The burden of hyperkalaemia on hospital healthcare resources.

Hyperkalaemia is associated with prolonged hospital admission and worse mortality. Hyperkalaemia may also necessitate clinical consults, therapies for hyperkalaemia and high-dependency bed utilisation. We evaluated the 'hidden' human and organisational resource utilisation for hyperkalaemia in hospitalised patients. This was a single-centre, observational cohort study (Jan 2017-Dec 2020) at a tertiary-care hospital. The CogStack system (data processing and analytics platform) was used to search unstructured and structured data from individual patient records. Association between potassium and death was modelled using cubic spline regression, adjusted for age, sex, and comorbidities. Cox proportional hazards estimated the hazard of death compared with normokalaemia (3.5-5.0 mmol/l). 129,172 patients had potassium measurements in the emergency department. Incidence of hyperkalaemia was 85.7 per 1000. There were 49,011 emergency admissions. Potassium > 6.5 mmol/L had 3.9-fold worse in-hospital mortality than normokalaemia. Chronic kidney disease was present in 21% with potassium 5-5.5 mmol/L and 54% with potassium > 6.5 mmol/L. For diabetes, it was 20% and 32%, respectively. Of those with potassium > 6.5 mmol/L, 29% had nephrology review, and 13% critical care review; in this group 22% transferred to renal wards and 8% to the critical care unit. Dialysis was used in 39% of those with peak potassium > 6.5 mmol/L. Admission hyperkalaemia and hypokalaemia were independently associated with reduced likelihood of hospital discharge. Hyperkalaemia is associated with greater in-hospital mortality and reduced likelihood of hospital discharge. It necessitated significant utilisation of nephrology and critical care consultations and greater likelihood of patient transfer to renal and critical care.

The impact of group II pulmonary hypertension on congestive heart failure patients admitted with ST elevation myocardial infarction, a nationwide study.

Background: Pulmonary hypertension (PH) is a condition where the blood pressure increases in the pulmonary arteries, leading to reduced oxygen delivery to the body's tissues due to increased blood flow resistance. This condition can result in right ventricular hypertrophy, low cardiac output, and ischemia. In this study, the authors aim to investigate the impact of group II PH (GIIPH) on patients with congestive heart failure who were admitted with ST elevation myocardial infarction (STEMI) through a retrospective cohort study. Methods: Using the National Inpatient Sample (NIS) database from 2017 to 2020, a retrospective cross-sectional study of adult patients with a principal diagnosis of STEMI with a secondary diagnosis with or without GIIPH according to ICD-10 (International Classification of Disease, 10th edition) codes. Several demographics, including age, race, and gender, were analyzed. The primary endpoint was mortality, while the secondary endpoints included cardiogenic shock, mechanical intubation, length of stay in days, and patient charge in dollars. Multivariate logistic regression model analysis was used to adjust for confounders, with a P value less than 0.05 considered statistically significant. Results: The study included 26,925 patients admitted with a STEMI, 95 of whom had GIIPH. The mean age for patients with and without PH was 66.6 and 67.5 years, respectively. In the PH group, 37% were females compared to 34% in the non-PH group. The in-hospital mortality rate was higher in the PH group (31.6% vs. 9.6%, P<0.001, adjusted odds ratio (aOR) =3.33, P=0.02). The rates and adjusted odds of cardiogenic shock and mechanical ventilation were higher in the PH groups (aOR =1.15 and 2.14, respectively) but not statistically significant. Patients with PH had a longer length of stay and a higher total charge. Conclusions: GIIPH was associated with worse clinical and economic outcomes in heart failure patients admitted with STEMI.

Predictive factors of cognitive impairment in alcohol use disorder inpatients.

BACKGROUND: Cognitive impairments are common in patients with AUD and worsen the prognosis of addiction management. There are no clear guidelines for screening cognitive impairments in hospitalized patients with AUD. METHODS: Fifty-seven patients with an AUD history who were admitted to an acute hospital and assessed by the addiction care team were included. Those patients were screened for cognitive impairments using the Montreal Cognitive Assessment (MoCA) test. We collected clinical information regarding addiction history, comorbidities, and current treatments. Chi-square tests, t-tests, and Mann-Whitney tests were performed to determine factors associated with a pathological MoCA score (<26). RESULTS: A pathological MoCA score was positively associated with spatial-temporal disorientation, difficulty in recalling addiction history, patient underreporting of AUD and a date of last alcohol consumption lower than 11 days ago, and negatively associated with a reason for hospitalization due to alcohol-related health issues. No medication was associated with cognitive impairments. CONCLUSIONS: Clinical elements from assessment by the addiction care team allow for relevant indication for screening cognitive impairments.

Methods for Estimating Costs for Stays at Inpatient Rehabilitation Facilities and Long-Term Care Hospitals.

OBJECTIVE: To describe and compare three methods for estimating stay-level Medicare facility (Part A) costs using claims and cost-report data for inpatient rehabilitation facilities (IRFs) and long-term care hospitals (LTCHs), the two hospital-based post-acute care providers. DESIGN: We calculated stay-level facility costs using different methods. Method 1 used routine costs per day and ancillary cost-to-charge ratios. Method 2 used routine and ancillary cost-to-charge ratios (freestanding IRFs and LTCHs only). Method 3 used facility-specific operating cost-to-charge ratios from the Provider Specific File. For each method, we compared the costs to payments and charges at the claim and facility levels and examined facility margins. SETTING: Data are from 1,619 providers, including 266 freestanding IRFs, 909 IRF units, and 444 LTCHs. PARTICIPANTS: The analyses included 239,284 claims from 2014, of which 86,118 claims were from freestanding IRFs, 92,799 claims were from IRF units, and 60,367 claims were from LTCHs. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURE(S): Costs and payments in 2014 United States Dollars RESULTS: For freestanding IRFs, the mean facility stay-level costs were calculated to be $13,610 (Method 1), $13,575 (Method 2) and $13,783 (Method 3). For IRF units, the mean facility stay-level costs were $17,385 (Method 1) and $19,093 (Method 3). For LTCHs, the mean facility stay-level costs were $36,362 (Method 1), $36,407 (Method 2), $37,056 (Method 3). CONCLUSIONS: The three methods resulted in small differences in facility mean stay-level costs. Using the facility-level cost-to-charge ratio (Method 3) is the least resource intensive method. While more resource intensive, using routine cost per day and ancillary cost-to-to-charge ratios (Method 1) for cost calculations allows differentiation in costs across patients based on differences in the mix of service use. As policymakers consider post-acute care payment reforms, cost, rather than charge or payment data, need to be calculated and the results of the methods compared.

Impact of COVID-19 infection among patients hospitalized for conventional pacemaker implantation: Analysis of the Nationwide Inpatient Sample (NIS) 2020.

Introduction: The cardiac pacemaker is indicated for treating various types of bradyarrhythmia, providing lifelong cardiovascular benefits. Recent data showed that COVID-19 has impacted procedure numbers and led to adverse long-term outcomes in patients with cardiac pacemakers. However, the impact of COVID-19 infection on the in-hospital outcome of patients undergoing conventional pacemaker implantation remains unclear. Method: Patients aged above 18 years who were hospitalized for conventional pacemaker implantation in the Nationwide In-patient Sample (NIS) 2020 were identified using relevant ICD-10 CM and PCS codes. Multivariable logistic and linear regression models were used to analyze pre-specified outcomes, with the primary outcome being in-patient mortality and secondary outcomes including system-based and procedure-related complications. Results: Of 108 020 patients hospitalized for conventional pacemaker implantation, 0.71% (765 out of 108 020) had a concurrent diagnosis of COVID-19 infection. Individuals with COVID-19 infection exhibited a lower mean age (73.7 years vs. 75.9 years, p = .027) and a lower female proportion (39.87% vs. 47.60%, p = .062) than those without COVID-19. In the multivariable logistic and linear regression models, adjusted for patient and hospital factors, COVID-19 infection was associated with higher in-hospital mortality (aOR 4.67; 95% CI 2.02 to 10.27, p < .001), extended length of stay (5.23 days vs. 1.04 days, p < .001), and linked with various in-hospital complications, including sepsis, acute respiratory failure, post-procedural pneumothorax, and venous thromboembolism. Conclusion: Our study suggests that COVID-19 infection is attributed to higher in-hospital mortality, extended hospital stays, and increased adverse in-hospital outcomes in patients undergoing conventional pacemaker implantation.

Impact of COVID-19 infection on the in-hospital outcome of patients hospitalized for heart failure with comorbid atrial fibrillation: Insight from the National Inpatient Sample (NIS) database 2020.

Introduction: Atrial fibrillation (AF) and heart failure (HF) commonly coexist, resulting in adverse health and economic consequences such as declining ventricular function, heightened mortality, and reduced quality of life. However, limited information exists on the impact of COVID-19 on AF patients that hospitalized for HF. Methods: We analyzed the 2020 U.S. National Inpatient Sample to investigate the effects of COVID-19 on AF patients that primarily hospitalized for HF. Participants aged 18 and above were identified using relevant ICD-10 CM codes. Adjusted odds ratios for outcomes were calculated through multivariable logistic regression. The primary outcome was inpatient mortality, with secondary outcomes including system-based complications. Results: We identified 322,090 patients with primary discharge diagnosis of HF with comorbid AF. Among them, 0.73% (2355/322,090) also had a concurrent diagnosis of COVID-19. In a survey multivariable logistic and linear regression model adjusting for patient and hospital factors, COVID-19 infection was associated with higher in-hospital mortality (aOR 3.17; 95% CI 2.25, 4.47, p < 0.001), prolonged length of stay (ß LOS 2.82; 95% CI 1.71, 3.93, p < 0.001), acute myocarditis (aOR 6.64; 95% CI 1.45, 30.45, p 0.015), acute kidney injury (AKI) (aOR 1.48; 95% CI 1.21, 1.82, p < 0.001), acute respiratory failure (aOR 1.24; 95% CI 1.01, 1.52, p 0.045), and mechanical ventilation (aOR 2.00; 95% CI 1.28, 3.13, p 0.002). Conclusion: Our study revealed that COVID-19 is linked to higher in-hospital mortality and increased adverse outcomes in AF patients hospitalized for HF.

[Reform proposal "Occasional surgical oncology" : Medical strategic analysis and ramifications of the draft bill within the framework of the Hospital Treatment Improvement Act (KHVVG) from the perspective of a university hospital]. / Reformvorhaben "Gelegenheits-Onkochirurgie" : Medizinstrategische Analyse und Auswirkungen der Gesetzesinitiative im Rahmen des Krankenhausversorgungsverbesserungsgesetzes (KHVVG) aus der Perspektive eines Universitätsklinikums.

BACKGROUND: Cancer remains the second most common cause of death in Germany. Performance management and specialization concepts in medicine have the potential to positively influence the care and chances of survival of patients. OBJECTIVE: From the perspective of the University Hospital Freiburg (UKF), the legislative initiative within the framework of the Hospital Treatment Improvement Act (KHVVG) results in a number of medical strategic implications. This article explains and discusses the background, objectives and contents of the reform project "Occasional surgical oncology" and provides perspectives on strategic fields of action. MATERIAL AND METHODS: Analysis and interpretation of the draft of the Act for improvement of the treatment quality in hospitals and on the reform of the remuneration structures (Federal Government draft act). RESULTS: From the point of view of the UKF hospitals should engage in cooperative discussions with neighboring hospitals at the earliest opportunity to shape regional healthcare with the goals of mapping the local allocation of oncology patients for optimal treatment, mitigating the loss of patients at affected locations and preparing for patient growth at facilities that will continue to provide treatment in surgical oncology. DISCUSSION: The ongoing legislative process and the fact that a reliable analysis of relevant treatment areas will be possible for hospitals in the first half of 2025, presents particular challenges for hospitals and the strategic planning of activities. The gaps in the bill presented in this article should be urgently addressed to avoid undermining the project's goals and to support the hospitals remaining in the healthcare system in their preparations.

Frailty predicts adverse outcomes in older patients with pulmonary embolism.

AIM: This study aims to evaluate the impact of frailty on the outcomes of older patients with pulmonary embolism (PE). METHODS: Using the National Inpatient Sample database, we identified 288 070 patients aged 65 or older who were admitted with a primary diagnosis of PE from 2017 to 2019. Frailty was assessed using the Hospital Frailty Risk Score (HFRS), and patients were categorized into low-, intermediate-, and high-frailty-risk groups. Multivariate logistic regression was used to calculate adjusted odds ratios for all outcomes. RESULTS: These patients were categorized into low-risk (57.6%, 161 420), medium-risk (39.9%, 111 805), and high-risk (2.5%, 7075) groups. High-risk patients, predominantly females with multiple comorbidities, exhibited significantly higher mortality rates and adverse outcomes. The HFRS showed a good discriminating ability in predicting mortality (area under the receiver operating characteristic curve = 0.7796). Frailty was associated with increased use of advanced therapeutic interventions and critical care resources such as thrombolysis, catheter-directed therapies, inferior vena cava filter placement, mechanical ventilation, vasopressor use, and intensive care unit admission. CONCLUSION: Frailty markedly affects outcomes in older PE patients. The HFRS offers a valuable prognostic tool in this population, suggesting that integrating frailty assessments into clinical practice could enhance care strategies and improve patient outcomes. Our findings underscore the need for further research to refine frailty-based care paradigms. Geriatr Gerontol Int 2024; ••: ••-••.

Evaluation of a Dialectical Behavior Therapy Didactic for Medical Trainees in an Acute Adolescent Inpatient Psychiatric Unit.

OBJECTIVE: Dialectical behavior therapy (DBT) is an evidence-based treatment for patients with suicidality and emotion dysregulation. There is increasing evidence of using DBT in psychiatric inpatient units for youth. On inpatient units, the majority of treatment is provided by psychiatry trainees, often with limited therapy experience. The study's objective was to assess the impact of a 1-h weekly DBT training for a range of medical trainees rotating through a child and adolescent acute inpatient unit. METHODS: Participants were 55 medical students, psychiatry residents, and child and adolescent psychiatry fellows who rotated on an inpatient unit for youth and participated in a 1-h DBT didactic. There was one group who attended less than four sessions and the other attended 5 or more sessions. A pre- and post-method design was used to collect data on participants' confidence, competence, and knowledge of DBT and working with suicidal youth. RESULTS: Comparing pre- and post-data for all participants, the DBT training was found to lead to significant benefits for trainees' comfort with therapy, prioritizing therapy during inpatient care, knowledge of DBT, comfort with DBT, and confidence in treating children and adolescents with suicidality. There were no significant differences in the type of trainee or dose of training. CONCLUSION: This study supports the benefit of a brief DBT didactic to provide training to a wide range of trainees to improve therapeutic care in an inpatient psychiatric unit for youth.

Minimally invasive distal pancreatectomy for pancreatic adenocarcinoma: A propensity-matched national analysis on surgical outcomes and healthcare disparities.

BACKGROUND: Pancreatic adenocarcinoma of distal pancreas is hard to treat due to late presentation. While open distal pancreatectomy with splenectomy has had favourable outcomes, it has also had many complications which were low among Minimally invasive procedures. This retrospective cohort analysis compares minimally invasive and open distal pancreatectomy (MIDP) outcomes using a national inpatient database. METHODS: The study used 2016-2020 NIS data. The study included 1577 distal pancreatic malignant tumor surgery patients. There were 530 Minimally Invasive and 1047 Open groups. Propensity matched analysis was performed on surgical groups to reduce confounding variables. RESULTS: In comparison to open procedures, minimally invasive techniques reduced hospital stays by 10 â€‹% (OR â€‹= â€‹0.90, 95 â€‹% CI 0.86-0.93). While not statistically significant, the unmatched analysis linked MIDP to lower in-hospital mortality. African Americans were 37 â€‹% less likely to undergo MIDP than Caucasians (OR â€‹= â€‹0.63, 95 â€‹% CI â€‹= â€‹0.40-0.96). CONCLUSION: Nationwide analysis suggests MIDP may be a safe and effective surgical treatment for distal pancreatic adenocarcinoma. It may reduce hospital stays and mortality over open surgery. The study also suggests race may affect minimally invasive procedure rates.

Social Disparities in Pulmonary Embolism and Deep Vein Thrombosis During COVID-19 Pandemic From a Nationwide Inpatient Sample (2020).

INTRODUCTION / OBJECTIVES: Studies have shown that Coronavirus Disease 2019 (COVID-19) is associated with a hypercoagulable state. Studies have yet to examine the interconnectedness between COVID-19, hypercoagulability, and socioeconomics. The aim of this work is to investigate socioeconomic factors that may be associated with pulmonary embolism (PE), Deep Vein Thrombosis (DVT), and COVID-19 in the United States (U.S.). METHODS: We performed a 1-year (2020) analysis of the National Inpatient Sample database. We identified all adult patients diagnosed with COVID-19, acute PE, or acute DVT using unweighted samples. We calculated the correlation and odds ratio (OR) between COVID-19 and 1) PE, and 2) DVT. We executed a univariate analysis followed by a multivariate analysis to examine the effect of different factors on PE and DVT during the COVID-19 pandemic. RESULTS: 322,319 patients were identified with COVID-19, while 78,101 and 67,826 patients were identified with PE and DVT, respectively. PE and DVT, as well as, inpatient mortality associated with both conditions are significantly correlated to COVID-19. The OR between COVID-19 and PE was 2.04, while the OR between COVID-19 and DVT was 1.44. Using multivariate analysis, COVID-19 was associated with a higher incidence of PE (coefficient 2.05) and DVT (coefficient 1.42). Other factors that were significantly associated (p<0.001) with increased incidence of PE and DVT along with their coefficients, respectively, include Black race (1.23, 1.14); top quartile income (1.08, 1.16); west region (1.10, 1.04); urban teaching facilities (1.09, 1.63); large bed size hospitals (1.08, 1.29); insufficient insurance (1.88, 2.19); hypertension (1.24, 1.32); and obesity (1.41, 1.25). Factors that were significantly associated (p<0.001) with decreased incidence of PE and DVT along with their coefficients, respectively, include Asians/Pacific Islanders (0.52, 0.53); female sex (0.79, 0.74); homelessness (0.62, 0.61); and diabetes mellitus (0.77, 0.90). CONCLUSION: In a nationwide inpatient sample of the United States, COVID-19 is positively correlated to venous thromboembolism - including its subtypes: pulmonary embolism and deep vein thrombosis. Utilizing multivariate analysis, Black race, male sex, top quartile income, west region, urban teaching facilities, large bed size hospitals, and insufficient social insurance were significantly associated with increased incidence of PE and DVT. Asians / Pacific Islanders, female sex, homelessness, and diabetes mellitus were significantly associated decreased incidence of PE and DVT.

A local review of section 17 leave forms in conjunction with the Mental Health Act Code of Practice: recommendations for future practice.

AIMS AND METHOD: The aim of this project was to set out recommendations for the section 17 leave form to reflect guidance provided in the Mental Health Act 1983: Code of Practice, following local Care Quality Commission feedback. We reviewed guidance in the Code and publicly available leave forms to identify items to include in the leave form. Then, we determined which publicly available leave forms included each item and reviewed whether the item should be included in the leave form and whether any reformulation was needed. RESULTS: Using the method described, we identified a list of items that should be included in the leave form. When comparing the leave forms of different trusts, there was considerable variation with respect to which items were included in each form. CLINICAL IMPLICATIONS: We provide some recommendations for future practice regarding section 17 leave forms to facilitate consistency with the Code and between different trusts.

Implementation of a practice model for inpatient psychiatric clinical pharmacist practitioners with prescriptive authority at a veterans health care facility.

Clinical pharmacists play a valuable role on collaborative health care teams, especially in the field of mental health. However, there is a need to explore innovative practice models that optimize their potential in providing comprehensive medication management in inpatient psychiatric settings. This report aims to describe the implementation of a practice model using an inpatient psychiatric clinical pharmacist practitioner performing comprehensive medication management. The implementation of a practice model using a psychiatric clinical pharmacist practitioner was a feasible way to deliver comprehensive medication management and other clinical services in an inpatient psychiatric setting amid staffing challenges. Whereas limitations such as resource constraints must be considered, the success of this model highlights the value of a versatile psychiatric clinical pharmacist practitioner. These findings might offer insight to other health care facilities considering a similar approach to provide mental health care through the use of a psychiatric clinical pharmacist practitioner.

Incidence and risk factors of blood transfusion after total knee arthroplasty: A retrospective nationwide inpatient sample database study.

Introduction: Common postoperative complications of total knee arthroplasty (TKA) include blood transfusion. Although risk factors and incidence of blood transfusion have been studied through national databases, the relative impact of each risk factor needs to be synthesized over a longer time period into a new model need to be revised. Material and methods: Patient data were extracted from the National Inpatient Sample (NIS), which is the largest hospital care database in the US, and analyse patient data retrospectively from 2010 through 2019. The final data included the patients undergoing TKA. The final analysis assessed the demographics of patients, type of insurance, type of hospital, length of stay (LOS), preoperative comorbidities, total charge, inpatient mortality, medical-surgical postoperative complications. Results: After extracting data from the NIS database, a total of 1,250,533 patients with TKA were included in the analysis, and the rate of transfusion was 6.60 %. TKA patients who receive blood transfusion had longer LOS (from 2-3 days to 3-4 days), more preoperative comorbidities, higher inpatient mortality rate, and increased total charge (P < 0.001). Moreover, postoperative complications associated with inpatients included sepsis, acute myocardial infarction and shock. Elective admission and private insurance were also regarded as protective factors. Conclusion: Blood transfusion could bring postoperative complications to patients, which were also linked to health costs and risks. It was also a common preoperative comorbidities for older patients who underwent TKA. Through better blood management strategies, we could reduce patient transfusion rates and improve clinical outcomes.Level of Evidence: Diagnostic Level Ⅲ.

Surgical Site Infection Risk Factors in Hip Arthroplasty for Transcervical Femoral Neck Fractures.

Background Hip fracture patients often experience surgical site infections (SSIs) as a major infectious complication after undergoing total hip arthroplasty (THA), which can lead to extended hospital stays, increased mortality, and higher healthcare costs. This study aimed to determine the incidence of SSI and identify the risk factors associated with it after THA. Objective This study aimed to explore the correlation between blood transfusion along with other factors and the occurrence of SSIs in postoperative patients who underwent THA for transcervical femoral neck fractures. Methods We conducted a retrospective analysis by reviewing the medical records of patients aged 60-80 years who underwent surgery for hip fractures at the Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia No. 21 in Monterrey, Mexico, between January 2020 and January 2021. We analyzed potential risk factors such as age, sex, transfusion necessity, preoperative hemoglobin levels, history of diabetes mellitus, arterial hypertension, and end-stage chronic disease. Data are presented as numbers and percentages, and statistical analyses were performed using IBM SPSS Statistics for Windows, Version 28.0 (Released 2021; IBM Corp., Armonk, New York, United States). Results The study included 87 patients, of whom 55 (63%) were women with an average age of 73 years. SSIs were identified in 12 (13.8%) patients. Among those with infections, nine (75%) had a history of blood transfusion (p=0.05). Diabetes, hypertension, and chronic kidney disease also increased the risk for infection. There was no association with gender, age, American Society of Anesthesiologists (ASA) risk, and preoperative hemoglobin. Conclusions We found a heightened risk of SSI in patients with a history of blood transfusions, emphasizing the need for careful consideration and monitoring during the perioperative period. Additionally, patients with comorbidities such as diabetes, hypertension, and chronic kidney disease were more susceptible to SSI, underscoring the importance of preoperative assessment and targeted preventive measures. Further research and collaboration are needed to refine strategies for mitigating SSI risk factors and optimizing healthcare resource utilization.

Safety of thyroidectomy in hospitalized patients: A descriptive analysis of the NSQIP thyroidectomy-targeted data.

BACKGROUND: Some patients undergo thyroidectomy while hospitalized for a related or independent indication. Outcomes have not been described in this group. METHODS: The 2016-2018 thyroidectomy-targeted NSQIP datasets were queried for patients admitted for ≥1 day preoperatively. 1:1 propensity score matching was employed to compare the outcomes of admitted patients to outpatients, including surgical and thyroidectomy-specific outcomes. Multivariable logistic regression determined factors associated with poor outcomes. RESULTS: Of 18,078 patients, 312 were admitted at least 1 day prior to surgery. Inpatients had higher ASA classifications and rates of several comorbidities compared to the general population. After propensity score matching, inpatients had higher rates of overall complications, unplanned reoperation, and bleeding. They also experienced higher rates of thyroidectomy-specific complications such as hypocalcemia and neck hematoma. By multivariable regression, admission prior to surgery was associated with development of any complications. CONCLUSION: Thyroidectomy in hospitalized patients carries an increased risk of complications. Patients requiring thyroidectomy while already hospitalized should be counseled accordingly.

Inpatient Outcomes of Cirrhosis-related Cachexia in the United States.

Background and Aims: Cachexia is a metabolic syndrome defined by a loss of more than 5% of body weight in patients with chronic diseases. The goal of this study was to investigate the link between cirrhotic cachexia and hospital mortality and the 30-day risk of all-cause readmission. Methods: The study utilized Nationwide Readmission Database for the years 2016-2019 in which all patients older than 18 year old with a primary diagnosis of cirrhosis were included. We excluded patients with a concurrent diagnosis of Human Immunodeficiency Virus, chronic lung disease, end-stage renal disease, malignancy, heart failure, and certain neurological diseases. We compared baseline characteristics and outcomes between those who were cachectic and those who were not. Survey multivariate logistic regression was used to analyze the independent impact of cachexia on categorical outcomes. Results: The study cohort was 342,030 cases. Cachexia was identified in approximately 17% of the study population (58,509 discharges). The mean age was 56 years. Slightly more female patients noted in cachexia group (41% vs 38%). Inpatient mortality during index hospitalization were higher in patients with cirrhotic cachexia (6.7% vs 3%, P < .01). Inpatient mortality during first all-cause readmission within 30 days of index discharge was also higher in cachexia group (8.6% vs 6.5%, P < .01). Conclusion: Cachexia is an adverse prognosticator for inpatient outcomes in patients with cirrhosis. It is associated with greater readmission rates, inpatient mortality, and prolonged hospital admissions.

Colorectal Post-polypectomy Bleeding in Outpatient versus Inpatient Treatment: Propensity Score Matching Analysis.

Objectives: Delayed bleeding is the most frequent adverse event associated with endoscopic mucosal resection (EMR) and hot snare polypectomy (HSP) of colorectal polyps. However, whether the incidence of delayed bleeding differs between outpatient and inpatient treatment is unknown. Therefore, in this study, we aimed to evaluate delayed bleeding rates between outpatient and inpatient endoscopic treatments and clarify the safety of outpatient treatment. Methods: We enrolled 469 patients (1077 polyps) and 420 patients (1080 polyps) in the outpatient and inpatient groups, respectively, who underwent EMR or HSP for colorectal polyps at our institution between April 2020 and May 2023. Using propensity score matching, we evaluated the delayed bleeding rates between the two groups. Delayed bleeding was defined as a hemorrhage requiring endoscopic hemostasis occurring within 14 days of the procedure. Results: Propensity score matching created 376 (954 polyps) matched patient pairs. The median maximum diameter of polyps removed was 10 mm in both groups. Delayed bleeding rates per patients were 1.3% (5/376) in the outpatient group and 2.9% (11/376) in the inpatient group (P=0.21). In term of per polyp, early delayed bleeding (occurring within 24 hours) rates were higher in the inpatient group than outpatient group (0.2% [2/954] vs. 1.1% [10/954], respectively; P=0.04). No severe bleeding requiring a transfusion occurred in either group. Conclusions: Outpatient endoscopic treatment did not increase delayed bleeding compared with inpatient treatment. Outpatient treatment would be safe and common for the removal of colorectal polyps.

Patient's Experiences of a Cognitive Behaviour Therapy Informed Crisis Intervention for Psychosis Delivered in Inpatient Settings: A Qualitative Exploration.

Cognitive behaviour therapy for psychosis (CBTp) should be offered to patients receiving psychiatric inpatient care, yet very little is known about patients' perspectives on this. The aim of this study was to examine patients' experiences of a CBTp-informed intervention delivered in inpatient settings. We recruited 10 participants from the intervention arm of a randomised controlled trial examining the feasibility and acceptability of a CBTp-informed intervention for psychiatric inpatient settings. We undertook semistructured interviews examining their experiences of the intervention and analysed them using thematic analysis. The study was conducted in partnership with a coproduction group of key stakeholders (people with lived experience, family and carers, and clinicians). The intervention was found helpful by almost all participants, and all participants would recommend it to others in similar situations to themselves. The results demonstrated that participants valued the therapist's professionalism and emphasised the importance of the therapeutic relationship. Participants highlighted the importance of the therapy focusing on navigating admission and developing skills to manage the crisis experience so they could return to their normal lives. Participants described challenges to having psychological therapy in the acute crisis context including therapy interruptions and ongoing distressing experiences of psychosis. The study demonstrated the importance of prioritising the therapeutic relationship, that therapy was a valued process to navigate admission and discharge, but that some environmental and patient-level challenges were present. Further research is needed to explore inpatients' experiences of psychological interventions in this setting. TRIAL REGISTRATION: ISRCTN trial registry: ISRCTN59055607.