Hospital-Level Care at Home for Patients with Cirrhosis.

BACKGROUND: Patients with cirrhosis have a 30-day readmission rate of over 30%. Novel care delivery models are needed to reduce healthcare costs and utilization associated with cirrhosis care. One such model is Home Hospital (HH), which provides inpatient-level care at home. Limited evidence currently exists supporting HH for cirrhosis patients. AIMS: The aims of this study were to characterize patients with cirrhosis who received hospital-level care at home in a two-site clinical trial and to describe the care they received. Secondary aims included describing their outcomes, including adverse events, readmissions and mortality. METHODS: We identified all patients with cirrhosis who enrolled in HH as part of a two-site clinical trial between 2017 and 2022. HH services include daily clinician visits, intravenous and oral medications, continuous vital sign monitoring, and telehealth specialist consultation. We collected sociodemographic data and analyzed HH stays, including interventions, outcomes, adverse events, and follow-up. RESULTS: 22 patients with cirrhosis (45% Hispanic; 50% limited English proficiency, median MELD-Na 12) enrolled in HH during the study period. Interventions included lab chemistries (82%), intravenous medications (77%), specialist consultation (23%), and advanced diagnostics/procedures (23%). The median length of stay was 7 days (IQR 4-12); 186 bed-days were saved. Two patients (9%) experienced adverse events (AKI). No patients required escalation of care; 9% were readmitted within 30 days. CONCLUSIONS: In this two-site study, HH was feasible for patients with cirrhosis, holding promise as a hepatology delivery model. Future randomized trials are needed to further evaluate the efficacy of HH for patients with cirrhosis.

Single-lead arrhythmia detection through machine learning: cross-sectional evaluation of a novel algorithm using real-world data.

BACKGROUND: Computer-assisted interpretation of single-lead ECG is the preliminary method for clinicians to flag and further evaluate an arrhythmia of clinical importance for acutely ill patients. Critical scrutiny of novel detection algorithms is lacking, particularly in external real-world data sets. This study's objective was to evaluate a hybrid machine learning model's ability to classify eight arrhythmias from a single-lead ECG signal from acutely ill patients. METHODS: This cross-sectional external retrospective evaluation of a previously trained hybrid machine learning model against an ECG reading team in the setting of home hospital care (acute care delivered at home substituting for traditional hospital care) draws from patients admitted at two hospitals in Boston, Massachusetts, USA between 12 June 2017 and 23 November 2019. We calculated classifier statistics for each arrhythmia, all arrhythmias and strips where the model identified normal sinus rhythm. RESULTS: The model analysed 2 680 162 min of single-lead ECG data from 423 patients and identified 691 478 arrhythmias. Patients had a mean age of 70 years (SD, 18), 60% were female and 45% were white. For any arrhythmia, the model had a sensitivity of 98%, a specificity of 100%, an accuracy of 98%, a positive predictive value of 100%, a negative predictive value of 93% and an F1 Score of 99%. Performance was best for pause (F1 Score, 99%) and worst for paroxysmal supraventricular tachycardia (F1 Score, 92%). The model's false positive rate for any arrhythmia was 0.2%, ranging from 0.4% for pause to 7.2% for paroxysmal supraventricular tachycardia. The false negative rate for any arrhythmia was 1.9%. CONCLUSIONS: A hybrid machine learning model was effective at classifying common cardiac arrhythmias from a single-lead ECG in real-world data.

Hospital-Level Care at Home for Patients With Acute Respiratory Disease: A Descriptive Analysis.

BACKGROUND: Home hospital (HH) care is hospital-level substitutive care delivered at home for acutely ill patients who traditionally would be cared for in the hospital. Despite HH care programs operating successfully for years and scientific evidence of similar or better outcomes compared with bricks-and-mortar care, HH care outcomes in the United States for respiratory disease have not been evaluated. RESEARCH QUESTION: Do outcomes differ between patients admitted to HH care with acute respiratory illness vs those with other acute general medical conditions? STUDY DESIGN AND METHODS: This was a retrospective evaluation of prospectively collected data of patients admitted to HH care (2017-2021). We compared patients requiring admission with respiratory disease (asthma exacerbation [26%], acute exacerbation of COPD [33%], and non-COVID-19 pneumonia [41%]) to all other patients admitted to HH care. During HH care, patients received two nurse and one physician visit daily, IV medications, advanced respiratory therapies, and continuous heart and respiratory rate monitoring. Main outcomes were acute and postacute health care use and safety. RESULTS: We analyzed 1,031 patients; 24% were admitted for respiratory disease. Patients with and without respiratory disease were similar: mean age, 68 ± 17 years, 62% women, and 48% White. Patients with respiratory disease more often were active smokers (21% vs 9%; P < .001). Eighty percent of patients showed an FEV1 to FVC ratio of ≤ 70; 28% showed a severe or very severe obstructive pattern (n = 118). During HH care, patients with respiratory disease showed less health care use: length of stay (mean, 3.4 vs 4.6 days), laboratory orders (median, 0 vs 2), IV medication (43% vs 73%), and specialist consultation (2% vs 7%; P < .001 for all). Ninety-six percent of patients completed the full admission at home with no mortality in the respiratory group. Within 30 days of discharge, both groups showed similar readmission, ED presentation, and mortality rates. INTERPRETATION: HH care is as safe and effective for patients with acute respiratory disease as for those with other acute general medical conditions. If scaled, it can generate significant high-value capacity for health systems and communities, with opportunities to advance the complexity of care delivered.

Are non-abstinent reductions in World Health Organization drinking risk level a valid treatment target for alcohol use disorders in adolescents with ADHD?

INTRODUCTION: Abstinence from drinking represents the primary treatment target for alcohol use disorders (AUD) in youth, but few adolescents who engage in problematic drinking seek treatment. A reduction in World Health Organization (WHO) drinking risk level has been established as valid and reliable non-abstinent treatment target for AUD in adults but remains unstudied in youth. METHODS: The present study used data from the NIDA-CTN-0028 trial to examine associations between reductions in WHO drinking risk level and changes in global functioning and attention-deficit hyperactivity disorder (ADHD) symptoms during treatment in a sample of adolescents (ages 13-18 years) with ADHD and comorbid substance use disorder (SUD) (n = 297, 61% with AUD) receiving a 16-week intervention that combined ADHD pharmacotherapy (OROS-methylphenidate vs. placebo) and drug-focused cognitive-behavioral therapy. RESULTS: Shifts in drinking risk level during treatment were highly variable in adolescents treated for ADHD/SUD, and influenced by AUD diagnostic status. In the total sample, 15% of participants had a 2-level or greater reduction in WHO drinking risk level, with 59% and 24% showing no change or an increase in risk-level during treatment respectively. Achieving at least a 2-level change in WHO drinking risk level during treatment was associated with greater reduction in ADHD symptoms and better functional outcomes. CONCLUSIONS: These findings parallel the adult AUD literature and provide preliminary support for the use 2-level reductions in WHO risk levels for alcohol use as a clinically valid non-abstinent treatment outcome for youth with ADHD and comorbid AUD.

Draft Genome Sequence of Halomonas sp. Strain ML-15, a Haloalkaliphilic, Polycyclic Aromatic Hydrocarbon-Degrading Bacterium.

Halomonas sp. strain ML-15 is an aerobic, haloalkaliphilic bacterium capable of degrading polycyclic aromatic hydrocarbons (PAHs). The draft genome sequence of the isolate contains 19 contigs encompassing 4.8 Mb and a G+C content of 65.38%. This sequence will provide essential information for future studies of PAH degradation, particularly under haloalkaliphilic conditions.

Terminalia ferdinandiana Exell: Extracts inhibit Shewanella spp. growth and prevent fish spoilage.

Shewanella spp. are major causes of fish spoilage. Terminalia ferdinandiana (Kakadu plum) extracts were investigated for their ability to inhibit Shewanella spp. growth. Leaf and fruit extracts displayed potent growth inhibitory properties against all Shewanella spp. The methanolic leaf extract was a particularly potent inhibitor of S. putrefaciens (DD MIC 93; LD MIC 73 µg/mL), S. baltica (DD MIC 104 µg/mL; LD MIC 85 µg/mL), S. frigidimarina (DD MIC 466 µg/mL; LD MIC 391 µg/mL) and S. loihica (DD MIC 95 µg/mL; LD MIC 55 µg/mL) growth. The aqueous and ethyl acetate leaf extracts were also potent growth inhibitors, with MIC values generally substantially <1000 µg/mL. Treatment of Acanthopagrus butcheri Munro fillets with methanolic Kakadu plum extracts significantly inhibited bacterial growth for 15 days at 4 °C. All Kakadu plum extracts were nontoxic in the Artemia franciscana bioassay. LC-MS analysis identified several compounds which may contribute to the inhibition of Shewanella spp. growth.

Inhibition of Shewanella spp. growth by Syzygium australe and Syzygium luehmannii extracts: natural methods for the prevention of fish spoilage.

Syzygium australe and Syzygium luehmannii fruit and leaf were investigated for their ability to inhibit Shewanella spp. growth. Extracts of both Syzygium spp. displayed potent growth inhibitory properties against all Shewanella spp. tested in disc diffusion and liquid diffusion assays. In general, S. australe extracts were more potent inhibitors of Shewanella spp. growth, and the fruit extracts were generally better than the corresponding leaf extracts. The methanolic S. australe fruit extract was a particularly potent inhibitor of all Shewanella spp. growth, with MIC values as low as 87 µg/mL. The aqueous and ethyl acetate S. australe fruit extracts were similarly potent inhibitors of Shewanella spp. growth, albeit with slightly higher MIC values. Several other Syzygium spp. extracts also were potent bacterial growth inhibitors, albeit with MIC values generally >1000 µg/mL. The most potent S. australe fruit extracts were nontoxic in the Artemia franciscana bioassay, with LC50 values substantially >1000 µg/mL. The potent bacterial growth inhibitory activity and lack of toxicity of the S. australe fruit extracts indicate their potential as natural fish and seafood preservatives.