 2,2%; muerte: 1,5%). Ningún factor se asoció con el riesgo de EA combinado a 30 días. CONCLUSIONES: La mayoría de los pacientes con 65 años o más atendidos en los SUH por síncope son dados de alta directamente desde urgencias, y los EA a los 30 días fueron poco frecuentes, pero difíciles de predecir. La hospitalización se relacionó con presencia de comorbilidad y ausencia de deterioro cognitivo.

Long-term survival after out-of-hospital cardiac arrest in children: outcomes in Andalusia in 2008-2019. / Supervivencia a largo plazo de la parada cardiaca extrahospitalaria en edad pediátrica: resultados en Andalucía durante el periodo 2008-2019.

OBJECTIVE: To determine survival to discharge and neurological outcomes on long-term follow-up of pediatric patients attended for out of-hospital cardiac arrest (OHCA). METHODS: Retrospective study based on an ongoing OHCA registry. Patients aged 16 years or younger were included. Futile resuscitation attempts were excluded. Neurological outcome on hospital discharge and on follow-up was based on variables in the Pediatric Cerebral Performance Category (PCPC) scale. Cases from January 1, 2008, through December 31, 2019, were extracted, and 2 surveys were carried out in May 2021 and January 2023. Patient follow-up time ranged from 1 to 13 years. RESULTS: Of the 13 778 patients in the registry, we found 277 (2.0%) who were aged 16 years or younger. One hundred thirty-seven patients (49.5%) were transported to a hospital, and spontaneous circulation was restored in 99 (35.7%). Thirty-six patients (13%) were discharged. The median (interquartile range) follow-up time was 2172 (978-3035) days. Thirty-one of these patients (86.1%) were alive at follow-up, 3 had died, and 2 were lost to follow-up. Neurological outcomes had worsened in 2 and improved in 6 patients. The neurological outcome of 27 of the 31 patients with complete follow-up data (87.1%) was good (PCPC scores of 1 or 2). CONCLUSIONS: In spite of the low incidence of shockable rhythm in pediatric OHCA, survival with a good neurological outcome is comparable to survival in adults. Children who are discharged after OHCA maintained or improved their neurological function over the long term.

OBJETIVO: Conocer la supervivencia al alta y la evolución neurológica tras seguimiento a largo plazo de pacientes pediátricos atendidos por parada cardíaca extrahospitalaria. METODO: Estudio retrospectivo basado en un registro continuo de parada cardiaca extrahospitalaria. Se incluyeron los pacientes pediátricos (edad menor o igual a 16 años). Se excluyeron reanimaciones consideradas fútiles. Se tomaron como variables resultado el estado neurológico al alta hospitalaria y al seguimiento de los pacientes, siguiendo el modelo de la Pediatric Cerebral Performance Category. El periodo fue del 1 de enero de 2008 al 31 de diciembre de 2019. Se realizaron dos encuestas, en mayo del 2021 y enero del 2023 con un periodo de seguimiento entre 1 y 13 años. RESULTADOS: De los 13.778 pacientes, 277 (2,0%) eran menores de 16 años; 137 (49,5%) trasladados al hospital, 99 de ellos (35,7%) con recuperación de circulación espontánea. Recibieron el alta hospitalaria 36 pacientes (13%). En el seguimiento, mediana (RIC) de 2.172 [978-3.035] días, 31 pacientes (86,1%) seguían con vida, 3 pacientes fallecieron y en dos casos no obtuvimos información. Dos pacientes sufrieron un empeoramiento del estado neurológico y 6 mejoraron. Finalmente, 27 de los 31 pacientes (87,1%) que completaron el seguimiento tenían una buena situación neurológica (PCPC1-2). CONCLUSIONES: A pesar de presentar una incidencia baja, la supervivencia con buen estado neurológico al alta hospitalaria de la parada cardiorrespiratoria extrahospitalaria pediátrica es comparable a la del adulto. Los pacientes pediátricos que recibieron el alta hospitalaria tras una parada cardiorrespiratoria extrahospitalaria mantuvieron o mejoraron su estado neurológico en el seguimiento a largo plazo.