Greater readmission rates after total hip arthroplasty with discharge to a facility vs. home: A propensity score matched analysis.

Purpose: Provided that total hip arthroplasties (THA) are some of the most common surgical procedures performed, there is a necessity to understand all factors that contribute to risks of adverse outcomes postoperatively and to find solutions to avoid these events with preventive measures. This retrospective cohort study sought to assess differences in (1) postoperative complication rates, (2) readmission rates and reasons, and (3) demographic variables that contribute to readmissions based on discharge destination within the first 30 days after a THA. Methods: Patients undergoing THA (27130) between 2015 and 2020 were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database based on procedural codes. Propensity score matching was then employed to reduce selection bias, and Chi-square tests and one-way analysis of variance (ANOVA) were performed. Multivariable analysis was then used to look for other factors associated with readmission risk. Results: 219,960 patients were identified with 189,841 discharged to home, 19,355 to a skilled nursing facility (SNF), and 10,764 to a rehabilitation facility. The rehabilitation and SNF cohorts both had greater rates of readmission (4.56 % home vs. 6.88 % SNF vs. 6.90 % rehabilitation, P<0.001) and any adverse event (AAE, 9.02 % vs. 18 % vs. 21.3 %, P<0.001) after matching. Older age, longer operative time, American Society of Anesthesiologists (ASA) classification four, chronic obstructive pulmonary disease (COPD), bleeding disorders, steroid use, and smoking were associated with an increased risk of readmission after THA. Conclusion: Overall, THAs were shown to have low postoperative complications and readmissions in all patient populations despite differences in discharge destination which continues to demonstrate the safety and validity of this often elective procedure. However, the statistically significant risk of complications and readmissions in addition to the higher costs associated should be accounted for when considering patient discharges to a non-home facility.

O efeito conjunto de gemelaridade e prematuridade no aleitamento materno exclusivo na alta hospitalar / The joint effect of twinning and prematurity on exclusive breastfeeding at hospital discharge / El efecto conjunto de la gemelaridad y la prematuridad en la lactancia materna exclusiva al momento del alta hospitalaria

Objetivo: estimar a prevalência de Aleitamento Materno Exclusivo (AME) entre gemelares pré-termos e investigar o efeito de nascer gemelar e pré-termo no AME na alta hospitalar. Método: coorte prospectiva de recém-nascidos em uma instituição localizada no Rio de Janeiro, no período de 13 de março de 2017 a 12 de outubro de 2018. Dados coletados em questionário e prontuário médico. Foi utilizado DAG para construção do modelo conceitual, análise exploratória dos dados e regressão logística múltipla. Resultados: a prevalência de AME na alta hospitalar de gemelares pré-termos foi de 47,8%. Pré-termos apresentaram maior chance de não estarem em AME na alta hospitalar. Não gemelares apresentaram maior chance de não estarem em AME na alta hospitalar. Conclusão: pouco mais da metade dos gemelares pré-termo não estavam em AME na alta hospitalar. Prematuros tiveram maior chance de não estarem em AME. Não gemelares pré-termo apresentaram maior chance de não estarem em AME.

Objective: to estimate the prevalence of Exclusive Breastfeeding (EBF) in preterm twins and to investigate the effect of twin and preterm birth on EBF at hospital discharge. Method: prospective cohort of newborns in an institution located in Rio de Janeiro, from March 13, 2017, to October 12, 2018. Data collected through a questionnaire and medical records. A DAG was used to build the conceptual model, exploratory data analysis and multiple logistic regression. Results: prevalence of EBF at hospital discharge of preterm twins of 47.8%. Preterm infants were more likely to not be on EBF at hospital discharge. Non-twins were more likely to not be on EBF at hospital discharge. Conclusion: just over half of preterm twins were not on EBF at hospital discharge. Preterm infants had a greater chance of not being on EBF. Preterm non-twins were more likely to not be on EBF.

Objetivo: estimar la prevalencia de Lactancia Materna Exclusiva (LME) entre gemelos prematuros y investigar el efecto de nacer gemelo y prematuro en la LME al momento del alta hospitalaria. Método: cohorte prospectiva de recién nacidos en una institución ubicada en Rio de Janeiro, entre 13//marzo/2017 y 12/octubre/2018. Los datos se recolectaron mediante cuestionario y expediente médico. Se utilizó DAG para la construcción del modelo conceptual, análisis exploratorio de los datos y regresión logística múltiple. Resultados: la prevalencia de LME en el alta hospitalaria de gemelos prematuros fue del 47,8%. Los prematuros tuvieron mayor probabilidad de no estar en LME en el alta hospitalaria. Los no gemelares tuvieron mayor probabilidad de no estar en LME en el alta hospitalaria. Conclusión: poco más de la mitad de los gemelos prematuros no estaban en LME en el alta hospitalaria. Los prematuros tuvieron mayor probabilidad de no estar en LME. Los no gemelos prematuros presentaron mayor probabilidad de no estar en LME.

Urchin-like Co3O4 microspheres-boosted catalytic oxidation: Environmentally-friendly CO2 vapor generation for total organic carbon detection by microplasma optical emission spectrometry.

Total organic carbon (TOC) is a crucial indicator of organic pollutants, widely used in environmental water quality monitoring and risk assessment. Conventional TOC detection methods often require high temperatures, complex equipment, and inefficient oxidation processes, limiting their field application due to time consumption, intricate operations, and limited sensitivity. Therefore, we developed a novel approach for TOC measurement using catalytic oxidation vapor generation coupled with miniaturized point discharge optical emission spectrometry (µPD-OES). This method employs urchin-like Co3O4 microspheres to convert organic pollutants to carbon dioxide during persulfate catalytic oxidation, followed by collection and quantification via carbon atomic emission line (λ = 193.0 nm). Standard or sample solutions were acidified with phosphoric acid and purged with Ar before quantification. Under optimal conditions, the proposed method achieved a detection limit of 0.01 mg L-1, offering precision (RSD, n = 11) better than 3.7 %. The feasibility of the system was tested using a certified reference material (GBW(E)082053) and environmental water samples, achieving satisfactory recoveries (98-102 %). This method provides high oxidation efficiency, sensitivity, and accuracy, while also reducing the demand for expensive and bulky instruments and minimizing energy consumption, making it suitable for rapid, sensitive field analysis of TOC.

[Outpatient coronary angiography and percutaneous coronary interventions before and after the COVID-19 pandemic : experience of the Versailles hospital centre]. / Coronarographie et angioplastie coronaire ambulatoire avant et après la pandémie de COVID-19 : expérience du centre hospitalier de Versailles.

BACKGROUND: Same day discharge (SDD) diagnostic coronary angiography and percutaneous coronary interventions (PCIs) are increasingly performed, and indications extend to more complex procedures and more fragile patients. We report the evolution of SDD interventional cardiology activity in our centre since 2016, particularly before and after the COVID-19 pandemic. Secondarily, we analysed the feasibility and safety of SDD PCI. MATERIALS AND METHODS: We analysed the number and percentage of SDD coronary angiograms and PCIs (elective or ad hoc), during 4 periods of 11 months each, from September 2016 to July 2024. Periods 1 and 2 took place before COVID-19, periods 3 and 4 after. We also compared the rate of complications and conversion to hospitalisation between periods 1-2 and 4. RESULTS: A total of 9587 procedures were analysed, including 1558 SDD procedures. The total number of SDD interventional cardiology procedures increased progressively over the 4 periods, from 146 SDD procedures (7.5%) in 2016-2017 to 620 (27.2%) in 2023-2024. This increase included both diagnostic coronary angiograms (respectively: 10.9%; 12.2%; 33.6% then 28.9%) and PCIs (respectively: 0.9%; 5.6%; 16.1% then 24.4%). In the immediate post-COVID-19 period, a significant increase, uncorrelated with the natural progression, was observed for SDD diagnostic coronary angiography and ad-hoc PCI. There were no deaths or serious complications, the rate of minor complications (1.1%) and conversion to conventional hospitalisation (4.5%) were low. CONCLUSION: Provided a careful patient selection and rigorous organisation, SDD coronary angiography and PCI can safely be performed. The increase in the SDD interventional procedures, favoured by organisational (COVID-19) or economic constraints, need to be amplified.

A Novel Preoperative Risk Score to Identify Patients at High Risk for Non-Home Discharge After Elective Open Abdominal Aortic Aneurysm Repair.

BACKGROUND: Non-home discharge (NHD) to a rehabilitation or skilled nursing facility after vascular surgery is poorly described despite its impact on patients. For home-dwelling patients undergoing elective surgery, the need for postoperative NHD can have meaningful implications on quality of life, long-term outcomes, and healthcare spending. Understanding post-surgical NHD risk is essential to preoperative counseling and shared decision making. This is particularly true for the treatment of abdominal aortic aneurysms as the postoperative course can vary between open and endovascular surgery. We aimed to identify independent predictors of NHD following elective open abdominal aortic aneurysm repair (OAR), and to create a clinically useful preoperative risk score. METHODS: Elective OAR cases were queried from the SVS Vascular Quality Initiative from years 2013-2022. A risk score was created by splitting the data set into two-thirds for development and one-third for validation. A parsimonious stepwise hierarchical multivariable logistic regression controlling for hospital level variation was performed in the development dataset, and the beta-coefficients were used to assign points for a risk score. The score was then validated, and model performance assessed. RESULTS: Overall, 8,274 patients were included and 1,502 (18.2%) required NHD. At baseline, patients who required NHD were more likely to be ≥ 80 years old (23.6% vs. 6.5%), female (35.9% vs. 23.1%), not independently ambulatory (14.6% vs. 4.3%), anemic (24.4% vs. 13.9%), have COPD (41.6% vs. 30.7%), ASA class ≥ 4 (41.0% vs. 32.5%), and a supraceliac proximal clamp (9.8% vs. 5.7%; all P<0.05). Multivariable analysis in the development group identified the following independent predictors of NHD: age ≥ 80 years, not independently ambulatory, proximal clamp location, hypogastric artery occlusion, anemia (Hb <12 g/dL), chronic obstructive pulmonary disease, female sex, hypertension, and American Society of Anesthesiologists class ≥ 4. These were then used to create a 14-point risk score. Patients were stratified into three groups based upon their risk score: low risk (0-4 points; n=4,966) with an NHD rate of 9.9%, moderate risk (5-6 points; n=2,442) with an NHD rate of 25.5%, and high risk (≥ 7 points; n=886) with an NHD rate of 44.6%. The risk score had good predictive ability with c-statistic=0.73 for model development and c-statistic=0.72 in the validation dataset. CONCLUSIONS: This novel risk score can predict NHD following elective OAR using characteristics that can be identified preoperatively. Utilization of this score may allow for improved risk assessment, preoperative counseling, and shared decision making.

Extending Dynamic Blind Interaction: Microgap Discharge-Induced Flexible Virtual Electrotactile Braille.

Braille is an essential implement for the blind to communicate with outside, but traditional Braille is limited to a paper-based format that cannot directly provide real-time word information. In this work, a flexible virtual electrotactile Braille is proposed that can benefit the blind from blocked interaction. The Braille interface, S-shaped wires and a sphere electrode with a textile fingerstall integrated by silicone, offers flexibility and simultaneously generates the microgap through textile cracks, which achieves virtual electrotactile sensation by electrostatic discharge. Powered by a high-voltage triboelectric generator of 10.2 kV designed through the charge accumulation and induction strategy, the electrotactile stimulation is realized with a microgap discharge of only 40 µA current induced on the finger. A dynamic electrotactile Braille is finally assembled, controlled by a programmable relay array. The strategies of short circuit and voice reminder are employed, so that the recognition of dynamic Braille letters is realized with spatiotemporal electrotactile stimulation and high recognition accuracy. This virtual electrotactile Braille brings convenience for the blind to access the information world and illustrates its applications to promote virtual electrotactility in this special community.

Effects of Pulse Interval on Forming Process in Wire Arc Metal Additive Manufacturing Using Pulsed Arc Plasma.

To overcome the material processing challenges induced by high levels of heat input in wire arc additive manufacturing (WAAM), an innovative WAAM method using pulsed arc plasma (PAP-WAAM), was developed by the authors in the previous study. In this method, the PAP generated by the pulsed voltage was used as the heat source. The pulse interval can be defined as the time interval between adjacent pulse voltages, which determines the ignition time and frequency of the arc plasma, thus influencing the forming process. However, the effect of pulse interval on the forming process has not yet been revealed. Here, the effects of pulse interval on forming process during the PAP-WAAM of Ti6Al4V, including thermal behavior, arc plasma characteristics, and metal transfer process, were investigated by experiments and simulation. The results exhibited that the interpass temperature and maximum peak temperature decrease with increasing pulse interval at the same arc plasma power, indicating an alleviation of heat accumulation along the building direction. As the pulse interval increased, the ignition mode of the arc plasma changed from ignition between the tungsten electrode and the previously deposited layer to ignition between the tungsten electrode and filler wire, which increased the proportion of discharge energy allocated to the filler wire, thus reducing the overall heat input required for material deposition. When the pulse interval was 300 and 400 ms, only the uninterrupted bridging transfer mode was observed during the deposition process. The uninterrupted bridging transfer is considered to contribute to forming a smooth and consistent layer appearance. In addition, longer pulse intervals resulted in less surface oxidation, narrower wall thickness, and better macrostructure, attributed to reduced heat input and improved effective heat dissipation. This research reveals the effect of pulse interval on forming process during PAP-WAAM, which benefits the fabrication of desirable metal parts.

Patient preferences for the provision of NHS medicines helpline services: a discrete choice experiment.

Introduction: Patient medicines helpline services (PMHS) can reduce harm and improve medicines adherence and patient satisfaction after hospital discharge. There is little evidence of which PMHS attributes are most important to patients. This would enable PMHS providers to prioritise their limited resources to maximise patient benefit. Methods: Patient preferences for PMHS attributes were measured using a discrete choice experiment. Seven attributes were identified from past research, documentary analysis and stakeholder consultation. These were used to produce a D-efficient design with two blocks of ten choice sets incorporated into an online survey. Adults in the UK who took more than one medicine were eligible to complete the survey and were recruited via the Research for the Future database. Preferences were estimated using conditional logistic regression. Associations between participant characteristics and preferences were investigated with latent class models. Results: 460 participants completed the survey. The most valued attributes were weekend opening (willingness-to-pay, WTP: £11.20), evening opening (WTP: £8.89), and receiving an answer on the same day (WTP: £9.27). Alternative contact methods, immediate contact with a pharmacist and helpline location were valued less. Female gender and full-time work were associated with variation in preferences. For one latent class containing 27% of participants, PMHS location at the patient's hospital was the most valued attribute. Discussion: PMHS providers should prioritise extended opening hours and answering questions on the same day. Limitations include a non-representative sample in terms of ethnicity, education and geography, and the exclusion of people without internet access.

Malnutrition defined by global leadership initiative on malnutrition criteria impedes home discharge in acute care hospital admissions.

BACKGROUND & AIMS: Limited evidence exists on the association between malnutrition diagnosis using the Global Leadership Initiative on Malnutrition (GLIM) criteria in hospitalized acute care patients and their outcomes; several aspects still require clarification. This study aimed to evaluate the relationship between malnutrition, as defined by the GLIM criteria, at the time of acute hospital admission and discharge to home. METHODS: This retrospective observational study was conducted at a hospital that provides acute care in Japan. Adult patients admitted between July 2023 and April 2024 were included in this study. The primary outcome was the number of patients discharged to home, with in-hospital mortality as the secondary outcome. To ensure the reliability of the cohort-wide results, background factors were adjusted using propensity score matching. The two groups were compared based on the presence or absence of malnutrition, as defined by the GLIM criteria at admission. Furthermore, multiple logistic regression analysis was conducted, with the outcome as the dependent variable and malnutrition, diagnosed using the GLIM criteria, as the explanatory variable, adjusting for covariates. RESULTS: A total of 1007 patients were included in the final analysis, of whom 492 (49 %) were diagnosed without malnutrition, while 515 (51 %) were diagnosed with malnutrition according to the GLIM criteria. In the multivariate logistic regression analysis after matching, malnutrition defined by the GLIM criteria emerged as an independent factor associated with discharge to home (odds ratio [OR] = 0.37, 95 % confidence interval = 0.25-0.56, P < 0.001) when adjusting for age, sex, and various comorbidities. Among the GLIM sub-criteria, reduced muscle mass, reduced food intake or assimilation, and disease burden or inflammation were independently associated with discharge to home. Notably, disease burden/inflammation exhibited the lowest OR among the GLIM sub-criteria for discharge. CONCLUSION: Malnutrition diagnosed using the GLIM criteria upon admission in patients admitted to a regional hospital providing acute care was associated with decreased rates of discharge to home and increased in-hospital mortality. Specifically, attention should be paid to the criteria for reduced muscle mass and disease burden or inflammation within the GLIM framework.

Development of optimized ensemble machine learning-based prediction models for wire electrical discharge machining processes.

This paper proposes development of optimized heterogeneous ensemble models for prediction of responses based on given sets of input parameters for wire electrical discharge machining (WEDM) processes, which have found immense applications in many of the present-day manufacturing industries because of their ability to generate complicated 2D and 3D profiles on hard-to-machine engineering materials. These ensembles are developed combining predictions of the three base models, i.e. random forest, support vector machine and ridge regression. These three base models are first framed utilizing the training datasets, providing predictions for all the responses under consideration. Based on these predictions, two optimization problems are formulated for each of the responses, while minimizing root mean squared error and mean absolute error, for subsequent development of two optimized ensembles whose predictions are the weighted sum of the predictions of the base models. The prediction performance of all the five models is ascertained through nine statistical metrics, after which a cumulative quality loss-based multi-response signal-to-noise (MRSN) ratio for each model is computed, for each of the responses, where a higher MRSN ratio indicates greater accuracy in prediction. This study is conducted using two experimental datasets of WEDM process. Overall, the optimized ensemble models having higher MRSN ratios than the base models are indicated to deliver better prediction accuracy.

Exploring non-thermal plasma technology for microalgae removal.

The global population and economic development surge has substantially increased water demand, resulting in heightened sewage and pollutant generation, posing environmental hazards. Addressing this challenge necessitates the implementation of efficient and cost-effective water reclamation methods. Non-thermal plasma technology (NTP) has emerged as a promising solution, garnering attention for its superior efficiency compared to alternatives. While existing studies have predominantly focused on energy efficiency and pollutant removal, limited research has delved into the biological removal aspect, particularly concerning algae. This study utilized a dielectric barrier plasma diffuser to eliminate Spirulina microalgae (Spirulina platensis) from wastewater solutions, demonstrating higher algae removal and superior mass transfer compared to alternative plasma methods. The effect of sample volume, input voltage and power, flow rate, and initial solution concentration on the algae removal was investigated. Investigation of operational parameters revealed the best condition resulting in a 98 % removal rate and 20 g/kWh energy efficiency. The best conditions for the removal of Spirulina microalgae were considered in a sample volume of 50 mL, a voltage of 7.6 kV, a flow rate of 700 mL/min, and an initial solution concentration of 1280 mg/liter. Scanning Electron Microscope (SEM) images illustrated the impact of active species on cell structure, leading to the destruction of spiral form and loss of reproductive ability. The study underscores the potential of NTP for efficient algae removal and identifies key active species involved in the process. The removal of Spirulina microalgae was attributed to a combination of singlet oxygen (1O2), hydroxyl radicals, and ozone.

The effect of plasma activated water on antimicrobial activity of silver nanoparticles biosynthesized by cyanobacterium Alborzia kermanshahica.

BACKGROUND: Silver nanoparticles are extensively researched for their antimicrobial properties. Cold atmospheric plasma, containing reactive oxygen and nitrogen species, is increasingly used for disinfecting microbes, wound healing, and cancer treatment. Therefore, this study examined the effect of water activated by dielectric barrier discharge (DBD) plasma and gliding arc discharge plasma on the antimicrobial activity of silver nanoparticles from Alborzia kermanshahica. METHODS: Silver nanoparticles were synthesized using the boiling method, as well as biomass from Alborzia kermanshahica extract grown in water activated by DBD and GA plasma. The physicochemical properties of the synthesized nanoparticles were evaluated using UV-vis spectroscopy, Fourier-transform infrared (FTIR) spectroscopy, dynamic light scattering (DLS), zeta potential analysis, transmission electron microscopy (TEM), and gas chromatography-mass spectrometry (GC-MS) analysis. Additionally, the disk diffusion method was used to assess the antimicrobial efficacy of the manufactured nanoparticles against both Gram-positive and Gram-negative bacteria. RESULTS: The spectroscopy results verified the presence of silver nanoparticles, indicating their biosynthesis. The highest amount of absorption (1.049) belonged to the nanoparticles synthesized by boiling under GA plasma conditions. Comparing the FTIR spectra of the plasma-treated samples with DBD and GA revealed that the DBD-treated samples had more intense peaks, indicating that the DBD method proved to be more effective in enhancing the functional groups on the silver nanoparticles. The DLS results revealed that the boiling method synthesized silver nanoparticles under DBD plasma treatment had a smaller particle size (149.89 nm) with a PDI of 0.251 compared to the GA method, and the DBD method produced nanoparticles with a higher zeta potential (27.7 mV) than the GA method, indicating greater stability of the biosynthesized nanoparticles. Moreover, the highest antimicrobial properties against E. coli (14.333 ± 0.47 mm) were found in the DBD-treated nanoparticles. TEM tests confirmed that spherical nanoparticles attacked the E. coli bacterial membrane, causing cell membrane destruction and cell death. The GC-MS results showed that compounds like 2-methylfuran, 3-methylbutanal, 2-methylbutanal, 3-hydroxy-2-butanone, benzaldehyde, 2-phenylethanol, and 3-octen-2-ol were much higher in the samples that were treated with DBD compared to the samples that were treated with GA plasma. CONCLUSION: The research indicated that DBD plasma was more efficient than GA plasma in boosting the antimicrobial characteristics of nanoparticles. These results might be a cornerstone for future advancements in utilizing cold plasma to create nanoparticles with enhanced antimicrobial properties.

Epidemiology of heart failure presentations to United States emergency departments from 2016 to 2023.

INTRODUCTION: Heart failure (HF) is a common condition prompting presentation to the Emergency Department (ED) and is associated with significant morbidity and mortality. However, there is limited recent large-scale, robust data available on the admission rates, evaluation, and treatment of HF in the ED setting. METHODS: This was a cross-sectional study of ED presentations for HF from 1/1/2016 to 12/31/2023 using the Epic Cosmos database. All ED visits with ICD-10 codes corresponding to acute HF were included. We excluded congenital heart disease and isolated right-sided HF. Outcomes included percentage of total ED visits, admission rates, troponin, B-type natriuretic peptide (BNP), chest radiography, and diuretic and nitroglycerin medication administration. Subgroup analyses of medications were performed by medication and route of administration (transdermal, sublingual/oral, and intravenous). RESULTS: Out of 190,694,752 ED encounters, 2,626,011 (1.4 %) visits were due to acute HF. Of these, 1,897,369 (72.3 %) were admitted to the hospital. The majority of patients had a troponin (90.3 %), BNP (91.1 %), and chest radiograph (89.5 %) ordered. 82.5 % received intravenous diuresis, while 46.2 % received oral diuresis. The most common diuretic was furosemide (78.4 % intravenous, 32.5 % oral), followed by bumetanide (9.5 % intravenous, 7.1 % oral), and torsemide (0 % intravenous, 8.1 % oral). Nitroglycerin was given in 26.0 %, with the most common route being sublingual/oral (16.6 %), followed by transdermal (9.2 %) and intravenous (3.5 %). CONCLUSION: HF represents a common reason for ED presentation, with the majority of patients being admitted. All patients received diuresis in the ED, with the majority receiving intravenous diuresis with furosemide. Approximately one-quarter received nitroglycerin with the sublingual/oral route being most common. These findings can help inform health policy initiatives, including admission decisions and evidence-based medication administration.

A Tool to Help Nurses Provide Health Education on Adverse Pregnancy Outcomes and Cardiovascular Health.

Adverse pregnancy outcomes are associated with poor short- and long-term cardiovascular health. However, patients and their health care providers may not have knowledge of this risk or of the healthful practices that can reduce this risk. Childbirth care can be a pivotal time in the patient-clinician relationship to build awareness and spur prevention planning. As part of the American Heart Association-supported program entitled Providing an Optimized and Empowered Pregnancy for You (P3OPPY), our team collaborated with a community advisory board to create a teaching handout about adverse pregnancy outcomes for incorporation into hospital-based postpartum care. This handout can be used by pregnancy and maternity care providers, including postpartum nurses, to provide health education on how adverse pregnancy outcomes can influence risk for future cardiovascular disease and what can be done for prevention.

Do marked discharge summaries with recommendation text boxes enhance patient safety? A nationwide survey.

BACKGROUND: Danish hospital physicians are required to mark their discharge summaries addressing whether the patient's general practitioner (GP) is recommended to follow up as well as suggest follow-up actions. AIM: To investigate whether a new form of discharge summaries may contribute to improve the perceived patient safety following transition from hospitals to general practice. DESIGN & SETTING: This paper reports data from a questionnaire sent to a representative sample of GPs in Denmark. METHOD: A questionnaire was prepared for GPs based on background material, focus group interviews and discussions with relevant professionals. It was subsequently pilot tested by fellow researchers and GPs and revised prior to the presently reported survey. RESULTS: Of 310 participating GPs, 197 (63%) 'totally agree' or 'partly agree' that the marked discharge summaries with a recommendation text box contribute to a better handover to general practice, and 223 (72%) 'totally agree' or 'partly agree' that they improve patient safety. CONCLUSION: The majority of responding GPs believe that the marked discharge summaries with a recommendation text box enhance patient safety and facilitate the transition of care to general practice following hospital discharge.

Dissolved organic nitrogen depresses the expected outcome of wastewater treatment upgrading on effluent eutrophication potential mitigation: Molecular mechanistic insight.

Continuously tightening total nitrogen (TN) discharge standards in wastewater treatment plants is a common practice worldwide to mitigate eutrophication. However, given the different bioavailability of effluent dissolved organic nitrogen (DON) and inorganic nitrogen, a great inefficiency of the TN-targeted upgrading might be hidden because of the poor understanding of its impact on effluent eutrophication potential mitigation. Here we show that the tightening TN discharge standards could only considerably promote inorganic nitrogen removal, however, DON concentrations remained constant across different effluent TN levels (p > 0.05, Kruskal-Wallis test). Surprisingly, restricting TN in turn increases the reactivity of DON molecules owing to the accumulation of produced DON by acting on the key biotic and abiotic transformation reactions. The difficulty of removing DON and the increased DON reactivity during wastewater treatment upgrading contribute to the practical elimination effect of effluent eutrophication potential exhibiting lower than expected. This work challenges the rationality of the prevailing pursuit for extreme-low TN discharge, calling for shifting the focus of wastewater treatment upgrading towards the more fundamental eutrophication-targeted perspective.

Prenatal Substance Exposure and Infant Discharge Placement: Results From the ACT NOW Study.

It is critical that researchers gather evidence of factors that identify infants at risk of out-of-home placement based on types of substance exposures and demographic characteristics. This study applied a validated medical record data extraction tool on data derived from a multi-site (N = 30) pediatric clinical trials network (ISPCTN) study of Neonatal Opioid Withdrawal (ACT NOW study). Participants included 1808 birthing parent-infant dyads with documented NOWS scoring or prenatal opioid exposure. Non-Hispanic White pregnant persons comprised the largest proportion of the sample (69.8%), followed by Non-Hispanic Black (11.6%), Non-Hispanic Multiracial and Other race (8.5%), and Hispanic (6.2%). Most notably, infant prenatal substance exposure across alcohol, cocaine, meth/amphetamine, and opioids, had the lowest possibility of discharging to parent(s). Additionally, latent class analysis identified distinct classes of substance use during pregnancy that were associated with different probabilities of discharging to parent(s). Specifically, less than half of infants (47%-49%) in the Poly-use and Meth/amphetamine classes were discharged to their parent(s). Severity of infant withdrawal symptoms influenced placement decisions within the Poly-use and Prescription Opioid classes. Findings can inform standard practices for increasing support for pregnant persons and substance-exposed infants including identification, subsequent referrals, communication with Child Protective Services, and plans of safe care.

Why do patients stay in hospital after enhanced recovery thoracoscopic wedge resection? A prospective observational study.

OBJECTIVES: This single-centre prospective observational study aimed to investigate reasons for prolonged hospitalization (over the median length of stay [LOS]) after enhanced recovery thoracoscopic (ERAS 3-port VATS) wedge resection. METHODS: All patients were evaluated twice daily by an investigator for reasons of hospitalization. Each reason was analysed individually. Predictors for prolonged hospitalization were identified using a multivariable backward stepwise logistic regression model. RESULTS: A total of 150 consecutive patients (lymphadenectomy 8.7%) were included from November 2022 to December 2023, with a median LOS of 1 (interquartile range 1-2) day. Of these, 55 patients (36.7%) experienced prolonged hospitalization. The main reasons included postoperative pain (16.0%), air leak (14.7%), and social factors (14.7%), followed by oxygen dependency (7.3%), gastrointestinal factors (5.3%), urinary factors (4.7%), pneumonia (1.3%), pleural effusion (1.3%), chylothorax (0.7%), atrial fibrillation (0.7%), confusion (0.7%), and fatigue (0.7%). Multivariable analysis revealed that an increase in percentage of predicted forced expiratory volume in 1 second (FEV1%pre) by 1% (odds ratio [OR] 0.41, P = 0.023) and percentage of predicted diffusing capacity for carbon monoxide (DLCO%pre) by 1% (OR 0.95, P = 0.002) decreased likelihood of prolonged hospitalization. Conversely, each additional pack-year (OR 1.01, P = 0.028) and living alone (OR 3.55, P = 0.005) increased the risk of prolonged hospitalization. CONCLUSIONS: Prolonged hospitalization (LOS > 1 day) after ERAS 3-port VATS wedge resection, with 8.7% lymphadenectomy, was mainly due to pain, air leak, and social factors. Smokers with decreased FEV1%pre or DLCO%pre and patient living alone were at increased risk.

Home, but Homebound after Traumatic Brain Injury: Risk Factors and Associations with Nursing Home Entry and Death.

OBJECTIVE: To examine risk factors associated with homeboundness 1-year following traumatic brain injury (TBI) and to explore associations between homebound status and risk of future mortality and nursing home entry. DESIGN: Secondary analysis of a longitudinal prospective cohort study SETTING: TBI Model Systems (TBIMS) Centers PARTICIPANTS: Community-dwelling TBIMS participants (n=6,595) who sustained moderate-severe TBI between 2006-2016, and resided in a private residence 1-year post-injury. INTERVENTIONS: N/A MAIN OUTCOME MEASURES: Homebound status (leaving home ≤1-2 days per week), 5-year mortality, and 2- or 5-year nursing home entry. RESULTS: In our sample, 14.2% of individuals were homebound 1-year post-injury, including 2% who never left home. Older age, having less than a Bachelor's degree, Medicaid insurance, living in the Northeast or Midwest, dependence on others or special services for transportation, unemployment or retirement, and needing assistance for locomotion, bladder management, and social interactions at 1-year post-injury were associated with being homebound. After adjustment for potential confounders and an inverse probability weight for nonrandom attrition bias, being homebound was associated with a 1.69-times (95% CI: 1.35-2.11) greater risk of five-year mortality, and a non-significant but trending association with nursing home entry by 5 years post-injury (RR=1.90, 95% CI: 0.94, 3.87). Negative associations between homeboundness and mortality were consistent by age subgroup (± 65 years). CONCLUSIONS: The negative long-term health outcomes among persons with TBI who rarely leave home warrants the need to re-evaluate home discharge as unequivocally positive. The identified risk factors for homebound status, and its associated negative long-term outcomes, should be considered when preparing patients and their families for discharge from acute and post-acute rehabilitation care settings. Addressing modifiable risk factors for homeboundness, such as accessible public transportation options and home care to address mobility, could be targets for individual referrals and policy intervention.

Costs, efficiency, and patient-reported outcomes associated with suture-mediated percutaneous closure for atrial fibrillation ablation: Secondary analysis of a randomized clinical trial.

INTRODUCTION: To evaluate the cost and efficiency of suture-mediated percutaneous closure (SMC) compared to manual compression (MC) after atrial fibrillation (AF) ablation. SMC has been demonstrated to be efficacious in reducing hemostasis and bedrest times after AF ablation. To date, randomized data comparing the direct and indirect cost between the two techniques have not been described. METHODS: We conducted a 1:1 randomized trial comparing SMC to MC following AF ablation. The primary endpoints have been previously published. However, secondary endpoints pertinent to indirect cost including complication rates, hospital utilization (i.e., delays in discharge, additional patient encounters, nursing utilization), pain, patient reported outcomes, as well as the direct costs of care associated with AF ablation were collected. We also performed secondary analysis of the primary endpoint to evaluate for a learning curve, and subgroups analysis comparing efficacy across different numbers of access sites and compared to those in the MC group with a figure-of-eight suture (Fo8), that could potentially have impacted the relative efficiency of the procedure. RESULTS: A total of 107 patients were randomized and included: 53 in the SMC group and 54 in MC. A learning curve was observed in the SMC group between the first and second half of the study group (p = 0.037), with no such difference in the MC group. After accounting for the number of access sites, time to hemostasis remained shorter in the SMC Group (p = 0.002). Compared to those in the Fo8 arm (n = 37), the time to hemostasis remained shorter in the SMC group (p = 0.001). Among those planned for same-day discharge, there were more delays in the MC group (31.5% vs. 11.3%, p = 0.0144). Rates of major and minor complications were similar between SMC and MC groups at discharge (p = 0.243) and 30 days (p = 1.00), as were nursing utilization, self-reported pain, and overall patient reported outcomes. The overall cost of care related to the procedure was similar between the MC and SMC groups ($56 533.65 [$45 699.47, $66 987.64] vs. $57 050.44 [$47 251.40, $66 426.34], p = 0.601). CONCLUSION: SMC has been shown to decrease time to hemostasis and ambulation and facilitate earlier same-day discharge after AF ablation without an increase in direct or indirect costs.