Reductions in inpatient and outpatient mental health care in germany during the first year of the COVID-19 pandemic - What can we learn for a better crisis preparedness?

BACKGROUND: During the COVID-19 pandemic, reports from several European mental health care systems hinted at important changes in utilization. So far, no study examined changes in utilization in the German mental health care inpatient and outpatient mental health care system comprehensively. METHODS: This longitudinal observational study used claims data from two major German statutory health insurances, AOK PLUS and BKK, covering 162,905 inpatients and 2,131,186 outpatients with mental disorders nationwide. We analyzed changes in inpatient and outpatient mental health service utilization over the course of the first two lockdown phases (LDPs) of the pandemic in 2020 compared to a pre-COVID-19 reference period dating from March 2019 to February 2020 using a time series forecast model. RESULTS: We observed significant decreases in the number of inpatient hospital admissions by 24-28% compared to the reference period. Day clinic admissions were even further reduced by 44-61%. Length of stay was significantly decreased for day clinic care but not for inpatient care. In the outpatient sector, the data showed a significant reduction in the number of incident outpatient diagnoses. CONCLUSION: Indirect evidence regarding the consequences of the reductions in both the inpatient and outpatient sector of care described in this study is ambiguous and direct evidence on treatment outcomes and quality of trans-sectoral mental healthcare is sparse. In line with WHO and OECD we propose a comprehensive mental health system surveillance to prepare for a better oversight and thereby a better resilience during future global major disruptions.

Big data analysis reveals significant increases in complications, costs, and hospital stay in revision total knee arthroplasty compared to primary TKA.

INTRODUCTION: Despite significant advancements in total knee arthroplasty (TKA), some patients require revision surgery (R-TKA) due to complications such as infection, mechanical loosening, instability, periprosthetic fractures, and persistent pain. This study aimed to explore the specific causes leading to R-TKA, associated complications, including infection, mechanical failure, and wound issues, as well as costs, mortality rates, and hospital length of stay (LOS) using data from a large national database. METHODS: Data from the nationwide inpatient sample (NIS), the largest publicly available all-payer inpatient care database in the United States were analysed from 1 January 2016 to 31 December 2019. The study included 44,649 R-TKA cases, corresponding to 223,240 patients, with exclusions for nonelective admissions. Various statistical analyses were used to assess clinical outcomes, including in-hospital mortality, postoperative complications, LOS, and hospitalization costs. RESULTS: Among 2,636,880 TKA patients, 8.4% underwent R-TKA. R-TKA patients had higher rates of chronic conditions, including mental disorders (36.4%) and renal disease (9.9%). Additionally, these patients often experienced instability, necessitating revision surgery. Infection (22.3%) was the primary reason for R-TKA, followed by mechanical loosening (22.9%) and instability. Compared to primary TKA patients, R-TKA patients exhibited higher in-hospital mortality (0.085% vs. 0.025%), longer LOS (3.1 vs. 2.28 days), and higher total charges ($97,815 vs. $62,188). Postoperative complications, including blood transfusion (4.6% vs. 1.3%), acute kidney injury (4.4% vs. 1.8%), venous thromboembolism (0.55% vs. 0.29%), infection, and wound problems, were significantly higher in R-TKA patients. CONCLUSIONS: This study provides detailed insights into t LOS, costs, and complications associated with specific etiologies of revision TKA. Our findings emphasize the need for targeted preoperative optimization and patient education. This approach can help reduce the incidence and burden of R-TKA, improve patient care, optimize resource allocation, and potentially decrease the overall rates of complications in revision surgeries. LEVEL OF EVIDENCE: Level III.

A Programme of Hepatitis C Surveillance With Active Linkage to Care (HEAL) for Inpatients in Two Tertiary Hospitals in Jiangsu, China.

Hepatitis C virus (HCV) infection is a major public health burden in China, affecting more than 10 million individuals. We aimed to evaluate the effectiveness of a hospital-based intervention programme for HCV Surveillance with linkage to care (HEAL) in a prospective cohort. The HEAL programme was carried out targeting inpatients from non-infectious departments of two tertiary hospitals in Jiangsu, China. It consisted of an educational campaign to raise awareness of physicians from non-IDs to promote HCV surveillance, a patient-navigator-centred clinical algorithm responsible for the efficient follow-up of patients with positive HCV antibody, including comprehensive testing, diagnosis and treatment. We characterised the rate of linkage to HCV diagnosis, care and treatment during the pre-intervention period (from 1 July 2016 and June 30, 2018) and after the intervention (from March 2019 to May 2021). During the pre-intervention period, 89,303 (45.3%) out of 196,780 non-ID inpatients were screened for anti-HCV, and 631 patients were tested positive. One hundred and fifty-six (24.7%) patients was followed up for HCV RNA confirmatory testing, and 58 (37.1%) of patients further were diagnosed with chronic HCV infection (CHC). Only 18 (31.3%) of the diagnosed patients with CHC were linked to hepatitis C clinics for treatment, 10 (55.6%) patients received antiviral regimen. Among them, two (11.1%) received DAA treatment, while eight (44.4%) adopted peginterferon/ribavirin regimen. During the intervention period, 232,275 patients were hospitalised in non-infectious department and 151,203 (65.1%) were screened for anti-HCV. Of these, 960 patients tested positive for HCV antibodies, resulting in a prevalence of anti-HCV positivity of 0.63%. Six hundred and seventy (69.8%) patients were enrolled, and 100% were followed up for HCV RNA confirmatory testing. Two hundred and ninety-one (43.4%) individuals with active HCV were identified. Two hundred and thirty-eight (81.8%) of HCV-infected individuals were linked to HCV care, and 157 (65.9%) were linked to treatment. Compared to the pre-intervention period, there was a 2.61-fold increase in the percentage of patients linked to care and a 5.94-fold increase in the proportion of patients who started DAAs therapy. This HEAL programme achieved enhanced HCV Surveillance with linkage to care, which has been demonstrated as an effective strategy in the hospital setting to improve the hepatitis C care continuum by identifying inpatients unaware of their HCV status and facilitating their access to HCV treatment.

Aggressive Behaviour Risk Assessment Tool for Hospitalised Patients in Non-Psychiatric Inpatient Units.

AIM: To refine and validate an electronic version of the Aggressive Behaviour Risk Assessment Tool (ABRAT) and determine the sensitivity and specificity for identifying potentially violent patients in non-psychiatric inpatient units. DESIGN: A prospective cohort study design was used. METHODS: All patients admitted or transferred to three inpatient units of an acute care hospital in Nebraska, USA, from 7 February to 9 April 2023, were included. The 10-item ABRAT assessments were performed daily for the first 3 days of admission. The violent events were collected until discharge in three categories: Physical aggression towards others, physical aggression towards property and verbal intimidation/threat towards others. Kendall's tau tests and a multivariate logistic regression procedure were performed to select a parsimonious set of items that best predict violent events. RESULTS: Of 1179 patients, 69 had ≥1 violent event (5.9%). The revised six-item tool with item weighting was named ABRAT for Hospitalised Patients (ABRAT-H). The area under the curve from the Receiver Operating Characteristics analysis was 0.82. The sensitivity and specificity at a cutoff score of two were 68.1% and 85.2%, respectively. As ABRAT-H scores increased, the percentage of violent patients also increased and for patients with scores ≥5, 55.2% became violent. CONCLUSION: ABRAT-H appears to be useful for identifying potentially violent patients in non-psychiatric inpatient units with satisfactory sensitivity and specificity. IMPLICATIONS FOR PATIENT CARE: The availability of ABRAT-H may help provide focused preventive measures that target patients at high risk for violence and reduce violent events. IMPACT: A majority of the nursing workforce is employed in acute care hospital setting, and the availability of ABRAT-H can further enhance the culture of a safe work environment and have positive impacts not only on the nurses' physical and mental health but also on the quality of patient care. REPORTING METHOD: We have adhered to relevant STROBE guidelines for reporting observational studies. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Health & Productivity Management Associated With Improved Efficiency of Inpatient Health Care: Cross-sectional Study Using FY2021 Bed Function Report.

This study examined the relationship between health and productivity management (H&PM) and inpatient health care efficiency in hospitals. This cross-sectional study is based on 1108 hospitals using data from the FY2021 Bed Function Report. The presence of Certified H&PM Organization was the proxy variable for H&PM implementation. The efficiency value obtained using the input-oriented Banker-Charners-Cooper model of data envelopment analysis was a proxy variable for inpatient health care efficiency. The input variables were the number of hospital beds, registered physicians, ward nurses, and other staff members in the ward. The output variable was the total number of patients in the ward per year. We conducted a Wilcoxon rank-sum test and compared certified and non-certified hospitals. The efficiency value was the objective variable, and certification presence was the explanatory variable. We used a stepwise method, including adjustment variables, to confirm whether the certification presence remained in the final multiple regression model. Efficiency was significantly higher in certified hospitals than non-certified hospitals. Certification presence remained in the final multiple regression model (ß = .027, CI = -0.004 to 0.057, P = .085). Although not statistically significant, certified hospitals tended to have higher efficiency compared to non-certified hospitals. These findings suggested that hospitals that actively engage in H&PM may have higher efficiency in inpatient health care. However, further research is needed to establish the causal relationship.

Characteristics of self-harm on an adolescent psychiatric inpatient unit based on neurodevelopmental diagnoses.

Introduction: Engagement in self-harm is common among youth in psychiatric inpatient units, however the nature of self-harm may be different in psychiatric care due to the increased supervision and theoretically decreased access to typical means of self-harm. This study aims to describe daily reports of self-harm experienced during psychiatric inpatient stays among adolescents and compare these inpatient self-harm experiences based on neurodevelopmental diagnoses (NDDs, including autism) given that self-harm methods differ across NDD diagnostic groups outside of the inpatient unit. Methods: Data were derived from a larger study of risk factors among a sample of 119 suicidal adolescent inpatients, recruited from a large, urban adolescent inpatient psychiatric unit. Participants answered a daily series of self-report questions, including items about self-harm engagement, frequency, and methods used since the last survey. Results: There was no difference in the number of participants who reported any engagement in self-harm based on diagnostic group (χ2 = 0.08, p = .96). There were also no differences in the frequency of self-harm across diagnostic groups (F = 2.40, p = .12). There were no differences in the use of any method across diagnostic groups (ps > 0.05). Conclusions: Findings revealed that in an inpatient unit where patients are presenting for self-harm risk, there are no significant differences in engagement, frequency, or methods used for self-harm based on autism and NDD status. These analyses provide valuable clinical information regarding a lack of differences in self-harm by these diagnostic subgroups. Future research should seek to further explore functional purposes of self-harm on inpatient unit and how this differs by diagnoses.

Differential effects of oral versus intravenous hydrocortisone and dexamethasone on capillary blood glucose levels in adult inpatients - a single centre study.

BACKGROUND: Corticosteroids raise blood glucose concentrations; however, it remains unknown which form of administration, oral or intravenous, is associated with the greatest degree of blood glucose rise in hospitalised patients. Furthermore, whether the pattern of the associated hyperglycaemia throughout the day differs depending on the route of administration. METHODS: This was a single centre retrospective study of 384 adult inpatients receiving oral or intravenous hydrocortisone and dexamethasone. Data on capillary glucose concentrations and time taken over seven days were collected. A mixed model for repeated measures was applied to compare changes in glucose concentration over time for oral and intravenous corticosteroids. An auto-regressive covariance structure was employed to model correlations between repeated measurements. This was adjusted for age, sex, pre-admission diabetes, and/or pre-admission corticosteroid status. RESULTS: No significant difference was found between oral and intravenous hydrocortisone on day one or across all seven days (Mean Difference 0.17mmol/l (-1.39, 1.75), p=0.827, and Mean Difference 0.20mmol/l (-0.61, 1.01), p=0.639 respectively). There were no differences in mean glucose concentrations between those on oral or intravenous dexamethasone on day one or across all seven days (Mean Difference 0.41mmol/l (-0.55,1.38), p=0.404 and Mean Difference -0.09mmol/l (-1.05,0.87), p=0.855respectively). CONCLUSION: This study found that oral and intravenous administration of hydrocortisone and dexamethasone, do not have a significantly differing impact on blood glucose levels. Capillary glucose monitoring is strongly recommended in all individuals who are on either oral or intravenous corticosteroids.

Co-Designing Remote Patient Monitoring Technologies for Inpatients: Systematic Review.

BACKGROUND: The co-design of health technology enables patient-centeredness and can help reduce barriers to technology use. OBJECTIVE: The study objectives were to identify what remote patient monitoring (RPM) technology has been co-designed for inpatients and how effective it is, to identify and describe the co-design approaches used to develop RPM technologies and in which contexts they emerge, and to identify and describe barriers and facilitators of the co-design process. METHODS: We conducted a systematic review of co-designed RPM technologies for inpatients or for the immediate postdischarge period and assessed (1) their effectiveness in improving health outcomes, (2) the co-design approaches used, and (3) barriers and facilitators to the co-design process. Eligible records included those involving stakeholders co-designing RPM technology for use in the inpatient setting or during the immediate postdischarge period. Searches were limited to the English language within the last 10 years. We searched MEDLINE, Embase, CINAHL, PsycInfo, and Science Citation Index (Web of Science) in April 2023. We used the Joanna Briggs Institute critical appraisal checklist for quasi-experimental studies and qualitative research. Findings are presented narratively. RESULTS: We screened 3334 reports, and 17 projects met the eligibility criteria. Interventions were designed for pre- and postsurgical monitoring (n=6), intensive care monitoring (n=2), posttransplant monitoring (n=3), rehabilitation (n=4), acute inpatients (n=1), and postpartum care (n=1). No projects evaluated the efficacy of their co-designed RPM technology. Three pilot studies reported clinical outcomes; their risk of bias was low to moderate. Pilot evaluations (11/17) also focused on nonclinical outcomes such as usability, usefulness, feasibility, and satisfaction. Common co-design approaches included needs assessment or ideation (16/17), prototyping (15/17), and pilot testing (11/17). The most commonly reported challenge to the co-design process was the generalizability of findings, closely followed by time and resource constraints and participant bias. Stakeholders' perceived value was the most frequently reported enabler of co-design. Other enablers included continued stakeholder engagement and methodological factors (ie, the use of flexible mixed method approaches and prototyping). CONCLUSIONS: Co-design methods can help enhance interventions' relevance, usability, and adoption. While included studies measured usability, satisfaction, and acceptability-critical factors for successful implementation and uptake-we could not determine the clinical effectiveness of co-designed RPM technologies. A stronger commitment to clinical evaluation is needed. Studies' use of diverse co-design approaches can foster stakeholder inclusivity, but greater standardization in co-design terminology is needed to improve the quality and consistency of co-design research.

Adverse mental health inpatient experiences: Qualitative systematic review of international literature.

BACKGROUND: Trauma has a well-established link with poor health outcomes. Adverse experiences in mental health inpatient settings contribute to such outcomes and should impact service design and delivery. However, there is often a failure to fully address these experiences. OBJECTIVE: To describe the spectrum of negative experiences that people identify while they are inpatients in adult mental health services. DESIGN: Qualitative systematic review of the international literature. SETTING(S): Inpatient mental health settings globally. PARTICIPANTS: Analysis includes findings from 111 studies across 25 countries. METHODS: CINAHL, MEDLINE and PsycINFO were searched from 2000 onwards, supplemented by Google Scholar. Studies were appraised using the Critical Appraisal Skills Programme qualitative checklist. Data were synthesised using the 'best-fit' framework synthesis approach, enriched by patient and public involvement. RESULTS: Adverse mental health inpatient experiences can be conceptualised under three headings: the ecosystem (the physical environment and the resources available, and other people within or influential to that environment); systems (processes and transitions); and the individual (encroachments on autonomy and traumatisation). CONCLUSIONS: This paper highlights the interplay between systemic, environmental and individual factors contributing to adverse experiences in mental health inpatient settings. By recognising and addressing these factors, we can significantly enhance patient outcomes. Application of adversity to Bronfenbrenner's ecological systems theory provides a strategic approach to improving service design and delivery, advocating for environments that prioritise patient safety, dignity and respect. However, further research is needed to validate the framework and effectively integrate these insights into practice, ultimately transforming the inpatient care experience for all stakeholders. REGISTRATION: The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022323237). TWEETABLE ABSTRACT: Review suggests traumatic experiences in mental health inpatient settings can worsen outcomes. Urges redesign of environment, processes and autonomy to improve care @dr_nutmeg @EmxEn @RAVresearchUoB @IMH_UoB.

The Impact of Artificial Intelligence on Internal Medicine Physicians: A Survey of Procedural and Non-procedural Specialties.

BACKGROUND: Artificial intelligence (AI) is increasingly being integrated into various aspects of healthcare, including internal medicine. However, the impact of AI on physicians across different internal medicine specialties remains unclear. This study assesses AI's adoption, utilization, and perceived impact among procedural and non-procedural internal medicine physicians. METHODS: A comprehensive survey questionnaire was designed to cover current AI use, perceived impact on diagnostic accuracy, treatment decisions, patient outcomes, challenges, ethical concerns, and future expectations. The survey was distributed to a diverse sample of internal medicine physicians across various specialties, including procedural (e.g., interventional cardiology, gastroenterology) and non-procedural (e.g., endocrinology, rheumatology) fields. Responses were analyzed using descriptive statistics, chi-square tests, t-tests, and logistic regression. RESULTS: The survey received responses from 22 internal medicine physicians, with 64% (n=14) representing procedural specialties and 36% (n=8) representing non-procedural specialties. Sixty-eight percent (n=15) of respondents reported using AI tools in their practice, with higher adoption rates among procedural specialties (n=11, 79%) compared to non-procedural specialties (n=4, 50%). Surveyed physicians reported that AI improved diagnostic accuracy (n=12, 80%), treatment decisions (n=10, 67%), and patient outcomes (n=13, 87%). However, 55% (n=12) of respondents expressed concerns about the interpretability and transparency of AI algorithms. Non-procedural specialists were more likely to perceive AI as a threat to their job security (n=3, 38%) than procedural specialists (n=3, 21%). The most common challenges to AI adoption were lack of training (n=16, 73%), cost (n=13, 59%), and data privacy concerns (n=11, 50%). CONCLUSION: This study assesses the perceived impact of AI on internal medicine physicians, highlighting the differences between procedural and non-procedural specialties. The findings underscore the need for specialty-specific considerations in developing and implementing AI tools. While AI can potentially improve diagnostic accuracy, treatment decisions, and patient outcomes, addressing challenges such as lack of training, cost, and data privacy concerns is crucial for widespread adoption. Moreover, the study emphasizes the importance of ensuring the interpretability and transparency of AI algorithms to foster trust among physicians. As AI continues to evolve, it is essential to engage internal medicine physicians across specialties in the development process to create AI tools that effectively complement their expertise and improve patient care. Further research should focus on developing best practices for AI integration in internal medicine and evaluating the long-term impact on patient outcomes and healthcare systems.

Surgical management of spinal multiple myeloma: insights from the National Inpatient Sample database.

Background: Management of multiple myeloma (MM) of the spine includes a multimodal approach consisting of chemotherapy, bisphosphonates, radiation, and surgical intervention. This study aims to explore the trends in surgical treatment of MM including hospital costs, odds of complications, and the impact of patient comorbidities on the risk of complications using the National Inpatient Sample (NIS) database. Methods: The NIS was queried for patients with MM and plasmacytoma of the spine who underwent surgical intervention between 2005 and 2014. Rates of spinal decompression, spinal stabilization with or without decompression, and vertebral augmentation were analyzed. The effect of various patient characteristics on outcome was analyzed by multivariate analysis and stratified by surgical procedure. Results: Vertebral augmentation (9,643, 65.7%) was the most commonly performed procedure, followed by spinal stabilization with or without decompression (4,176, 28.4%) and then decompression alone (868, 5.9%). The total population-adjusted rate of surgical management for MM remained stable during the study period, while the rate of spinal stabilization increased (P<0.001) and the rate of vertebral augmentation decreased (P=0.01). Vertebral augmentation was associated with shorter inpatient hospital stay, lower total cost, and higher likelihood of discharging to home. The complication rate increased over time for vertebral augmentation procedures (P<0.001) while spinal stabilization and decompression complication rates remained stable. The complication rate for all procedures was higher in male patients (P<0.001) and increased with the number of patient comorbidities (P<0.001). Conclusions: Spinal surgery seems to be increasing for the management of spinal MM in the inpatient setting, while the rate of vertebral augmentation is decreasing. Vertebroplasty and similar palliative procedures may continue to decrease as advancements in surgical technology and technique allow for safer surgical intervention. The decision to employ aggressive surgical intervention, however, must always take into account the patient's comorbidities, overall systemic disease burden, and the potential for significant enhancement in meaningful clinical outcome.

Case Identification of Depression in Inpatient Electronic Medical Records: Scoping Review.

Background: Electronic medical records (EMRs) contain large amounts of detailed clinical information. Using medical record review to identify conditions within large quantities of EMRs can be time-consuming and inefficient. EMR-based phenotyping using machine learning and natural language processing algorithms is a continually developing area of study that holds potential for numerous mental health disorders. Objective: This review evaluates the current state of EMR-based case identification for depression and provides guidance on using current algorithms and constructing new ones. Methods: A scoping review of EMR-based algorithms for phenotyping depression was completed. This research encompassed studies published from January 2000 to May 2023. The search involved 3 databases: Embase, MEDLINE, and APA PsycInfo. This was carried out using selected keywords that fell into 3 categories: terms connected with EMRs, terms connected to case identification, and terms pertaining to depression. This study adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: A total of 20 papers were assessed and summarized in the review. Most of these studies were undertaken in the United States, accounting for 75% (15/20). The United Kingdom and Spain followed this, accounting for 15% (3/20) and 10% (2/20) of the studies, respectively. Both data-driven and clinical rule-based methodologies were identified. The development of EMR-based phenotypes and algorithms indicates the data accessibility permitted by each health system, which led to varying performance levels among different algorithms. Conclusions: Better use of structured and unstructured EMR components through techniques such as machine learning and natural language processing has the potential to improve depression phenotyping. However, more validation must be carried out to have confidence in depression case identification algorithms in general.

Clinical Outcomes of Sickle Cell Disease Patients With Myocardial Infarction Undergoing Percutaneous Coronary Intervention: A Nationwide Analysis.

Sickle cell disease (SCD) patients are predisposed to various cardiovascular complications due to the nature and progression of the disease; the clinical outcomes of SCD patients experiencing myocardial infarction (MI) and undergoing percutaneous coronary intervention (PCI) are not well known. This study aims to explore a comprehensive nationwide analysis of the clinical outcomes in SCD patients who have suffered an MI and subsequently undergone PCI. It also identifies potential complications and compares their outcomes with non-SCD counterparts with the same interventions. We conducted a retrospective analysis of SCD patients who have suffered an MI and subsequently undergone PCI using the National Inpatient Sample (NIS) database from 2016 to 2020. The primary outcome was mortality, while the secondary outcomes were the average length of stay, comorbid conditions, and cardiovascular outcomes. Logistic, linear, and Poisson regression model analysis applied for outcomes and adjusting co-founders. P-value <0.05 was considered significant. A total of 775 patients were analyzed for MI who had PCI with SCD, with a mean age of 58±1.06 years. SCD patients exhibited higher rates of comorbidities, including diabetes mellitus (45.81% vs. 37.84%), obesity (23.87% vs. 20.85%), and chronic kidney disease (CKD) (29.03% vs. 17.36%). Heart failure was more common among SCD patients with 34.19% vs. 26.02% in non-SCD patients (OR 1.5, CI 1.1-2.1, p-value=0.02). Other cardiovascular complications such as stroke, ventricular arrhythmias, atrial fibrillation, pulmonary edema, cardiogenic shock, cardiac arrest, and mortality did not significantly differ between SCD and non-SCD (P-values >0.05). The study observed that SCD patients experienced a significantly higher incidence of heart failure than non-SCD patients. This implies that SCD patients undergoing PCI for MI exhibit distinct clinical outcomes compared to their non-SCD counterparts.

Impact of Non-Alcoholic Fatty Liver Disease on Sepsis Inpatient Outcomes: A Nationwide Sample Analysis (2000-2019).

Background/Objectives: Patients with Non-Alcoholic Fatty Liver Disease (NAFLD) are reported to have an increased risk of developing severe infections, leading to hospitalizations with sepsis. However, data regarding the impact of comorbid NAFLD on in-hospital outcomes of patients with sepsis is scarce. Methods: This nationwide retrospective observational study using discharge data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), and Agency for Healthcare Research and Quality included 21,057,911 adult patients who were admitted to hospitals in the United States between 2000 and 2019 with a primary discharge diagnosis of sepsis. These patients were categorized according to the presence or absence of comorbid NAFLD. The twenty-year trend of nationwide NAFLD prevalence among sepsis inpatients was elucidated. Multivariable logistic regression analysis was used to analyze NAFLD's impact on sepsis outcomes. Results: In the twenty-year study period, the prevalence of NALFD among sepsis inpatients trended up from 1.2% in 2000 to 4.2% in 2019. Similar trends were observed in regional analysis. While overall sepsis mortality decreased, comorbid NAFLD in sepsis patients was consistently associated with a higher adjusted in-hospital all-cause mortality rate (adjusted odds ratio (OR), 1.19; 95% confidence interval (CI), 1.07-1.32), higher odds of developing septic shock, and higher likelihood of development of multi-organ dysfunction. Conclusions: Comorbid NAFLD in the stage of NASH or cirrhosis is associated with higher in-hospital all-cause mortality and worse clinical outcomes in sepsis inpatients. Addressing this rising epidemic will be of paramount importance to improve sepsis in-hospital outcomes.

In-Hospital Outcomes of Patients With Acute Respiratory Distress Syndrome Treated With Extracorporeal Membrane Oxygenation.

BACKGROUND: Treatment of acute respiratory distress syndrome (ARDS) with extracorporeal membrane oxygenation (ECMO) remains controversial. OBJECTIVE: This study aims to examine outcomes in ARDS patients treated with or without ECMO. METHODS: Using the National Inpatient Sample (NIS) database, all ARDS patients including those who were treated with ECMO were included in the analysis. Univariable and multivariable logistic regressions were used to estimate the odds of in-hospital outcomes between groups. RESULTS: A total of 2,540,350 patients were identified (2,538,849 with ARDS; 1,501 with ARDS on ECMO). The patients who underwent ECMO included younger patients and more men. Using ECMO in ARDS patients was associated with higher in-hospital mortality, cardiopulmonary arrest, major bleeding, sepsis, acute kidney injury, and longer hospital stays (31.7 vs. 8.3 days; p < 0.001 for all). A subgroup analysis based on age and sex had similar outcomes. CONCLUSION: Using ECMO in patients with ARDS was associated with worse in-hospital outcomes, including mortality and length of stay.

Randomized Trial to Evaluate Effects of Peer- and Clinician-Led Interventions for Caregivers of Individuals With Acquired Brain Injury.

Objective: To evaluate the effectiveness of 2 interventions for caregivers of patients with acquired brain injury (ABI) transitioning home after inpatient rehabilitation, to prepare them for the role of caregiving and reduce stress and depression. Design: Controlled trial with participants randomly assigned to (1) usual care (UC), (2) clinician-delivered Problem-Solving Training (PST), or (3) peer-led Building Better Caregivers (BBC) training; both experimental interventions initiated during the inpatient rehabilitation stay, delivered virtually, of similar intensity (six 60-minute sessions), and focused on managing stress and building skills related to caregiving. Setting: Nonprofit rehabilitation hospital specializing in care of persons with acquired brain and spinal cord injuries. Participants: Caregivers (n=169) of patients with ABI (54 stroke; 115 other ABI) admitted for rehabilitation whose discharge location was home with care provided by family members (caregivers: 83% women, 62% White, age [mean ± SD]: 51±11.5 y). Participants were recruited from February 2021 to November 2022, when COVID-19 restrictions were in place. Interventions: Noted above. Main Outcome Measures: Caregiver-reported stress, depressive symptoms, and caregiving self-efficacy; patient unplanned hospital readmissions and emergency department visits 30 days post discharge. Results: Only 61% of participants in the 2 intervention groups completed 3 or more of 6 intervention sessions and only 53% completed all data collection surveys. Statistically significant improvements between UC and PST groups were noted for caregiver stress (p=.039). Positive differences in caregiver self-efficacy found between UC and the BBC intervention groups approached significance at 30 days after discharge (p=.054). Patient unplanned hospital readmissions and days hospitalized were also higher, albeit not statistically significant, for UC participants than both intervention groups. Conclusions: Although positive findings were noted, results were negatively affected by study limitations including low enrollment and limited engagement (intervention completion and follow-up outcomes assessment). These limitations resulted, in part, from restrictions put into place during the COVID-19 pandemic, which limited contact with study participants and required alterations to the BBC intervention likely influencing its effectiveness. Despite limitations noted, the encouraging findings suggest the need for further research.

Baseline Nutritional Status and Rehabilitation Progress in Individuals Requiring Inpatient Rehabilitation: A Retrospective Cohort Study.

Objective: To evaluate the relationships between baseline nutritional status, medical events (MEs), and rehabilitation outcomes in individuals undergoing inpatient rehabilitation (IR). Design: A retrospective single center cohort study. Setting: An IR ward. Participants: This study included 409 patients (mean age, 80 years; men, 170 [42%]) undergoing IR for hospital-associated deconditioning, neurologic disorders, or musculoskeletal diseases. Participants were grouped according to the Controlling Nutritional Status score at admission: normal nutrition (NN): 0 to 1, mild malnutrition (MM): 2 to 4, and moderate/severe malnutrition (M/SM): 5 to 12. Interventions: None. Main Outcome Measures: The primary outcomes included MEs leading to death or acute illness requiring transfer to other hospitals for specialized treatments. The secondary outcomes were the rehabilitation efficiency scores (changes in Functional Independence Measure [FIM] score divided by length of stay) for motor function (FIM-M) and cognitive function (FIM-C). Results: Among the 409 participants, 300 (73%) were malnourished at admission. The adjusted hazard ratios (95% confidence interval) for MEs in the MM and M/SM groups relative to the NN group were 1.48 (0.67-3.27) and 0.98 (0.34-2.81), respectively. No significant differences were observed among the 3 groups in FIM-M efficiency scores (mean ± SD, NN: 0.49±0.51 vs MM: 0.41±0.57 vs M/SM: 0.44±1.06, P=.7) or FIM-C efficiency scores (0.04±0.06 vs 0.04±0.06 vs 0.08±0.4, P=0.1). Analysis of covariance showed no significant association between MM or M/SM group and FIM-M efficiency score (beta coefficient = -0.038, P=.6; beta coefficient = 0.15, P=.1, respectively) or FIM-C efficiency score (beta coefficient = 0.004, P=.8; beta coefficient = 0.047, P=.08, respectively). Conclusion: No significant associations were observed between the baseline nutritional status and MEs, FIM-M efficiency score, or FIM-C efficiency score in individuals undergoing IR.

International comparison of hospitalizations and emergency department visits related to mental health conditions across high-income countries before and during the COVID-19 pandemic.

OBJECTIVE: To explore variation in rates of acute care utilization for mental health conditions, including hospitalizations and emergency department (ED) visits, across high-income countries before and during the COVID-19 pandemic. DATA SOURCES AND STUDY SETTING: Administrative patient-level data between 2017 and 2020 of eight high-income countries: Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US). STUDY DESIGN: Multi-country retrospective observational study using a federated data approach that evaluated age-sex standardized rates of hospitalizations and ED visits for mental health conditions. PRINCIPAL FINDINGS: There was significant variation in rates of acute mental health care utilization across countries. Among the subset of four countries with both hospitalization and ED data, the US had the highest pre-COVID-19 combined average annual acute care rate of 1613 episodes/100,000 people (95% CI: 1428, 1797). Finland had the lowest rate of 776 (686, 866). When examining hospitalization rates only, France had the highest rate of inpatient hospitalizations of 988/100,000 (95% CI 858, 1118) while Spain had the lowest at 87/100,000 (95% CI 76, 99). For ED rates for mental health conditions, the US had the highest rate of 958/100,000 (95% CI 861, 1055) while France had the lowest rate with 241/100,000 (95% CI 216, 265). Notable shifts coinciding with the onset of the COVID-19 pandemic were observed including a substitution of care setting in the US from ED to inpatient care, and overall declines in acute care utilization in Canada and France. CONCLUSION: The study underscores the importance of understanding and addressing variation in acute care utilization for mental health conditions, including the differential effect of COVID-19, across different health care systems. Further research is needed to elucidate the extent to which factors such as workforce capacity, access barriers, financial incentives, COVID-19 preparedness, and community-based care may contribute to these variations. WHAT IS KNOWN ON THIS TOPIC: Approximately one billion people globally live with a mental health condition, with significant consequences for individuals and societies. Rates of mental health diagnoses vary across high-income countries, with substantial differences in access to effective care. The COVID-19 pandemic has exacerbated mental health challenges globally, with varying impacts across countries. WHAT THIS STUDY ADDS: This study provides a comprehensive international comparison of hospitalization and emergency department visit rates for mental health conditions across eight high-income countries. It highlights significant variations in acute care utilization patterns, particularly in countries that are more likely to care for people with mental health conditions in emergency departments rather than inpatient facilities The study identifies temporal and cross-country differences in acute care management of mental health conditions coinciding with the onset of the COVID-19 pandemic.

Inpatient Care for Elderly Suicide Survivors: Nurse-Led Mindfulness-Based Cognitive Therapy.

Objective: The aim was to analyze the effects of nurse-led mindfulness-based cognitive therapy (MBCT) in hospitalized elderly suicide survivors. Methods: The data of middle-aged and elderly suicide survivors in the medical system and nursing records of our hospital from January 2018 to August 2023 were retrospectively collected. The patients were divided into conventional group and MBCT group according to whether they actively received MBCT. The general demographic data of the patients and the changes in the scores of Suicidal Ideation Scale (SSI), Beck Hopelessness Scale (BHS), Patient Health Questionnaire 15 (PHQ-15), and Geriatric Depression Scale (GDS-15) at admission and 3 and 6 months of follow-up were collected. Propensity score matching was used to balance the baseline data of the 2 groups. Multiple logistic regression analysis was used to determine the effect of the inpatient care program on each score. Results: A total of 160 patients were included in the study, including 100 patients in the MBCT group and 60 patients in the conventional group. There was no significant difference in baseline data between the 2 groups after matching (P > .05). Suicidal Ideation Scale score, BHS score, PHQ-15 score, and GDS-15 score in MBCT group were lower than those in conventional group at 6 months of follow-up (P < .05). At the same time, multiple logistic regression analysis showed that the intervention program was the main factor affecting the SSI (OR = 1.538, P = .010), BHS (OR = 1.614, P = .006), PHQ-15 (OR = 1.797, P = .001), and GDS-15 scores (OR = 1.642, P = .004) at 6 months of follow-up. Conclusions: The application of nurse-led MBCT in hospitalized elderly suicide survivors may reduce suicidal ideation, hopelessness, and depression and improve physical symptoms.

Does outpatient mutual-aid reduce oncology patients' utilization of inpatient services?-An empirical study of outpatient mutual-aid policy in Wuhan, China.

BACKGROUND: The escalating costs of healthcare had prompted countries to undertake reforms, and in recent years China had focused on overhauling its outpatient healthcare system. China implemented the outpatient mutual-aid policy which had led to a change in the costs associated with outpatient treatment from being fully self-paid by the patient to being partially self-paid. PURPOSE: This study aimed to assess the impact of the outpatient mutual-aid policy on inpatient services for oncology patients in Wuhan, China, exploring the impact that the cumbersome administration of health insurance would have on patient welfare. METHODS: 24,260 oncology patients of the health insurance reimbursement database in Wuhan spanning from January 2022 to July 2023 were included. After data processing, 12,985 patients were included in the control group and 11,275 patients were included in the experimental group. The regression discontinuity design was employed to assess the impact of the policy. RESULTS: The findings was that the implementation of the outpatient mutual-aid would result in a reduction of 1.2 days in the length of stay for oncology patients, a decrease in hospital costs by 5%, and a decline in expenditure of the health insurance reimbursement funds by 5 per cent. CONCLUSIONS: Incorporating outpatient costs into reimbursement supplanted the utilization of inpatient services, enhanced the allocation of healthcare resources, and alleviated the financial burden on oncology patients. Furthermore, it highlighted the detrimental impact of eligibility review to verify that a patient meets the reimbursement requirements of the health insurance policy on patient welfare.