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Liver transplantation is the definitive treatment for individuals with end-stage liver disease. However, a range of medical and physical complications frequently arise following transplantation, which can hinder a patient's overall recovery. Post-operative rehabilitation is often necessary to support and enhance functional outcomes. This review explores the role of early mobilization and inpatient rehabilitation, outlines the rehabilitation process, defines the role of the physiatrist and the interdisciplinary rehabilitation team, and examines the potential functional gains for liver transplant recipients who undergo inpatient rehabilitation.

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Objective: To estimate the association between tobacco use and the prevalence of psychotropic medication use and prescribed dosage among inpatients and outpatients with severe mental disorders treated at a neuropsychiatric hospital. Methods: Observational, cross-sectional, analytical study conducted on May 3, 2023. Smoking status and prescribed psychotropic medications were recorded for all hospitalized patients and community-based outpatients. Dosages were reported in mg/day, defined daily doses (DDD), and for antipsychotics as chlorpromazine equivalents (CPZeq). Bivariate and multivariate analyses were performed. Results: Tobacco use data were collected from 325 out of 425 total patients (71.7% male, mean age [SD]: 51.4 [14.4] years, 56% inpatients, 70.2% with schizophrenia and related psychosis). The prevalence of smoking was 72.3%, with differences by gender (78.1% in males vs. 57.8% in females, p < 0.001), and decreased with age (18-39 years: 86.1%; 40-59 years: 71.7%; ⩾ 60 years: 63.2%; p = 0.01). Mean dosages of antipsychotics, clozapine, and olanzapine measured in CPZeq were higher in smokers than in non-smokers by 35.4%, 37.1%, and 33.3%, respectively. After adjusting for confounding factors, smoking was associated with a 21.8% higher dosage of antipsychotics (95% CI: 0.4%-43.2%; p = 0.046), equivalent to an additional 132.2 mg/day (24.2-240.1; p = 0.017) of clozapine and 5.4 mg/day (1.2-9.6; p = 0.012) of olanzapine. The average dosage of sedatives/hypnotics was 45.5% higher among smokers (13.6%-89.5%; p = 0.008). Conclusion: A high prevalence of smoking was found among patients with severe mental disorders, associated with higher average dosages of sedatives/hypnotics and antipsychotics, particularly clozapine and olanzapine.

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BACKGROUND: Minimally invasive posterior lumbar interbody fusion (MIS-PLIF) is commonly performed to treat degenerative lumbar spinal conditions. Patients of advanced age often present with multiple comorbidities and reduced physiological reserves, influencing surgical risks and recovery. The growing aging population has led to a rising demand for care for older adults, posing significant challenges for health care systems worldwide. OBJECTIVE: This study aimed to identify the associations between different age groups and MIS-PLIF outcomes. METHODS: This study retrospectively analyzed data from the United States Nationwide Inpatient Sample collected between 2016 and 2020. Patients aged ≥60 years who underwent MIS-PLIF were eligible for inclusion in this study. Patients were categorized into age groups (60-69, 70-79, and ≥80 y). Logistic and linear regressions were used to determine the associations between the study variables and outcomes, including in-hospital mortality, complications, nonroutine discharge, and length of stay. RESULTS: A total of 785 patients aged ≥60 (mean age 69.4, SD 0.2) years who underwent MIS-PLIF were included in the analysis, and 18.7% (147/785) experienced at least one complication. After adjustment, compared with patients aged 60 to 69 years, the risk of nonroutine discharge was significantly increased in patients aged 70 to 79 years (adjusted odds ratio 2.33, 95% CI 1.57-3.46; P<.001) and ≥80 years (adjusted odds ratio 4.79, 95% CI 2.64-8.67; P<.001). No significant differences in the risk of complications or length of hospital stay were observed across the age groups. CONCLUSIONS: In older patients undergoing MIS-PLIF, advanced age is an independent predictor of nonroutine discharge. Furthermore, our findings suggest that age alone is not an independent risk factor for complications or extended hospital stays among older patients. These findings underscore that MIS-PLIF is a viable option for older patients, for whom extra attention may still be needed for postoperative care. Implementing age-stratified management for older patients undergoing MIS-PLIF may have important clinical policy implications.

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BACKGROUND: Invasive fungal infections (IFI) are a prominent cause of morbidity and mortality among patients with haematological malignancies (HMs). Diagnostic work-up excluding IFI is mandatory in case of persistent fever while antifungal treatment (AFT) is started. OBJECTIVES: We aimed to describe antifungal prophylaxis (AFP) and AFT among haematological patients with IFI managed in clinical practice, focusing on microbiological and radiological characteristics, 30-day outcome and therapeutic options after AFT failure. PATIENTS AND METHODS: We enrolled 461 consecutive adult and paediatric patients with HMs, in which an intravenous AFT was started from September 2019 to December 2021. After serum galactomannan (GM) and chest CT scan, they were stratified as presenting with proven, probable, and possible IFI according to 2008 EORTC-MSG criteria. Fungal isolates were detected from culture tests in 17.5% and from biopsy in 1.5% of patients. Mould active and non-active AFP was used in 42.3% and 16.5% of cases, respectively. RESULTS: Use of AFP significantly impact on serum GM negativity (p < 0.001 for mould active and p = 0.04 for mould non active, respectively). Use of mould non-active prophylaxis significantly correlates with radiological imaging (typical p = 0.0037, IC (0.370-0.825) and negative -p = 0.0031, IC (0.241-0.750)). Toxicity, progression, and drug interaction were responsible for therapy change in 58 (12%) patients: 18 patients with proven/probable IFI needed multiple courses of AFT. At 30 days from starting AFT, overall mortality with IFI was 23/461 (5%). CONCLUSIONS: In this observational study, we recorded an impact of AFP on serum GM results and radiological imaging. Need of AFT should be carefully evaluated, as diagnostic work-up might be affected not only by specific disease risk but also by previous AFP.

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Importance: Prior research conducted in private for-profit health care systems has suggested that social determinants of health (SDOH) play a role in adverse postoperative outcomes. Whether these findings translate to universal health care systems is unknown. Objective: To quantify the association of SDOH with risk of 30-day mortality after scheduled inpatient surgery. Design, Setting, and Participants: This cohort study was conducted in Ontario, Canada's most populous province. The cohort included consecutive adult patients (aged ≥18 years) who were eligible for Ontario's universal health insurance and underwent a scheduled inpatient surgical procedure between January 1, 2017, and December 31, 2023. Diagnostic and procedural, demographic, vital statistics, and other data were obtained from linked health administrative databases. Exposures: SDOH including neighborhood income, immigration status, and migration recency. Main Outcome and Measure: Death within 30 days of index surgery. Logistic regression models were used to estimate the adjusted and unadjusted odds ratios (AORs and ORs) of the association of each SDOH with 30-day mortality. Results: Overall, 1 036 759 patients (median [IQR] age, 66 [56-74] years; 526 158 females [50.8%]) who underwent a range of scheduled inpatient surgical procedures were included. Of these patients, 1780 (0.9%) from the lowest-income areas died, as did 1307 (0.6%) from the highest-income areas. Patients from the lowest-income areas were at 52.0% increased odds of death (OR, 1.52; 95% CI, 1.42-1.64) compared with those from the highest-income areas. This association persisted with models partially adjusted for demographic and procedural factors (AOR, 1.54; 95% CI, 1.44-1.66) and fully adjusted for comorbidities (AOR, 1.43; 95% CI, 1.33-1.54). A dose-response association was demonstrated between neighborhood income and mortality, with odds of death increasing with diminishing income (eg, quintile 3 vs quintile 5: AOR, 1.18 [95% CI, 1.10-1.27]; quintile 2 vs quintile 5: AOR, 1.32 [95% CI, 1.22-1.42]). There was evidence of effect modification of the association between neighborhood income and mortality by procedure complexity (eg, effect estimate for quintile 4 and high complexity: -0.0776 [95% CI, -0.2722 to 0.1169]; P = .002). Immigrant and refugee status and recent migration (<5 years) demonstrated reduced odds of mortality in unadjusted analyses, but these associations diminished with risk adjustment. Conclusions and Relevance: In this cohort study, residency in lowest-income neighborhood was associated with increased risk of postoperative mortality despite adjustment for patient, procedure, and hospital factors. Improving postoperative outcomes likely requires addressing underlying SDOH disparities.

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Background: Antipsychotics and benzodiazepines are prescribed for hyperactive delirium despite their side effects and lack of supportive evidence. Valproic Acid (VPA) improves agitation without QTc prolongation, excessive sedation, and parkinsonism. However, high quality evidence for this is lacking in delirium. Methods: This retrospective study involved hospitalized patients seen by Palliative medicine from 10/1/2019 to 4/17/2020 who received VPA for at least 24 hours for hyperactive delirium. Patients were excluded if VPA was used for seizures or bipolar disorder. We hypothesized that VPA improves agitation and thus reduces the use of opioids, antipsychotics, and benzodiazepines. Results: Twenty patients, 50% women, and a median age of 81.5 years were treated. Nine had cancer, five dementia and two had strokes. The median daily VPA dose was 831.6 mg (IQR 671.4 -1016.4). Due to the small numbers, we did not find a statistically significant differences in benzodiazepine, opioid, or antipsychotic use on days 1, 2, or 3. VPA was used as monotherapy in 10 patients, with no additional antipsychotic or benzodiazepines needed. Eleven patients were on comfort care measures at the time of VPA initiation. Ten died in the hospital. Three were discharged home, and seven transferred to a skilled nursing facility. Discussion: This study explored the use of VPA in palliative care. VPA may be effective in treating aggitation. Randomized controlled trials are needed to validate VPA benefits in treating agitated delirium.

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BackgroundObstructive sleep apnea (OSA) is a recognized risk factor for aortic dissection development due to its association with arterial hypertension, negative intrathoracic pressures during respiratory efforts, and further development of aortic false lumen. However, the impact of OSA on the outcomes of type A aortic dissection (TAAD) repair has not been extensively investigated. Therefore, this study aimed to perform a population-based analysis of the impact of OSA on in-hospital outcomes following TAAD repair.MethodsPatients who underwent TAAD repair were identified in National Inpatient Sample from the last quarter of 2015-2020. Multivariable logistic regressions were employed to compare the in-hospital outcomes between patients with and without OSA, where demographics, comorbidities, hospital characteristics, primary payer status, and transfer-in status were adjusted for.ResultsThere were 465 (10.86%) and 3817 (89.14%) patients with and without OSA who underwent TAAD repair. Patients with and without OSA had comparable in-hospital mortality (9.89% vs 15.75%, aOR = 0.744, 95 CI = 0.535-1.035, P = .08). Patients with OSA had a higher risk of diaphragmatic paralysis (0.86% vs 0.21%, aOR = 4.821, 95 CI = 1.405-16.539, P = .01) but lower risks of pericardial complications (12.04% vs 19.02%, aOR = 0.675, 95 CI = 0.501-0.909, P = .01) and cardiogenic shock (11.40% vs 18.21%, aOR = 0.643, 95 CI = 0.472-0.875, P = .01). All other in-hospital outcomes were comparable.ConclusionWhile OSA is a known risk factor for the development of TAAD, it does not appear to significantly affect short-term surgical outcomes. Future research should focus on stratifying OSA by duration and severity and examining the long-term prognosis of these patients.

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Obesity, self-regulation, and inflammation interact through complex physiological and psychological pathways. Inflammation may not only impair self-regulation in youth with obesity but could also interfere with their ability to develop these skills, thereby hindering positive changes in unhealthy obesity-related behaviors. Given the limited research on this topic in youth with obesity, the current study explored the associations between inflammatory markers and self-regulation in children and adolescents with obesity undergoing multidisciplinary obesity treatment (MOT) in an inpatient setting. Three pre-registered research questions (https://osf.io/yavbf) were addressed: (1) the concurrent relationship between inflammatory markers (hs-CRP, IL-6 and TNFα) and self-regulation before treatment, (2) the predictive value of those baseline inflammatory markers for self-regulation improvements over the ten months of MOT, and (3) associations between changes in inflammatory markers and concurrent changes in self-regulation during treatment. The sample consisted of 143 children and adolescents (7-18 years; M = 14, SD = 2.2; 40.6 % boys) with obesity (Adjusted BMI1 Range = 134-288 %; M = 193.6, SD = 27.6), who participated in a double-blind randomized controlled trial. Using latent change score models, results showed that higher TNFα was associated with poorer self-reported self-regulation at pre-treatment. Reductions in TNFα were related to less improvement in parent-reported self-regulation during treatment. Results with hs-CRP and IL-6 were not significant. These finding provide partial support for the association between inflammation, particularly TNFα, and self-regulation, and underscore their complex, nuanced interplay in a clinical sample of youth with obesity.

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OBJECTIVE: FDG-PET/CT is useful in internal medicine for evaluation of patients with various inflammatory presentations. However, data regarding its diagnostic role in inpatients is limited. This study aims to assess the contribution of FDG-PET/CT in hospitalized patients. METHODS: An observational cohort study was conducted at a tertiary medical center in Israel from 2015 to 2020. We analyzed FDG-PET/CT scans of 260 adult inpatients from Internal Medicine, Cardiology, Medical Intensive Care, and Intensive Cardiac Care units. Scans done solely for malignancy follow-up were excluded. The primary outcome was a change in diagnosis and/or management, assessed by at least two physicians. RESULTS: Among the 260 patients, indications included infection (42%), inflammation (35%), suspected malignancy (17%), cardiac disease (5%), and other (1%). 80% of studies were clinically helpful. In 40% treatment was changed, either in type (27%) or duration (13%). 9% of studies contributed to diagnosis alone, and 7% contributed to localization. 23% were negative studies, eliminating additional testing. 1% showed incidental findings requiring treatment. In 43% of studies, there were new findings that were not visible by prior morphologic imaging. A significantly higher percentage of clinically helpful studies was observed in patients with foreign devices compared with those without devices (89% versus 74%, P = 0.003), while immunocompromised patients had a lower percentage of clinically helpful studies (74% versus 84%, P = 0.06). CONCLUSION: FDG-PET/CT is a useful, noninvasive diagnostic tool in patients hospitalized in Internal Medicine, Cardiology, and Intensive Care. This modality may aid in treatment and prevent unnecessary invasive procedures in selected patients.

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Introduction: Background and aims: there is a need for a kidney-specific nutritional screening tool for patients with renal failure. It was planned to perform the validity and reliability of the Renal Inpatient Nutrition Screening Tool screening tool developed for renal patients in Turkey. Methods: the validity and reliability of the Renal Inpatient Nutrition Screening Tool were investigated by comparing it with the Malnutrition Universal Screening Tool and the Subjective Global Assessment for assessing malnutrition in 153 adult patients newly admitted to the nephrology unit. Nutritional status was assessed using anthropometric measurements and nurse opinion was assessed using a questionnaire. Results: the Renal Inpatient Nutrition Screening Tool was found to be more sensitive than the Malnutrition Universal Screening Tool in identifying increased malnutrition risks and providing dietary guidance. Cramer V coefficient was 0.238 between the Malnutrition Universal Screening Tool and the Renal Inpatient Nutrition Screening Tool, and 0.137 between the Subjective Global Assessment and the Renal Inpatient Nutrition Screening Tool, indicating the compatibility of the Renal Inpatient Nutrition Screening Tool with the variables in the Malnutrition Universal Screening Tool screening tool. A significant positive moderate correlation was observed between the total number of red boxes in the Renal Inpatient Nutrition Screening Tool and the total score of Malnutrition Universal Screening Tool (p < 0.05; r = 0.404). Conclusions: the Renal Inpatient Nutrition Screening Tool is a valid and reliable tool for assessing malnutrition risks in renal patients in Turkey, particularly when used by experienced specialist nurses in nephrology units.

Introducción: Antecedentes y objetivos: existe la necesidad de una herramienta de detección nutricional específica en pacientes con insuficiencia renal. Se planeó evaluar la validez y confiabilidad de la herramienta de detección de nutrición en pacientes hospitalizados renales en Turquía. Métodos: se investigaron la validez y la confiabilidad de la Herramienta de Detección Nutricional en Pacientes Hospitalarios Renales comparándola con la Herramienta de Detección Universal de Malnutrición y la Evaluación Global Subjetiva para evaluar la malnutrición en 153 pacientes adultos recién ingresados en la unidad de nefrología. El estado nutricional se evaluó mediante mediciones antropométricas y la opinión de la enfermera se evaluó mediante un cuestionario. Resultados: se encontró que la herramienta de detección nutricional para pacientes hospitalizados con enfermedad renal era más sensible que la herramienta de detección universal de desnutrición para identificar mayores riesgos de desnutrición y brindar orientación dietética. El coeficiente V de Cramer fue de 0,238 entre la Herramienta de Detección Universal de Malnutrición y la Herramienta de Detección de Nutrición en Pacientes Hospitalarios Renales, y de 0,137 entre la Evaluación Global Subjetiva y la Herramienta de Detección de Nutrición en Pacientes Hospitalarios Renales, lo que indica la compatibilidad de la Herramienta de Detección de Nutrición en Pacientes Hospitalarios Renales con las variables de la herramienta de detección de Malnutrición Universal. Se observó una correlación moderada positiva significativa entre el número total de casillas rojas en la Herramienta de Detección Nutricional para pacientes hospitalizados con enfermedad renal y la puntuación total de la Herramienta de Detección Universal de Desnutrición (p < 0,05; r = 0,404). Conclusiones: la herramienta de detección nutricional para pacientes hospitalizados con insuficiencia renal es una herramienta de detección nutricional válida y confiable cuando la utilizan enfermeras especializadas experimentadas en unidades de nefrología para pacientes diagnosticados de insuficiencia renal en Turquía.

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A common factor in the pathogenesis of anorexia nervosa (AN) is compulsive exercise, often driven by a desire for weight loss. In an inpatient clinical setting, patients with AN are typically restricted from engaging in exercise as part of their daily clinical routine to prevent weight loss. As individually practiced physical activity (PA) is a relevant parameter, the aim of this study was to measure PA behavior in an inpatient AN population and compare it with healthy controls. A total of 128 participants, 64 female patients with AN (20 ± 6.1 years) and 64 sex and age-matched healthy controls (20 ± 4.7 years) were measured using accelerometers during 4 consecutive days (2 weekdays and 2 days at the weekend). AN patients were selected from a larger inpatient population based on clinical observation of insufficient weight gain during treatment, reflecting a subgroup with suspected elevated activity behavior. AN patients showed significantly longer daily walking durations (185 ± 44.6 min, vs. 121 ± 43.1 min), a higher step count (20498 ± 2224 vs. 13106 ± 4043) and longer running times (22 ± 31.2 min vs. 7 ± 8.9 min), whereas healthy controls spent more time during cycling (15 ± 11.8 min vs. 1.8 ± 2.3 min), all p < 0.01. PA did not differ significantly between weekdays and weekends in both groups. Despite PA restrictions, AN patients seem to engage more in PA than healthy controls during in-patient treatment. These results could be used in clinical settings to create awareness on compulsive exercise and for educational purposes during treatment.

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BACKGROUND: Psoriasis is a chronic skin disease that shares common inflammatory pathways with atherosclerosis. Although psoriasis is known to increase risk of developing coronary artery disease, the impact of psoriasis on outcomes after coronary artery bypass grafting (CABG) remains less established. This study aimed to compare the in-hospital outcomes of isolated CABG between patients with and without psoriasis through a population-based analysis of a national database. METHODS: Patients underwent CABG were selected from National Inpatient Sample from Q4 2015-2021. Patients with age <18 years and concomitant procedures were excluded. A 1:2 propensity-score matching was used to match demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status between psoriasis and non-psoriasis patients. In-hospital outcomes were assessed. RESULTS: There were 1,732 (0.95%) patients who underwent isolated CABG who had psoriasis. Patients with psoriasis were younger and more socioeconomically advantaged. After propensity-score matched to 3598 out of 191,175 non-psoriasis patients, patients with and without psoriasis had comparable in-hospital mortality rates (1.39% vs 1.03%, p = 0.27) and major adverse cardiovascular event (1.45% vs 1.86%, p = 0.31). Psoriasis patients had a slightly lower risk of venous thromboembolism (0.23% vs 0.67%, p = 0.04). All other in-hospital outcomes were comparable between psoriasis and non-psoriasis patients. CONCLUSIONS: The representation of psoriasis patients in CABG was lower than their prevalence in the general population. After propensity-score matching, outcomes for patients with and without psoriasis were comparable. Thus, despite the elevated cardiovascular risks associated with psoriasis, CABG may be as safe and as effective for these patients.

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This project aimed to evaluate the effect of patient portal utilization on patient experience and communication with care teams among hospitalized inpatients. Patients (n = 33) from an adult, 16-bed inpatient floor at an academic, level I trauma center completed a Web-based survey regarding their experience with a patient portal following training by medical students. Survey responses indicated a favorable perception of the portal. Most patients reported improved communication with healthcare providers and enhanced understanding of medications. The majority found the portal easy to navigate and expressed user satisfaction. The patient portal facilitated improved communication with care teams and a better understanding of medical management among patients. The study highlighted the importance of raising awareness about patient portal usage for inpatients. Health providers can foster improved communication, engagement, and medication education among hospitalized patients by promoting health information technology adoption.

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OBJECTIVE: To describe the prevalence, severity, and changes in symptom distress in children with serious illness seen by inpatient pediatric palliative care (PPC). STUDY DESIGN: Cross-sectional retrospective analysis of a multisite, inpatient PPC quality improvement dataset. We examined symptom prevalence and severity at the first PPC visit for 9 symptoms in children. For the 5 most prevalent symptoms, distress scores were dichotomized (none to mild and moderate to severe) and were analyzed for associations with patient and clinical characteristics and for changes in distress scores from first to second PPC visit and first to last PPC visit prior to hospital discharge or death. RESULTS: There were 1769 patient encounters between 2016 and 2022 across 5 hospitals in the dataset. Children were a median age of 5 years old (IQR 1-11). The most common diagnostic group was solid tumor and hematologic conditions (n = 716, 40.9%). Moderate to severe fatigue (n = 433, 51%), feeding issues (n = 512, 50%), dyspnea (n = 475, 41%), pain (n = 442, 37%), and anxiety (n = 308, 34%) were the 5 most prevalent symptoms. Moderate to severe symptom severity improved for all 5 symptoms (P < .001), but feeding issues persisted for nearly one-quarter of children. Notably, moderate to severe fatigue, feeding issues, and dyspnea at initial PPC assessment were associated with a higher likelihood of in-hospital death (each P < .05). CONCLUSIONS: In this dataset, moderate to severe symptoms often improved over the course of inpatient encounters. Moderate to severe fatigue, feeding issues, and dyspnea were associated with in-hospital death, suggesting a need to screen routinely for these symptoms as potential targets for improved PPC support.

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OBJECTIVE: Elevated physical activity is a feature of anorexia nervosa (AN), often associated with poorer clinical outcomes. Less is known about how physical activity energy expenditure (PAEE) prior to hospital admission relates to illness severity at presentation. METHOD: Secondary data analysis of the Study of Refeeding to Optimize Inpatient Gains, a randomized controlled trial comparing inpatient refeeding approaches in AN and atypical AN. Upon admission, patients self-reported: physical activity (past 7 days), Eating Disorder Examination-Questionnaire (EDE-Q), anxiety (GAD-7), depression (PHQ-A), distress tolerance (DTS), and menstrual status. Medical instability (heart rate and systolic blood pressure, orthostasis, electrolyte abnormalities) was assessed. PAEE was calculated by multiplying the activity-specific Metabolic Equivalent of Task (MET, kcal/kg/h) by the number of hours per activity; weekly METs for all activities were summed and averaged to obtain mean METs/day, then multiplied by admission body weight (kg) to obtain PAEE (kcal/d). Regressions assessed the association of PAEE and admission variables. RESULTS: Physical activity data were available for 91 of 116 patients (56% with AN, 95% female), with M (SD) age = 16.6 (2.5) years and %median Body Mass Index = 84.6 (11.4). Across 37 recorded activities, PAEE was 354 (319) kcal/day. Higher PAEE was associated with older age, longer duration of weight loss, higher eating restraint (EDE-Q; ß = 0.17, p = 0.04), and anxiety (GAD-7; ß = 0.57, p = 0.04), but not with markers of medical instability. DISCUSSION: Patients with high PAEE may need additional psychological support for anxiety and eating disorder cognitions during hospital admission. Further research is needed to understand how pre-admission PAEE relates to long-term recovery. PUBLIC SIGNIFICANCE STATEMENT: Patients with anorexia nervosa (AN) and atypical AN often report increased physical activity (PA). The extent to which energy expended in PA impacts indices of illness severity in the acute phase of illness is less well understood, especially among those who are subsequently hospitalized. Findings suggest patients expending greater energy in PA prior to admission may benefit from additional support to manage higher anxiety and eating restraint while in hospital. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02488109.

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PURPOSE: To investigate somatic health burden and self-rated health (SRH) among forensic psychiatric (FP) patients and the concordance between these two health measurements. Additionally, the study evaluates how different binary groupings of SRH responses impact concordance. METHODS: In a cross-sectional study, 67 inpatients from two Danish forensic psychiatric hospitals were assessed. SRH was measured using a single-item question from the validated and widely used SF-12 scale, and clinical evaluation was performed by a general physician using the Clinical Frailty Scale (CFS). SRH responses were dichotomised in two different ways to test concordance with clinical assessment, and detailed somatic health data were collected from consultations with health care professionals and patient records. RESULTS: Seventy-nine percent of FP patients assessed their own health as "good" or better despite the presence of risk factors such as history of smoking (median pack years = 20) and 25% having hypertension, 84% being overweight, and 55% having metabolic syndrome when assessed by a physician. We found a total of 195 somatic diagnoses with no clear trend in either diagnosis or organ system. Regardless of grouping, concordance between self-reported health and clinician-rated CFS remained low, ranging from 58 to 61%. CONCLUSION: This study reveals discrepancies between forensic psychiatric patients' subjective and clinically assessed health. The findings underscore the need to interpret SRH with caution in populations with severe mental illness, where discrepancies between SRH, physician-rated health and diagnoses burden are pronounced. Clinicians and researchers should approach SRH critically to avoid underestimating patients' health risks.

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Introduction: Introduction: chronic kidney disease (CKD) is a major risk factor for end-stage renal disease, and owing to its increasing global prevalence, poses a serious public health challenge. Patients with CKD frequently experience protein-energy wasting, frailty, sarcopenia, and cachexia, necessitating complex dietary restrictions, including protein, salt, and potassium limitation. Although a nutrition support team (NST) can improve nutritional status in hospitalised patients, additional interventions such as swallowing evaluation, oral care, and medication adjustments are crucial for effective outcomes. CKD is also strongly correlated with periodontal disease and diabetes: tooth loss and oral frailty exacerbate low nutritional intake, especially in older individuals. Objectives: to examine whether NST intervention combined with dental care would enhance nutritional and oral parameters in hospitalised patients referred for dental treatment. Methods: twenty-seven patients were assigned to either an NST-intervention (n = 10) or non-NST (n = 17) groups. We assessed serum albumin, C-reactive protein (CRP), body mass index (BMI), Subjective Global Assessment scores, remaining teeth, periodontal pocket depth, and bleeding on probing. Results: over a 1-month period, both groups showed significant decline in body weight and BMI, whereas albumin, CRP, and periodontal indices did not substantially change. The NST group demonstrated a higher proportion (50 %) of improved carbohydrate intake than the non-NST group (11 %), but this difference was not statistically significant. Reduced appetite was correlated with meal reduction, decreased body weight and meal reduction, and swallowing difficulties. Conclusions: short-term periodontal or NST interventions are insufficient for achieving significant improvements in CKD-associated malnutrition or periodontal status; therefore, more specialised interventions are needed.

Introducción: Introducción: la enfermedad renal crónica (ERC) es un factor de riesgo importante para la enfermedad renal en etapa terminal y, debido a su creciente prevalencia mundial, representa un serio desafío de salud pública. Los pacientes con ERC suelen experimentar desgaste energético-proteico, fragilidad, sarcopenia y caquexia, lo que implica restricciones dietéticas complejas que abarcan proteína, sal y potasio. Aunque un equipo de soporte nutricional (ESN) puede mejorar el estado nutricional de los pacientes hospitalizados, intervenciones adicionales como la evaluación de la deglución, el cuidado bucal y el ajuste de la medicación son cruciales para lograr resultados efectivos. La ERC también se correlaciona fuertemente con la enfermedad periodontal y la diabetes: la pérdida de dientes y la fragilidad bucal empeoran la escasa ingesta nutricional, especialmente en personas mayores. Objetivos: examinar si la intervención del ESN, combinada con el cuidado dental, mejoraría los parámetros nutricionales y orales en pacientes hospitalizados remitidos para tratamiento dental. Métodos: se asignó a 27 pacientes a dos grupos: intervención con ESN (n = 10) o sin ESN (n = 17). Se evaluaron la albúmina sérica, la proteína C reactiva (PCR), el índice de masa corporal (IMC), la puntuación de la Evaluación Global Subjetiva, los dientes remanentes, la profundidad de bolsa periodontal y el sangrado al sondeo. Resultados: durante un período de un mes, ambos grupos mostraron disminuciones significativas en el peso corporal y el IMC, mientras que la albúmina, la PCR y los índices periodontales no cambiaron sustancialmente. El grupo con ESN presentó una mayor proporción (50 %) de aumento en la ingesta de carbohidratos en comparación con el grupo sin ESN (11 %), aunque la diferencia no fue estadísticamente significativa. Se observó que la reducción del apetito se correlacionaba con la disminución de la ingesta en las comidas, la pérdida de peso y las dificultades de deglución. Conclusiones: las intervenciones a corto plazo de tipo periodontal o de ESN no son suficientes para lograr mejoras significativas en la malnutrición asociada a la ERC ni en el estado periodontal; por lo tanto, son necesarias intervenciones más especializadas.

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Neutropenic enterocolitis (NE) is an uncommon but serious complication in patients with acute myeloid leukemia (AML), often arising during periods of myelosuppression. Although recognized clinically, its broader impact on hospitalization outcomes and healthcare utilization in AML is poorly defined. To evaluate the association between NE and key inpatient outcomes, including in-hospital mortality, length of stay (LOS), and total hospital charges among patients with AML, this retrospective cross-sectional analysis was performed using the Nationwide Inpatient Sample (NIS) from 2018 to 2022. Multivariable models were fitted using survey-weighted logistic regression for mortality and Poisson regression with a log link for LOS and charges, adjusting for demographic and clinical covariates to calculate adjusted odds ratios (aORs) and adjusted incidence rate ratios (aIRRs), with corresponding 95 % confidence intervals (CIs). Among an estimated 344,545 AML hospitalizations, 3865 involved NE, which were associated with significantly longer hospitalizations and higher costs. In adjusted models, NE increased LOS by nearly 50 % (aIRR: 1.47, 95 % CI: 1.41-1.54) and total charges by over 40 % (aIRR: 1.44, 95 % CI: 1.35-1.53), with both associations being highly significant (p < 0.0001). In contrast, NE was not independently associated with in-hospital mortality (aOR: 0.89, 95 % CI: 0.75-1.06; p = 0.20). This study's findings indicate that, though NE was not a predictor of mortality, it is a strong driver of healthcare utilization in patients hospitalized with AML. These findings underscore NE's importance as a complication with major clinical and economic implications, highlighting the need for strategies to improve recognition and management in this vulnerable population.

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CONTEXT: Pain, agitation, and other refractory symptoms occur commonly in palliative patients. Dexmedetomidine has anxiolytic, analgesic, and sedating effects; however, its use remains uncommon in palliative care. In New Zealand, the Hospice Waikato Inpatient Unit has increasingly used dexmedetomidine since 2019 when symptoms are refractory and deep sedation is not desirable due to patient and prognostic factors. OBJECTIVES: To describe use of subcutaneous dexmedetomidine infusions in the Hospice Waikato Inpatient Unit, noting patient demographics, treatment characteristics, safety factors, and effectiveness. METHODS: A retrospective, observational review of clinical records, using descriptive statistics. RESULTS: Twenty-six infusions in 25 adult patients (≥18 years) were analyzed, of whom 24 (96%) had malignancy. Refractory pain (n=24, 92%) and agitated delirium (n = 13, 50%) were the commonest indications for dexmedetomidine. Median duration was 4 days (interquartile range 2.3-8.8 days). Infusion rates ranged between 0.2 and 1.4 mcg/kg/hr. Side effects occurred in 15 infusions (58%) but none required cessation. Potentiation of opioids, causing sedation, occurred once (4% of infusion events). Hemodynamic monitoring was seldom performed. Median change in Richmond Agitation-Sedation Score (RASS-PAL) over 24 hours was -2 (P = 0.0001) and clinicians perceived dexmedetomidine as effective within 24 hours in 23 cases (88%). Opioid and midazolam requirements often reduced but this effect was less pronounced beyond 24 hours. CONCLUSION: Dexmedetomidine subcutaneous infusion appears to be well-tolerated, safe, and effective in managing pain and agitation, while maintaining patients' ability to interact with family. It may avoid the need for palliative sedation therapy (PST) in some cases.

RESUMO

PURPOSE: Extended hospitalization can lead to fatigue, sleep disturbance, anxiety, depression, and functional decline in cancer patients. This retrospective observational study examined reasons for referral to inpatient one-on-one Yoga Therapy (YT) consultations and observed the delivery of YT to address symptoms. Exploratory analyses examined patient-reported outcomes (PROs) following a single YT session. METHODS: Data from inpatient YT consultations from January 2020 to March 2023 were evaluated. Information included demographics, referral reason, and self-reported symptom burden before and after YT using the modified Edmonton Symptom Assessment Scale (mESAS). Changes in mESAS scores were evaluated by the Wilcoxon signed-rank test. RESULTS: Pre-post mESAS responses were available for 88/130 YT referrals. Most patients were female (n = 88; 67.7%) and white (n = 101; 77.7%), with a mean age of 53.1. The most common cancer diagnosis was leukemia (19.2%), and 40.8% had metastatic disease. The primary referral reasons were fatigue (76.9%), anxiety/stress reduction (76.2%), and quality of life (62.3%). The highest patient-reported symptoms pre-YT were Fatigue (x ̅ = 5.26), decreased Well-Being (x ̅ = 4.89), and Sleep disturbances (x ̅4.66). Following YT, participants reported clinically and statistically significant reductions in Fatigue (mean difference (MD) = -1.62, p < 0.001, ES = 0.82), Anxiety (MD = -1.56, p < 0.001, ES = 0.78), and Pain (MD = 1.44, p < 0.001, ES = 0.79), with significant reductions in mESAS components except Financial Distress and Spiritual Pain. Change scores were larger for patients scoring ≥ 4 on a specific symptom pre-YT. CONCLUSIONS: Findings suggested that a single inpatient YT intervention provided immediate relief from symptom burden, especially for those reporting high symptom burden. The long-term effects of inpatient YT merits further study as a non-pharmacologic intervention to reduce symptom burden in patients with cancer.