Methodological and Clinimetric Evaluation of Inspiratory Respiratory Muscle Ultrasound in the Critical Care Setting: A Systematic Review and Meta-Analysis.

OBJECTIVE: Significant variations exist in the use of respiratory muscle ultrasound in intensive care with no society-level consensus on the optimal methodology. This systematic review aims to evaluate, synthesize, and compare the clinimetric properties of different image acquisition and analysis methodologies. DATA SOURCES: Systematic search of five databases up to November 24, 2021. STUDY SELECTION: Studies were included if they enrolled at least 50 adult ICU patients, reported respiratory muscle (diaphragm or intercostal) ultrasound measuring either echotexture, muscle thickness, thickening fraction, or excursion, and evaluated at least one clinimetric property. Two independent reviewers assessed titles, abstracts, and full text against eligibility. DATA EXTRACTION: Study demographics, ultrasound methodologies, and clinimetric data. DATA SYNTHESIS: Sixty studies, including 5,025 patients, were included with 39 studies contributing to meta-analyses. Most commonly measured was diaphragm thickness (DT) or diaphragm thickening fraction (DTF) using a linear transducer in B-mode, or diaphragm excursion (DE) using a curvilinear transducer in M-mode. There are significant variations in imaging methodology and acquisition across all studies. Inter- and intrarater measurement reliabilities were generally excellent, with the highest reliability reported for DT (ICC, 0.98; 95% CI, 0.94-0.99). Pooled data demonstrated acceptable to excellent accuracy for DT, DTF, and DE to predicting weaning outcome after 48 to 72 hours postextubation (DTF AUC, 0.79; 95% CI, 0.73-0.85). DT imaging was responsive to change over time. Only three eligible studies were available for intercostal muscles. Intercostal thickening fraction was shown to have excellent accuracy of predicting weaning outcome after 48-hour postextubation (AUC, 0.84; 95% CI, 0.78-0.91). CONCLUSIONS: Diaphragm muscle ultrasound is reliable, valid, and responsive in ICU patients, but significant variation exists in the imaging acquisition and analysis methodologies. Future work should focus on developing standardized protocols for ultrasound imaging and consider further research into the role of intercostal muscle imaging.

Do health service waiting areas contribute to the health literacy of consumers? A scoping review.

Health service waiting areas commonly provide health information, resources and supports for consumers; however, the effect on health literacy and related outcomes remains unclear. This scoping review of the literature aimed to explore the use of waiting areas as a place to contribute to the health literacy and related outcomes of consumers attending health appointments. Articles were included if they focussed on health literacy or health literacy responsiveness (concept) in outpatient or primary care health service waiting areas (context) for adult consumers (population) and were published after 2010. Ten bibliographic databases, one full-text archive, dissertation repositories and web sources were searched. The search yielded 5095 records. After duplicate removal, 3942 title/abstract records were screened and 360 full-text records assessed. Data were charted into a standardized data extraction tool. A total of 116 unique articles (published empirical and grey literature) were included. Most articles were set in primary and community care (49%) waiting areas. A diverse range of health topics and resource types were available, but results demonstrated they were not always used by consumers. Outcomes measured in intervention studies were health knowledge, intentions and other psychological factors, self-reported and observed behaviours, clinical outcomes and health service utilization. Intervention studies overall demonstrated positive trends in health literacy-related outcomes, although the benefit declined after 3-6 months. Research on using waiting areas for health literacy purposes is increasing globally. Future research investigating the needs of consumers to inform optimal intervention design is needed.

Health service waiting areas are commonly used to provide health resources (such as health information, resources and supports) for consumers. Health resources which are appropriate and accessible for consumers can improve health literacy by increasing health knowledge, supporting good decision-making or changing behaviours which may result in better health. Although it is common to offer health resources in health service waiting areas, the evidence supporting this practice is unclear. This scoping review of the literature focussed on the use of health service waiting areas as a place to contribute to the health literacy of adult consumers attending outpatient or primary care health appointments. A total of 116 unique articles were included which addressed this issue. Majority of articles were set in primary and community care waiting areas (49%). A range of health topics and resource types were available but these were not always used by consumers. Overall, interventions in waiting areas targeting health literacy-related outcomes resulted in positive outcomes, although the benefit declined after 3­6 months. Research on using waiting areas for health-literacy purposes is increasing worldwide. Future research is needed to identify how to optimize the effectiveness of interventions in waiting areas to benefit consumers.

Previously healthy unvaccinated adults have significant functional limitations in the medium and long term after mild COVID-19.

BACKGROUND AND OBJECTIVES: Ongoing symptoms of COVID-19 can persist for weeks or months after the initial COVID-19 infection. The aim of this study was to identify persistent symptoms (fatigue, cognition, quality of life, anxiety, depression and physical measures) in unvaccinated community-managed patients following COVID-19 infection. METHOD: This was a prospective nested observational study of health and wellbeing measures determined seven and 13 months after COVID-19 infection, alongside physical abilities after 18 months. RESULTS: Data analyses were completed on 62 participants (60% female, median age 35 years). Severe fatigue was noted in 47% of participants at seven months and this had not improved significantly by 13 months (45%). Quality of life and mental health scores were significantly worse in individuals with severe fatigue. One-quarter of participants demonstrated mild cognitive impairment at seven months. After 18 months, walking and lung function were normal, but grip strength was reduced in 26% of participants. DISCUSSION: A significant proportion of unvaccinated COVID-19 patients had not returned to pre-illness levels of health and function after one year; screening functional ability and mental wellbeing is warranted in unvaccinated people with COVID-19.

Predicting Discharge Destination in Older People From Acute General Medical Wards: A Systematic Review of the Psychometric Properties of 23 Assessment Tools.

BACKGROUND: Predicting discharge in older people from general medicine wards is challenging. It requires consideration of function, mobility, and cognitive levels, which vary within the cohort and may fluctuate over a short period. A previous systematic review identified 23 assessment tools associated with discharge destination in this cohort; however, the psychometric properties of these tools have not been explored. PURPOSE: To evaluate, synthesize, and compare the psychometric properties of 23 assessment tools used to predict discharge destination from acute general medical wards. METHODS: Four databases were systematically searched: Medline (Ovid), Embase (Ovid), Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Evidence-Based Medicine Review databases. Studies were included if participants were from general medicine or acute geriatric wards and investigated at least one psychometric property (reliability, internal consistency, measurement error, responsiveness, hypothesis testing, and structural or criterion validity) in 23 previously identified assessment tools. Data were extracted and methodological quality were assessed independently by 2 assessors using the COnsensus-based Standards for selection of health Measure INstruments (COSMIN) checklist. As per the COSMIN checklist, results were rated against "sufficient," "insufficient," or "indeterminate." RESULTS: Forty-one studies were included. The de Morton Mobility Index (DEMMI) was the most rigorously evaluated assessment tool; it scored "sufficient" psychometric properties in 5 of 7 psychometric categories. The Alpha Functional Independence Measure (AlphaFIM), Barthel Index, and Mini-Mental State Examination (MMSE) demonstrated "sufficient" psychometric properties in at least 3 psychometric categories. The remainder of the tools (n = 19, 83%) had "sufficient" psychometric properties in 2 or fewer psychometric categories. DISCUSSION AND CONCLUSION: Based on current evidence, out of 23 assessment tools associated with discharge destination in acute general medicine, the DEMMI has the strongest psychometric properties. Other tools with substantial evidence in this cohort include the AlphaFIM, MMSE, and Barthel Index. Research is required to thoroughly evaluate the psychometric properties of the remaining tools, which have been insufficiently researched to date. Results can be used by physical therapists to guide selection of appropriate tools to assess mobility and predict discharge destination. TRIAL REGISTRATION: A priori, PROSPERO (CRD 42017064209).

Physical activity is low before and during hospitalisation: A secondary observational study in older Australian general medical patients.

OBJECTIVES: To quantify physical activity in patients prior to and during an acute general medical hospital admission and explore relationships between mobility, pre- and in-hospital physical activity. METHODS: This was a prospective, single-site secondary observational study conducted on general medical wards at a tertiary hospital. Prehospital physical activity was measured via the Physical Activity Scale for the Elderly (PASE; scored 0-400); in-hospital physical activity was measured via accelerometry (time at metabolic equivalents [METs] > 1.5), and mobility was measured via the de Morton Mobility Index (DEMMI). Associations were determined via Spearman's correlations. RESULTS: Forty-six participants were included: median age 81 [76-85] years, 59% female, DEMMI on admission 39 [30-49]. Prehospital physical activity was low (PASE median 27.1 [1.6-61.9]). In-hospital physical activity was also low (0.5 [0.2-1.5] hours per day being physically active and 54 [16-194] steps per day taken). No statistically significant relationships existed between pre- and in-hospital physical activity (Spearman's rho (ρ) 0.24, 95% CI -0.08-0.53, p = 0.07). However, physical activity levels in the pre- and in-hospital settings were positively associated with patients' mobility in-hospital (Spearman's ρ 0.44, 95% CI 0.15-0.67, p = 0.002; Spearman's ρ 0.40, 95% CI 0.08-0.645, p = 0.011 respectively). CONCLUSIONS: Physical activity is low both before and during a general medical admission. Assessment of usual physical activity patterns should be part of the clinical assessment of patients in general medicine; however, the low activity levels observed indicate a need for valid and reliable tools suitable for an older, frail cohort. Findings will inform the development of physical activity guidelines during hospitalisation.

Assessment tools and factors used to predict discharge from acute general medical wards: a systematic review.

PURPOSE: To identify assessment tools and patient factors statistically associated with discharge destination in general medical inpatients. MATERIALS AND METHOD: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Four electronic databases were searched. Studies were eligible if they were a quantitative study design, had adult acute general medical inpatients and published in English. Outcomes of interest were tools or factors with statistical correlations with discharge destination (home, subacute or residential care). Articles were screened by two independent assessors. Data were extracted by one reviewer and independently checked by a second reviewer. Data were analysed/described descriptively. RESULTS: Twenty-three studies were included. Twenty-three tools and 44 factors were identified, which spanned Health Condition, Body Structure and Function, Activity, Participation, Environment and Personal concepts of the World Health Organisation International Classification of Function, Disability and Health (WHO ICF). CONCLUSIONS: The large number of tools and factors found and their distribution across several WHO ICF concepts exemplifies the complexities of predicting discharge. No single assessment tool that best predicts discharge destination was identified, but rather there were a variety of potential tools identified. Further research is needed to determine the psychometric properties of the identified assessment tools as well as additional predictors of subacute care (including rehabilitation). This is important as it may allow for timely clinical decision making. TRIAL REGISTRATION: A priori, PROSPERO (CRD42017064209).IMPLICATIONS FOR REHABILITATIONThis systematic review identified a large number of assessment tools and patient factors associated with discharge destination (home, subacute and residential care) in general medical inpatients.All of the domains of the WHO ICF framework are associated with discharge destination and must be considered.Clinicians in the acute setting can use these findings to assist selection of assessment tools to identify patients likely to need rehabilitation or subacute care.Early identification of patients who are unable to return to their place of residence is essential as it allows for provision of early rehabilitation and subsequent discharge planning.

Factors Associated With Discharge Destination in Community-Dwelling Adults Admitted to Acute General Medical Units.

BACKGROUND AND PURPOSE: General medical patients often present to the hospital with medical, social, cognitive, and functional issues that may impact discharge destination. The aim of this study was to investigate the association between patient factors at hospital admission and discharge destination in general medical patients. METHODS: This was a prospective, single-site observational study conducted on the general medical wards at a tertiary hospital. Inpatients admitted to the general medical unit and referred to physical therapy were included. Patients admitted from residential care were excluded. MAIN OUTCOME MEASURES: Data were collected a median of 2 days (interquartile range: 1-3) from hospital admission and included demographics, comorbidities (Charlson Comorbidity Index), premorbid physical function (Blaylock Risk Assessment Screening Score, BRASS), current function (de Morton Mobility Index, DEMMI and Alpha Functional Independence Measure, AlphaFIM), and cognition (Rowland Universal Dementia Assessment Scale, RUDAS). RESULTS: Between July 2016 and August 2017, 417 patients were recruited (53% female, median age: 81 years (interquartile range: 76-86). Of these, 245 patients were discharged directly home; 172 were not discharged home of whom 140 were discharged to a subacute temporary facility providing further opportunity for therapy and discharge planning. Patients discharged directly home had higher functional, mobility, and cognitive scores. Data were partitioned into training, validation, and test sets to provide unbiased estimates of sensitivity, specificity, receiver operating characteristic curve, and area under the curve. Models best associated with discharge were "DEMMI and toilet transfers" (sensitivity 82.1%, specificity 66.2%, area under the curve 83.8%, 95% confidence interval: 76.4-91.2) and "AlphaFIM and walking independence" (sensitivity: 66.7%, specificity: 83.1%, area under the curve: 81.5, 95% confidence interval: 73.2-89.7). CONCLUSION: Two models were created that differentiated between discharge home and not home and had similar statistical measures of validity. Although the models require further validation, clinicians should consider whether identification of patients likely to be discharged home or not home is of greater relevance for their clinical setting.