Causes and risk factors for same-day discharge failure after total hip and knee arthroplasty: a meta-analysis.

In recent decades, the trend toward early same-day discharge (SDD) after surgery has dramatically increased. Efforts to develop adequate risk stratification tools to guide decision-making regarding SDD versus prolonged hospitalization after total hip arthroplasty (THA) remain largely incomplete. The purpose of this report is to identify the most frequent causes and risk factors associated with SDD failure in patients undergoing THA and total knee arthroplasty (TKA). A systematic search following PRISMA guidelines of four bibliographic databases was conducted for comparative studies between patients who were successfully discharged on the same day and those who failed. Outcomes of interests were causes and risk factors associated with same-day discharge failure. Odds ratios (OR) were calculated for dichotomous variables, whereas mean differences (MD) were calculated for continuous variables. Meta-analysis was performed using RevMan software. Random effects were used if there was evidence of heterogeneity. Eight studies with 3492 patients were included. The most common cause of SDD failure was orthostatic hypotension, followed by inadequate physical condition, nausea/vomiting, pain, and urinary retention. Female sex was a risk factor for failure (OR 0.77, 95% CI 0.63-0.93), especially in the THA subgroup. ASA score IV (OR 0.33, 95% CI 0.14-0.76) and III (OR 0.72, 95% CI 0.52-0.99) were risk factors, as were having > 2 allergies and smoking patients. General anesthesia increased failure risk (OR 0.58, 95% CI 0.42-0.80), while spinal anesthesia was protective (OR 1.62, 95% CI 1.17-2.24). The direct anterior and posterior approaches showed no significant differences. In conclusion, orthostatic hypotension was the primary cause of SDD failure. Risk factors identified for SDD failure in orthopedic surgery include female sex, ASA III and IV classifications, a higher number of allergies, smoking patients and the use of general anesthesia. These factors can be addressed to enhance SDD outcomes.

Environmental Determinants of Post-Discharge Acute Respiratory Illness among Preterm Infants with Bronchopulmonary Dysplasia.

OBJECTIVE: To analyze the association of components of the Centers for Disease Control and Prevention (CDC) Environmental Justice Index (EJI) with respiratory health outcomes among infants with bronchopulmonary dysplasia (BPD) within one year after discharge from the neonatal intensive care unit. METHODS: This was a retrospective cohort study of a cohort of preterm infants with BPD. Multivariable logistic regression models estimated associations of EJI and its components with medically attended acute respiratory illness, defined as an ED visit or inpatient readmission, within one year of discharge from the neonatal intensive care unit. A mediation analysis was conducted to evaluate how environmental injustice may contribute to racial disparities in acute respiratory illness. RESULTS: Greater EJI was associated with an increased risk of medically attended respiratory illness (per EJI standard deviation increment, aOR 1.38, 95% CI: 1.12-1.69). Of the index's components, the Environmental Burden Module's Air pollution domain had the greatest association (aOR 1.44, 95% CI: 1.44-2.61). With respect to individual indicators within the EJI, Diesel Particulate Matter (DSLPM) and Air Toxic Cancer Risk (ATCR) demonstrated the strongest relationship (aOR 2.06, 95% CI: 1.57-2.71 and aOR 2.10, 95% CI: 1.59-2.78, respectively). Among non-Hispanic Black infants, 63% experienced a medically attended acute respiratory illness as compared to 18% of non-Hispanic White infants. DSLPM mediated 39% of the Black-White disparity in medically attended acute respiratory illness (p = 0.004). CONCLUSIONS: Environmental exposures, particularly air pollution, are associated with post-discharge respiratory health outcomes among preterm infants with BPD after adjusting for clinical, demographic, and social vulnerability risk factors. Certain types of air pollutants, namely, DSLPM, are more greatly associated with acute respiratory illness. Environmental exposures may contribute to racial disparities in medically attended acute respiratory illness among infants with BPD.

The correlation between the need for continuing care services, influencing factors, and social support and discharge readiness among discharged patients with pulmonary tuberculosis in China: A cross-sectional study.

OBJECTIVE: To understand the relationship between the need for continuing care services and influencing factors, social support, readiness for discharge among discharged pulmonary tuberculosis (PTB) patients. METHODS: A cross-sectional study was conducted among 170 patients from a database of discharged patients with PTB from September 2023 to January 2024. A demographic and disease characteristics questionnaire, continuing care services basic modality questionnaire, continuing care services need questionnaire, the Social Support Rating Scale (SSRS), and the Readiness for Hospital Discharge Scale (RHDS) were used for this investigation. Univariate analysis and multiple linear regression analysis were used to analyze the associated factors. RESULTS: The mean total score for the need for continuing care services among patients with PTB discharged from the hospital was (121.61 ± 22.98). The dimension with the highest score was health education guidance need. Compared to the the original hospital medical personnel, the primary source of care information after discharge was the local medical institutions was statistically significant and negatively correlated with continuing care service need (P = 0.005). Social support was positively associated with need for continuing care services (P = 0.042). CONCLUSION: Discharged PTB patients had a high degree of continuing care service need. Factors influencing the need for continuing care services are the primary source of care information after discharge was the local medical institutions, the social support. Medical staff need to provide targeted continuing care services based on relevant influencing factors to meet the discharge needs of patients.

Enteral nutrition on discharge from intensive care and 30-day unplanned readmission: An exploratory, retrospective study of association.

BACKGROUND & AIMS: Individuals who survive critical illness are often malnourished with inadequate oral nutrient intake after leaving the intensive care unit (ICU). Enteral nutrition (EN) improves nutrient intake but there is limited evidence on the impact of maintaining EN after discharge from the ICU. The objective of this exploratory study was to understand the association between EN maintenance after ICU and 30-day unplanned hospital re-admission, to inform on future prospective research into the effects of post-ICU nutrition. METHODS: This was a single-centre, retrospective study of ICU patients, requiring ventilation, who received EN for at least 3 days in ICU and were discharged to the ward. RESULTS: 102 patients met the inclusion criteria; 45 (44.1%) maintained EN and 57 (55.9%) discontinued EN after ICU discharge; there were no significant differences in demographics or clinical measures at ICU admission. Reason for EN discontinuation was documented in 38 (66.7%) patients, with 27 (71%) discontinuing EN due to a routine ward practice of feeding tube removal. Unplanned 30-day hospital re-admission occurred in 17 (16.7%) patients overall, 5 (11.1%) in the EN group and 12 (21.1%) in the non-EN group (crude odds ratio [OR] 0.47, 95% CI 0.15, 1.45, p = 0.188). After adjusting for age, sex, BMI and length of stay, there was a persistent trend to lower re-admission rates in the EN group (OR 0.37, 95% CI 0.09, 1.57, p = 0.176). CONCLUSIONS: EN maintenance after ICU discharge was associated with a trend to lower 30-day unplanned hospital re-admission rates. The clinically relevant reduction of about 50% in unplanned re-admission rates in this exploratory study warrants larger, prospective studies of post-ICU nutrition strategies based on clear discontinuation criteria to optimize nutrition and evaluate patient-centred outcomes.

Low phase angle: A predictor of functional status and discharge disposition in acute stroke older patients.

BACKGROUND & AIMS: This study aimed to investigate the effects of low phase angle (PhA) on functional status and discharge disposition during the acute phase in older patients with acute stroke. METHODS: We included consecutive patients who experienced acute stroke between October 2021 and December 2022. The exclusion criteria included: age<65 years, admission from other than home, death during hospitalization, inability to measure bioelectrical impedance analysis owing to implantation, and missing data. We defined low PhA (<5.28° for male and <4.62° for female) and categorized them into the low PhA group and normal group. The clinical outcomes were functional independence by the modified Rankin Scale (mRS) score (0-2, independence; 3-5, nonindependence) and discharge disposition (home or others). We used multivariate logistic regression analysis to examine the effect of low PhA on the mRS score at discharge and discharge disposition. RESULTS: Ultimately, a total of 205 patients were included in this analysis. More patients in the low PhA group were unable to be independent (27.7% vs. 66.7%, P < 0.001) and were unable to be discharged home (53.4% vs. 82.5%, P < 0.001) than in the normal group. Logistic regression analysis of the mRS scores showed that baseline low PhA decreased the likelihood of functional independence (odds ratio [OR] = 0.275, P = 0.003) and home discharge (OR = 0.378, P = 0.044). CONCLUSIONS: Low PhA is a risk factor for low functional status at hospital discharge; it decreases the likelihood of home discharge in older patients with acute stroke.

Low muscle mass in patients with stroke on admission reduces walking ability at discharge.

BACKGROUND & AIMS: Reduced skeletal muscle mass may negatively influence postural retention and walking function. This study aimed to examine the influence of the skeletal muscle mass index on walking function in patients with stroke. METHODS: This study included patients with cerebral infarction aged ≥65 years. The Asian Working Group for Sarcopenia's skeletal muscle mass index criteria were used to classify the participants into the low and high skeletal muscle mass index groups. The patient characteristics of the two groups were compared. The primary and secondary outcome measures were independent walking and walking speed, respectively. RESULTS: In total, 174 participants were included. There were no significant differences in the length of hospital stay, rehabilitation volume, or functional independence measure score at discharge between the males and females. Multivariate logistic regression analysis revealed that independent walking was independently associated with the skeletal muscle mass index on admission. The SMI, as an explanatory variable, was independently associated with the comfortable and fastest walking speeds. Faster walking was associated with higher skeletal muscle mass indexes on admission for both males and females. CONCLUSIONS: A low skeletal muscle mass index negatively influences walking function improvement in patients with stroke. A strategy aimed at increasing skeletal muscle mass can have beneficial effects on walking function in patients with stroke.

Nutritional risk predicts readmission within 30 and 180 days after discharge among older adult patients across a broad spectrum of diagnoses.

BACKGROUND AND AIMS: Hospital readmissions can have negative consequences for older adult patients, their relatives, the hospital, and society. Previous studies indicate that older adult patients who are at nutritional risk during hospital admission are at higher risk of readmission. There is a lack of studies investigating this relationship across different older adult patient groups while using recommended instruments and adjusting for relevant confounders. Thus, the aim of the present study was to investigate whether nutritional status according to the Nutrition Risk Screening 2002 during hospitalization predicted readmission among older adult patients within 30 and 180 days across a broad spectrum of wards and diagnoses when adjusting for age, sex, length-of-stay, diagnosis, and discharge destination. MATERIALS AND METHODS: The present study is a retrospective cohort study based on registry data and included 21,807 older adult patients (≥65 years) hospitalized during a 5-year period. In order to investigate the relationship between nutritional risk and readmission, hierarchical logistic regression analyses with readmission within 30 days (n = 8371) and 180 days (n = 7981) as the dependent variable were performed. RESULTS: Older adult patients at nutritional risk during the index admission were 1.44 times more likely to be readmitted within 30 days after discharge (P < 0.001), and 1.47 times more likely to be readmitted within 180 days after discharge (P < 0.001), compared to older adult patients who were not at nutritional risk during index admission when adjusting for age, sex, discharge destination, diagnosis group, and length-of-stay. CONCLUSIONS: Our results highlight the importance of focusing on nutritional status in older adults as a factor in the prevention of readmissions, including ensuring that practices, resources, and guidelines support appropriate screening procedures. Because nutritional risk predicts readmission both in a 30-days and 180-days perspective, the results point to the importance of ensuring follow-up on the screening result, both in the hospital context and after discharge.

Clinician Prediction of Survival vs Calculated Prediction Scores in Patients Requiring Extracorporeal Membrane Oxygenation.

BACKGROUND: Determining appropriate extracorporeal membrane oxygenation (ECMO) candidacy ensures appropriate utilization of this costly resource. The current ECMO survival prediction scores do not consider clinician assessment of patient viability. This study compared clinician prediction of survival to hospital discharge versus prediction scores. OBJECTIVES: The aim of this study was to compare clinician prediction of patients' survival to hospital discharge versus prognostic prediction scores (Respiratory ECMO Survival Prediction [RESP] or Survival After Veno-Arterial ECMO [SAVE] score) to actual survival. METHODS: This was an observational descriptive study from January 2020 to November 2021 conducted with interviews of nurses, perfusionists, and physicians who were involved during the initiation of ECMO within the first 24 hours of cannulation. Data were retrieved from the medical record to determine prediction scores and survival outcomes at hospital discharge. Accuracy of clinician prediction of survival was compared to the RESP or SAVE prediction scores and actual survival to hospital discharge. RESULTS: Accurate prediction of survival to hospital discharge for veno-venous ECMO by nurses was 47%, 64% by perfusionists, 45% by physicians, and 45% by the RESP score. Accurate predictions of patients on veno-arterial ECMO were correct in 54% of nurses, 77% of physicians, and 14% by the SAVE score. Physicians were more accurate than the SAVE score, P = .021, and perfusionists were significantly more accurate than the RESP score, P = .044. There was no relationship between ECMO specialists' years of experience and accuracy of predications. CONCLUSION: Extracorporeal membrane oxygenation clinicians may have better predictions of survival to hospital discharge than the prediction scores. Further research is needed to develop accurate prediction tools to help determine ECMO eligibility.

Changes in daily nursing needs and self-care capability of people with diabetes after in-hospital treatment for foot complications: A descriptive study.

AIM: A limited number of studies discuss the changes in patients' self-care skills and needs for assisted self-care after discharge from in-patient treatment due to diabetes foot ulcer-related complications. The aim of this study was to examine the ability to perform self-care and needs for assisted nursing interventions at hospital discharge, compared to pre-admission, for people with diabetes admitted and treated for foot ulcer-related complications. DESIGN: Retrospective patient record study. METHODS: A retrospective assessment was done on the medical records of a total of 134 patients with diabetes consecutively admitted to a specialist in-patient unit due to foot ulcer complications, between 1 November 2017 and 30 August 2018. Data on daily self-care needs and home situations at admission and discharge were recorded. RESULTS: The median age was 72 years (38-94), 103 (76.9%) were men and 101 (73.7%) had diabetes type 2. The median length of admission was 10 days (2-39). Infection was the most common cause of admission (51%), with severe ischaemia in 6%, and a combination of both in 20% of patients. Surgical treatment was performed in 22% and vascular intervention in 19% of patients. The percentage of patients discharged to their home without assistance was 48.1% compared to 57.5% before admission, discharge to home with assistance was 27.4% versus 22.4% before admission and 9.2% were discharged to short-term nursing accommodation versus 6% before admission. Three patients died during their stay in hospital. The need for help with medications increased from 14.9% of patients at admission to 26.7% at discharge and for mobility assistance from 23.1% to 35.9%. Social services at home were increased in 21.4% of patients at discharge.

The usefulness of universal ultrasound before hospital discharge for early diagnosing hip dysplasia in Korean neonates with breech presentation in a single center: A retrospective study.

Developmental dysplasia of the hip (DDH) is a broad-spectrum disorder. Early diagnosis and treatment are important for improved prognosis and a lower risk of long-term complications. Selecting high-risk infants is important for the early diagnosis of DDH using ultrasonography; however, there are no standard international guidelines. This study aimed to identify the usefulness of universal ultrasound before hospital discharge in breech-born neonates and proposes selective ultrasound for high-risk patients. A retrospective chart review was conducted to identify breech-born neonates who underwent hip ultrasonography before discharge for the detection of DDH between 2019 and 2023. Patients were categorized into DDH and non-DDH groups according to the ultrasound results. We compared sex, gestational age, birth weight, first-born status, twin pregnancy, associated anomalies, presence of symptoms, physical examination results, and timing of the first hip ultrasound. The medical records of the mothers were reviewed to identify the amount of amniotic fluid and duration of breech presentation. This study included 102 patients, of whom 62 and 40 were assigned to the non-DDH and DDH groups, respectively. Congenital anomalies, positive symptoms, and positive physical examination results were significant risk factors. However, female sex, first-born status, and oligohydramnios were not statistically significant. The duration of breech presentation during pregnancy was not significant. Additionally, the risk of Pavlik harnesses was higher in patients who underwent a positive physical examination. Universal ultrasonography before discharge is not recommended for the early diagnosis of DDH in all breech-born neonates because of the high rate of overdiagnosis. We recommend that ultrasonography be performed in patients with congenital anomalies, except for foot problems, or in those with a positive physical examination conducted by trained specialists.

Preliminary Analysis of Fall Concern Among Family Caregivers of Older Adults Discharged From the Hospital: A Psychometric Evaluation of the Carers' Fall Concern Instrument.

PURPOSE: To provide a preliminary descriptive analysis of the change in fall concern among family caregiver-care recipient dyads during hospitalization and after discharge as part of a prospective study exploring the psychometric properties of the Carers' Fall Concern Instrument. METHOD: Using a prospective cohort design, an interviewer-administered survey was completed by dyads at 48 hours before discharge and 1 week and 30 days after discharge. RESULTS: Of family caregivers, 76.9% thought their care recipient was at risk of falling and 61.5% were afraid of them falling. However, only 34.6% of older adults thought that they were at risk of falling and only 42.3% were afraid of falling. Family caregivers reported significantly less concern about falls after their care recipients were discharged. CONCLUSION: This study provided greater insight into caregiver-care recipient dyads' fall concern during their transition from hospital to home that may guide post-discharge fall prevention education on falls. [Journal of Gerontological Nursing, 50(5), 14-18.].

Re-Admissions of 'Unknown' Traumatic Brain Injury Patients - Inadequacy of Rehabilitative Services in a Developing Country.

BACKGROUND: In neurosurgical practice, continuous care after discharge and the ability to detect subtle indicators of clinical deterioration are mandatory to prevent the progression of a disease. The care of 'unknown' patients discharged to rehabilitation homes may not have this privilege, especially in resource-poor countries such as India. OBJECTIVE: We have attempted to study the causes and outcomes of re-admissions of 'unknown' patients with previous traumatic brain injury (TBI) to estimate the quality of nursing care in our rehabilitation centers. MATERIAL AND METHODS: The electronic hospital records of all consecutive 'unknown' TBI patients with unplanned re-admissions at our institute from January 2014 to December 2018 were retrospectively reviewed and analyzed for the factors determining the risk and outcomes of re-admission. RESULTS: Out of 245 patients sent to rehabilitation homes at discharge, 47 patients (19.18%) were re-admitted. A total of 33 patients (70%) were re-admitted between 1 month and 1 year. Out of these, 38 patients (80.9%) were re-admitted because of preventable causes. Fifteen patients (31.9%) died during the hospital stay. The rest of the 32 (68%) patients were discharged after the management of the concerned condition with an average hospital stay of 9 ± 11.1 days. The average Glasgow coma scale (GCS) at re-admission of the patients who died was 6 (range 3-11). Two patients were brought in the brain dead status, whereas 20 patients (42.6%) had a GCS of 5 or below at the time of re-admission. The risk of mortality among patients with non-preventable causes was 88.9% (8/9) compared to preventable causes 18.4% (7/38). However, preventable causes for re-admission are much more common, resulting in nearly a similar overall contribution to mortality. CONCLUSIONS: There is a high rate of mortality and morbidity in 'unknown' patients with TBI because of poor post-discharge care in developing countries. Because preventable causes are the major contributor to re-admissions, the re-admission rate is a good indicator of a lack of adequate rehabilitative services. The need for improving the post-discharge management of 'unknown' patients with TBI in resource-poor countries cannot be over-emphasized.

Implementation of outpatient hip and knee arthroplasty in a multicenter public healthcare setting.

BACKGROUND AND PURPOSE: Length of hospital stay after hip and knee arthroplasty is about 1 day in Denmark with few patients discharged on the day of surgery. Hence, a protocol for multicenter implementation of discharge on day of surgery has been instituted. We aimed to describe the implementation of outpatient hip and knee arthroplasty in a multicenter public healthcare setting. METHODS: We performed a prospective multicenter study from 7 public hospitals across Denmark. Patients were screened using well-defined in- and exclusion criteria and were discharged on day of surgery when fulfilling functional discharge criteria. The study period was from September 2022 to February 2023 with variable start of implementation. Data from the same centers in a 6-month period before the COVID pandemic from July 2019 to December 2019 was used for baseline control. RESULTS: Of 2,756 primary hip and knee arthroplasties, 37% (95% confidence interval [CI] 35-39) were eligible (range 21-50% in centers) and 52% (range 24-62%) of these were discharged on day of surgery. 21% (CI 20-23) of all patients (eligible and non-eligible) were discharged on day of surgery with a range of 10-31% within centers. This was an additional 15% (CI 13-17, P < 0.001) compared with patients discharged in the control period (6% in 2019). CONCLUSION: We found it possible to perform outpatient hip and knee replacement in 21% of patients in a public healthcare setting, probably to be increased with further center experience.

Interpretable (not just posthoc-explainable) medical claims modeling for discharge placement to reduce preventable all-cause readmissions or death.

We developed an inherently interpretable multilevel Bayesian framework for representing variation in regression coefficients that mimics the piecewise linearity of ReLU-activated deep neural networks. We used the framework to formulate a survival model for using medical claims to predict hospital readmission and death that focuses on discharge placement, adjusting for confounding in estimating causal local average treatment effects. We trained the model on a 5% sample of Medicare beneficiaries from 2008 and 2011, based on their 2009-2011 inpatient episodes (approximately 1.2 million), and then tested the model on 2012 episodes (approximately 400 thousand). The model scored an out-of-sample AUROC of approximately 0.75 on predicting all-cause readmissions-defined using official Centers for Medicare and Medicaid Services (CMS) methodology-or death within 30-days of discharge, being competitive against XGBoost and a Bayesian deep neural network, demonstrating that one need-not sacrifice interpretability for accuracy. Crucially, as a regression model, it provides what blackboxes cannot-its exact gold-standard global interpretation, explicitly defining how the model performs its internal "reasoning" for mapping the input data features to predictions. In doing so, we identify relative risk factors and quantify the effect of discharge placement. We also show that the posthoc explainer SHAP provides explanations that are inconsistent with the ground truth model reasoning that our model readily admits.

Discharge within 24 h, transvaginal natural orifice transluminal endoscopic surgery- more suitable for ambulatory surgery in gynecology procedures: a retrospective study.

BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) is an achievement in the field of minimally invasive surgery. However, the vantage point of vaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecologicalprocedures remains unclear. The main purpose of this study was to compare vNOTES with laparo-endoscopic single-site surgery, and to determine which procedure is more suitable for ambulatory surgery in gynecologic procedures. METHODS: This retrospective observational study was conducted at the Department of Gynecology, Chengdu Women's and Children's Central Hospital. The 207 enrolled patients had accepted vNOTES and laparo-endoscopic single-site surgery in gynecology procedures from February 2021 to March 2022. Surgically relevant information regarding patients who underwent ambulatory surgery was collected, and 64 females underwent vNOTES. RESULTS: Multiple outcomes were analyzed in 207 patients. The Wilcoxon Rank-Sum test showed that there were statistically significant differences between the vNOTES and laparo-endoscopic single-site surgery groups in terms of postoperative pain score (0 vs. 1 scores, p = 0.026), duration of anesthesia (90 vs. 101 min, p = 0.025), surgery time (65 vs. 80 min, p = 0.015), estimated blood loss (20 vs. 40 mL, p < 0.001), and intestinal exhaustion time (12.20 vs. 17.14 h, p < 0.001). Treatment with vNOTES resulted in convenience, both with respect to time savings and hemorrhage volume in surgery and with respect to the quality of the prognosis. CONCLUSION: These comprehensive data reveal the capacity of vNOTES to increase surgical efficiency. vNOTES in gynecological procedures may demonstrate sufficient feasibility and provide a new medical strategy compared with laparo-endoscopic single-site surgery for ambulatory surgery in gynecological procedures.

Interdisciplinary videoconference model for identifying potential adverse transition of care events following hospital discharge to postacute care.

Discharge from hospitals to postacute care settings is a vulnerable time for many older adults, when they may be at increased risk for errors occurring in their care. We developed the Extension for Community Healthcare Outcomes-Care Transitions (ECHO-CT) programme in an effort to mitigate these risks through a mulitdisciplinary, educational, case-based teleconference between hospital and skilled nursing facility providers. The programme was implemented in both academic and community hospitals. Through weekly sessions, patients discharged from the hospital were discussed, clinical concerns addressed, errors in care identified and plans were made for remediation. A total of 1432 discussions occurred for 1326 patients. The aim of this study was to identify errors occurring in the postdischarge period and factors that predict an increased risk of experiencing an error. In 435 discussions, an issue was identified that required further discussion (known as a transition of care event), and the majority of these were related to medications. In 14.7% of all discussions, a medical error, defined as 'any preventable event that may cause or lead to inappropriate medical care or patient harm', was identified. We found that errors were more likely to occur for patients discharged from surgical services or the emergency department (as compared with medical services) and were less likely to occur for patients who were discharged in the morning. This study shows that a number of errors may be detected in the postdischarge period, and the ECHO-CT programme provides a mechanism for identifying and mitigating these events. Furthermore, it suggests that discharging service and time of day may be associated with risk of error in the discharge period, thereby suggesting potential areas of focus for future interventions.

Persisting exercise ventilatory inefficiency in subjects recovering from COVID-19. Longitudinal data analysis 34 months post-discharge.

BACKGROUND: SARS-CoV-2 infection has raised concerns about long-term health repercussions. Exercise ventilatory inefficiency (EVin) has emerged as a notable long-term sequela, potentially impacting respiratory and cardiovascular health. This study aims to assess the long-term presence of EVin after 34 months and its association with cardiorespiratory health in post-COVID patients. METHODS: In a longitudinal study on 32 selected post-COVID subjects, we performed two cardiopulmonary exercise tests (CPETs) at 6 months (T0) and 34 months (T1) after hospital discharge. The study sought to explore the long-term persistence of EVin and its correlation with respiratory and cardiovascular responses during exercise. Measurements included also V̇O2peak, end-tidal pressure of CO2 (PETCO2) levels, oxygen uptake efficiency slope (OUES) and other cardiorespiratory parameters, with statistical significance set at p < 0.05. The presence of EVin at both T0 and T1 defines a persisting EVin (pEVin). RESULTS: Out of the cohort, five subjects (16%) have pEVin at 34 months. Subjects with pEVin, compared to those with ventilatory efficiency (Evef) have lower values of PETCO2 throughout exercise, showing hyperventilation. Evef subjects demonstrated selective improvements in DLCO and oxygen pulse, suggesting a recovery in cardiorespiratory function over time. In contrast, those with pEvin did not exhibit these improvements. Notably, significant correlations were found between hyperventilation (measured by PETCO2), oxygen pulse and OUES, indicating the potential prognostic value of OUES and Evin in post-COVID follow-ups. CONCLUSIONS: The study highlights the clinical importance of long-term follow-up for post-COVID patients, as a significant group exhibit persistent EVin, which correlates with altered and potentially unfavorable cardiovascular responses to exercise. These findings advocate for the continued investigation into the long-term health impacts of COVID-19, especially regarding persistent ventilatory inefficiencies and their implications on patient health outcomes.

Same-day discharge after large-bore access in percutaneous coronary intervention of chronic total coronary occlusions.

BACKGROUND: Same-day discharge (SDD) in patients undergoing percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) is appealing because of the increased patient comfort. However, data on SDD following large-bore vascular access are scarce. AIMS: We investigated the feasibility and safety of SDD in patients undergoing large-bore CTO PCI. METHODS: Between 2013 and 2023, 948 patients were prospectively enrolled in a single-centre CTO registry and underwent CTO PCI. SDD was pursued in all patients. Large-bore access was defined as the use of ≥7 French (Fr) sheaths in ≥1 access site. A logistic regression analysis was used to identify predictors for non-SDD. Clinical follow-up was obtained at 30 days. RESULTS: SDD was observed in 62% of patients. Large-bore access was applied in 99% of the cohort. SDD patients were younger and more often male, with lower rates of renal insufficiency and prior coronary artery bypass grafting. Local access site bleeding (odds ratio [OR] 8.53, 95% confidence interval [CI]: 5.24-13.87) and vascular access complications (OR 7.23, 95% CI: 1.98-26.32) made hospitalisation more likely, with vascular access complications occurring in 3%. At 30 days, the hospital readmission rate was low in both SDD and non-SDD patients (5% vs 7%; p=non-significant). Finally, SDD was not a predictor for major adverse cardiovascular events (MACE) at follow-up. CONCLUSIONS: Same-day discharge can be achieved in the majority of patients undergoing CTO PCI with large-bore (≥7 Fr) access. Similar low hospital readmission and MACE rates between SDD and non-SDD patients at 30 days demonstrate the feasibility and safety of SDD.

A study protocol for predictors of post-discharge mortality among children aged 5-14 years admitted to tertiary hospitals in Tanzania: A prospective observational cohort study.

INTRODUCTION: Globally, millions of children and adolescents die every year from treatable and preventable causes. Sub-Saharan Africa accounted for 55% of deaths of children aged 5-14 years in 2017. Despite this high burden, minimal effort has been directed toward reducing mortality among older children and adolescents in comparison to under-fives. Mortality rates of children post-discharge vary between 1-18% in limited-resource countries and are reported to exceed in-hospital mortality. In Tanzania, there is limited data regarding post-discharge mortality and its predictors among children aged 5-14 years. OBJECTIVES: This study aims to determine the post-discharge mortality rate and its predictors among children aged 5-14 years admitted to pediatric wards at MNH, MOI, and JKCI. METHODS AND ANALYSIS: This will be a prospective observational cohort study that will be conducted among children aged 5-14 years admitted to pediatric wards at Muhimbili National Hospital, Jakaya Kikwete Cardiac Institue, and Muhimbili Orthopedic Institue in Dar-Es-Salaam, Tanzania. Data will be collected using a structured questionnaire and will include socio-demographic characteristics, clinical factors, and patients' outcomes. Post-discharge follow-up will be done at months 1, 2, and 3 after discharge via phone call. Data will be analyzed using SPSS version 23. The association of demographic, social economic, and clinical factors with the outcome of all causes, 3 months post-discharge mortality will be determined by Cox regression, and survival rates will be displayed through Kaplan-Meier curves. DISCUSSION: This study will determine post-discharge mortality among children aged 5-14 years and its predictors in Tanzania. This information is expected to provide baseline data that will be useful for raising awareness of clinicians on how to prioritize and plan a proper follow-up of children following hospital discharge. These data may also be used to guide policy development to address and reduce the high burden of older children and adolescent mortality and may be used for future studies including those aiming to develop prediction models for post-discharge mortality among older children and adolescents.