Hospital in the Nursing Home program reduces emergency department presentations and hospital admissions from residential aged care facilities in Queensland, Australia: a quasi-experimental study.

BACKGROUND: There has been considerable publicity regarding population ageing and hospital emergency department (ED) overcrowding. Our study aims to investigate impact of one intervention piloted in Queensland Australia, the Hospital in the Nursing Home (HiNH) program, on reducing ED and hospital attendances from residential aged care facilities (RACFs). METHODS: A quasi-experimental study was conducted at an intervention hospital undertaking the program and a control hospital with normal practice. Routine Queensland health information system data were extracted for analysis. RESULTS: Significant reductions in the number of ED presentations per 1000 RACF beds (rate ratio (95 % CI): 0.78 (0.67-0.92); p = 0.002), number of hospital admissions per 1000 RACF beds (0.62 (0.50-0.76); p < 0.0001), and number of hospital admissions per 100 ED presentations (0.61 (0.43-0.85); p = 0.004) were noticed in the experimental hospital after the intervention; while there were no significant differences between intervention and control hospitals before the intervention. Pre-test and post-test comparison in the intervention hospital also presented significant decreases in ED presentation rate (0.75 (0.65-0.86); p < 0.0001) and hospital admission rate per RACF bed (0.66 (0.54-0.79); p < 0.0001), and a non-significant reduction in hospital admission rate per ED presentation (0.82 (0.61-1.11); p = 0.196). CONCLUSIONS: Hospital in the Nursing Home program could be effective in reducing ED presentations and hospital admissions from RACF residents. Implementation of the program across a variety of settings is preferred to fully assess the ongoing benefits for patients and any possible cost-savings.

Interventions targeting the elderly population to reduce emergency department utilisation: a literature review.

OBJECTIVE: High utilisation of emergency department (ED) among the elderly is of worldwide concern. This study aims to review the effectiveness of interventions targeting the elderly population in reducing ED utilisation. METHODS: Major biomedical databases were searched for relevant studies. Qualitative approach was applied to derive common themes in the myriad interventions and to critically assess the variations influencing interventions' effectiveness. Quality of studies was appraised using the Effective Public Health Practice Project (EPPHP) tool. RESULTS: 36 studies were included. Nine of 16 community-based interventions reported significant reductions in ED utilisation. Five of 20 hospital-based interventions proved effective while another four demonstrated failure. Seven key elements were identified. Ten of 14 interventions associated with significant reduction on ED use integrated at least three of the seven elements. All four interventions with significant negative results lacked five or more of the seven elements. Some key elements including multidisciplinary team, integrated primary care and social care often existed in effective interventions, while were absent in all significantly ineffective ones. CONCLUSIONS: The investigated interventions have mixed effectiveness. Our findings suggest the hospital-based interventions have relatively poorer effects, and should be better connected to the community-based strategies. Interventions seem to achieve the most success with integration of multi-layered elements, especially when incorporating key elements such as a nurse-led multidisciplinary team, integrated social care, and strong linkages to the longer-term primary and community care. Notwithstanding limitations in generalising the findings, this review builds on the growing body of evidence in this particular area.

How Practical Are Fiber Supercapacitors for Wearable Energy Storage Applications?

Future wearable electronics and smart textiles face a major challenge in the development of energy storage devices that are high-performing while still being flexible, lightweight, and safe. Fiber supercapacitors are one of the most promising energy storage technologies for such applications due to their excellent electrochemical characteristics and mechanical flexibility. Over the past decade, researchers have put in tremendous effort and made significant progress on fiber supercapacitors. It is now the time to assess the outcomes to ensure that this kind of energy storage device will be practical for future wearable electronics and smart textiles. While the materials, fabrication methods, and energy storage performance of fiber supercapacitors have been summarized and evaluated in many previous publications, this review paper focuses on two practical questions: Are the reported devices providing sufficient energy and power densities to wearable electronics? Are the reported devices flexible and durable enough to be integrated into smart textiles? To answer the first question, we not only review the electrochemical performance of the reported fiber supercapacitors but also compare them to the power needs of a variety of commercial electronics. To answer the second question, we review the general approaches to assess the flexibility of wearable textiles and suggest standard methods to evaluate the mechanical flexibility and stability of fiber supercapacitors for future studies. Lastly, this article summarizes the challenges for the practical application of fiber supercapacitors and proposes possible solutions.

Tumor-targeted nano-delivery system of therapeutic RNA.

The birth of RNAi technology has pioneered actionability at the molecular level. Compared to DNA, RNA is less stable and therefore requires more demanding delivery vehicles. With their flexible size, shape, structure, and accessible surface modification, non-viral vectors show great promise for application in RNA delivery. Different non-viral vectors have different ways of binding to RNA. Low immunotoxicity gives RNA significant advantages in tumor treatment. However, the delivery of RNA still has many limitations in vivo. This manuscript summarizes the size-targeting dependence of different organs, followed by a summary of nanovesicles currently in or undergoing clinical trials. It also reviews all RNA delivery systems involved in the current study, including natural, bionic, organic, and inorganic systems. It summarizes the advantages and disadvantages of different delivery methods, which will be helpful for future RNA vehicle design. It is hoped that this will be helpful for gene therapy of clinical tumors.

Additive Manufacturing in Orthopedics: A Review.

Additive manufacturing is an advanced manufacturing manner that seems like the industrial revolution. It has the inborn benefit of producing complex formations, which are distinct from traditional machining technology. Its manufacturing strategy is flexible, including a wide range of materials, and its manufacturing cycle is short. Additive manufacturing techniques are progressively used in bone research and orthopedic operation as more innovative materials are developed. This Review lists the recent research results, analyzes the strengths and weaknesses of diverse three-dimensional printing strategies in orthopedics, and sums up the use of varying 3D printing strategies in surgical guides, surgical implants, surgical predictive models, and bone tissue engineering. Moreover, various postprocessing methods for additive manufacturing for orthopedics are described.

Applications of Aptamer-Bound Nanomaterials in Cancer Therapy.

Cancer is still a major disease that threatens human life. Although traditional cancer treatment methods are widely used, they still have many disadvantages. Aptamers, owing to their small size, low toxicity, good specificity, and excellent biocompatibility, have been widely applied in biomedical areas. Therefore, the combination of nanomaterials with aptamers offers a new method for cancer treatment. First, we briefly introduce the situation of cancer treatment and aptamers. Then, we discuss the application of aptamers in breast cancer treatment, lung cancer treatment, and other cancer treatment methods. Finally, perspectives on challenges and future applications of aptamers in cancer therapy are discussed.

A mini-review of embedded 3D printing: supporting media and strategies.

Embedded 3D printing is an additive manufacturing method based on a material extrusion strategy. Its distinctive feature is that the printing process is carried out in a supporting medium, and the printed ink filaments can be embedded in the supporting medium. It makes the printing process almost undisturbed by gravity, and no additional support needs to be planned before the object is printed. In recent years, embedded 3D printing has been used in sensors, software robots, tissue engineering, dosage forms, and organ models, showing strong potential. This article summarizes embedded 3D printing's latest progress on supporting media and strategies in a short space.

Author Correction: 3D Printed Polyvinyl Alcohol Tablets with Multiple Release Profiles.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

3D Printed Polyvinyl Alcohol Tablets with Multiple Release Profiles.

The aim of this study was to explore the feasibility of using different 3D printed internal geometries as tablet formulations to obtain controlled release profiles. In order to obtain controllable release profiles, three types of tablet models (Cylinder, Horn and Reversed Horn) with controlled structures were designed. The cylinder model shows a constant release profile and can keep the drug concentration within a certain range. The horn model exhibits an increasing release profile, which is suitable for the patients who have the drug resistance in the course of medication. The reversed horn model has a decreasing release profile that would be applied to hypertension cure. Furthermore, three types of tablets were fabricated successfully by a fused deposition modeling three-dimensional (3D) printer and injected with paracetamol (APAP) -containing gels. The results of in vitro drug release demonstrate that tablets with three kinds of structures can produce constant, gradually increasing, and gradually decreasing release profiles, respectively. The release attributes can be controlled by using different 3D printed geometries as tablet formulations. More importantly, there are no residues after dissolution. The method of preparing customized tablets with distinguished release profiles presented in this study has the promising potential in the fabrication of patient-tailored medicines.

Cost analysis of improving emergency care for aged care residents under a Hospital in the Nursing Home program in Australia.

BACKGROUND: This study aims to examine the costs associated with a Hospital in the Nursing Home (HiNH) program in Queensland Australia directed at patients from residential aged care facilities (RACFs) with emergency care needs. METHODS: A cost analysis was undertaken comparing the costs under the HiNH program and the current practice, in parallel with a pre-post controlled study design. The study was conducted in two Queensland public hospitals: the Royal Brisbane and Women's Hospital (intervention hospital) and the Logan Hospital (control hospital). Main outcome measures were the associated incremental costs or savings concerning the HiNH program provision and the acute hospital care utilisation over one year after intervention. RESULTS: The initial deterministic analysis calculated the total induced mean costs associated with providing the HiNH program over one year as AU$488,116, and the total induced savings relating to acute hospital care service utilisation of AU$8,659,788. The total net costs to the health service providers were thus calculated at -AU$8,171,671 per annum. Results from the probabilistic sensitivity analysis (based on 10,000 simulations) showed the mean and median annual net costs associated with the HiNH program implementation were -AU$8,444,512 and-AU$8,202,676, and a standard deviation of 2,955,346. There was 95% certainty that the values of net costs would fall within the range from -AU$15,018,055 to -AU$3,358,820. CONCLUSIONS: The costs relating to implementing the HiNH program appear to be much less than the savings in terms of associated decreases in acute hospital service utilisation. The HiNH service model is likely to have the cost-saving potential while improving the emergency care provision for RACF residents.

Stretching Micro Metal Particles into Uniformly Dispersed and Sized Nanoparticles in Polymer.

There is a longstanding challenge to disperse metal nanoparticles uniformly in bulk polymers for widespread applications. Conventional scale-down techniques often are only able to shrink larger elements (such as microparticles and microfibers) into micro/nano-elements (i.e. nanoparticles and nanofibers) without much altering their relative spatial and size distributions. Here we show an unusual phenomenon that tin (Sn) microparticles with both poor size distribution and spatial dispersion were stretched into uniformly dispersed and sized Sn nanoparticles in polyethersulfone (PES) through a stack and draw technique in thermal drawing. It is believed that the capillary instability plays a crucial role during thermal drawing. This novel, inexpensive, and scalable method overcomes the longstanding challenge to produce bulk polymer-metal nanocomposites (PMNCs) with a uniform dispersion of metallic nano-elements.

Role of tumor microenvironment in tumorigenesis.

Tumorigenesis is a complex and dynamic process, consisting of three stages: initiation, progression, and metastasis. Tumors are encircled by extracellular matrix (ECM) and stromal cells, and the physiological state of the tumor microenvironment (TME) is closely connected to every step of tumorigenesis. Evidence suggests that the vital components of the TME are fibroblasts and myofibroblasts, neuroendocrine cells, adipose cells, immune and inflammatory cells, the blood and lymphatic vascular networks, and ECM. This manuscript, based on the current studies of the TME, offers a more comprehensive overview of the primary functions of each component of the TME in cancer initiation, progression, and invasion. The manuscript also includes primary therapeutic targeting markers for each player, which may be helpful in treating tumors.

Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia.

BACKGROUND: Hospital emergency department (ED) use by patients from residential aged care facilities (RACFs) is not always appropriate, and this calls for interventions to avoid some unnecessary uses. This study aims to compare patterns of ED use by RACF patients with and without a Hospital in the Nursing Home (HiNH) program. METHODS: RACF patients presenting to EDs of a hospital with and a hospital without this program during pre- and post-intervention periods were included. Data on patient demographics and ED presentation characteristics were obtained from the Emergency Department Information System database, and were analysed by descriptive and comparative statistics. RESULTS: In both hospitals, most RACF residents presenting to EDs were aged between 75-94 years, female, triaged at scale 3 to 5, and transferred on weekdays and during working hours. Almost half of them were subsequently admitted to hospitals. In accordance with the ICD-10-AM diagnostic coding system, diagnoses that consistently ranked among the top three reasons for visiting the two hospitals before and after intervention included Chapter XIX: injury and poisoning and Chapter X: respiratory diseases. Associated with the intervention, significant decreases in the numbers of presentations per 1 000 RACF beds were identified among patients diagnosed with Chapter XI: digestive diseases [rate ratio (95%CI): 0.09 (0.04, 0.22); P<0.0001] and Chapter XXI: factors influencing health status and contact with health services [rate ratio (95%CI): 0.22 (0.07, 0.66); P=0.007]. CONCLUSION: The HiNH program may reduce the incidence of RACF residents visiting EDs for diagnoses of Chapter XI and Chapter XXI.

Impact of a government triple zero awareness campaign on emergency department patient characteristics.

OBJECTIVE: To evaluate the impact of a government triple zero community awareness campaign on the characteristics of patients attending an ED. METHODS: A study using Emergency Department Information System data was conducted in an adult metropolitan tertiary-referral teaching hospital in Brisbane. The three outcomes measured in the 3 month post-campaign period were arrival mode, Australasian Triage Scale and departure status. These measures reflect ambulance usage, clinical urgency and illness severity, respectively. They were compared with those in the 3 month pre-campaign period. Multivariate logistic regression models were used to investigate the impacts of the campaign on each of the three outcome measures after controlling for age, sex, day and time of arrival, and daily minimum temperature. RESULTS: There were 17,920 visits in the pre- and 17,793 visits in the post-campaign period. After the campaign, fewer patients arrived at the ED by road ambulance (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.80-1.00), although the impact of the campaign on the arrival mode was only close to statistical significance (Wald χ(2) -test, P= 0.055); and patients were significantly less likely to have higher clinical urgency (OR 0.86, 95% CI 0.79-0.94), while more likely to be admitted (OR 1.68, 95% CI 1.38-2.05) or complete treatment in the ED (OR 1.46, 95% CI 1.23-1.73) instead of leaving without waiting to be seen. CONCLUSIONS: The campaign had no significant impact on the arrival mode of the patients. After the campaign, the illness acuity of the patients decreased, whereas the illness severity of the patients increased.

Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia / 世界急诊医学杂志（英文）

@#BACKGROUND: Hospital emergency department (ED) use by patients from residential aged care facilities (RACFs) is not always appropriate, and this calls for interventions to avoid some unnecessary uses. This study aims to compare patterns of ED use by RACF patients with and without a Hospital in the Nursing Home (HiNH) program. METHODS: RACF patients presenting to EDs of a hospital with and a hospital without this program during pre- and post-intervention periods were included. Data on patient demographics and ED presentation characteristics were obtained from the Emergency Department Information System database, and were analysed by descriptive and comparative statistics. RESULTS: In both hospitals, most RACF residents presenting to EDs were aged between 75–94 years, female, triaged at scale 3 to 5, and transferred on weekdays and during working hours. Almost half of them were subsequently admitted to hospitals. In accordance with the ICD-10-AM diagnostic coding system, diagnoses that consistently ranked among the top three reasons for visiting the two hospitals before and after intervention included Chapter XIX: injury and poisoning and Chapter X: respiratory diseases. Associated with the intervention, significant decreases in the numbers of presentations per 1000 RACF beds were identified among patients diagnosed with Chapter XI: digestive diseases [rate ratio (95％CI): 0.09 (0.04, 0.22);P<0.0001] and Chapter XXI: factors influencing health status and contact with health services [rate ratio (95％CI): 0.22 (0.07, 0.66);P=0.007]. CONCLUSION: The HiNH program may reduce the incidence of RACF residents visiting EDs for diagnoses of Chapter XI and Chapter XXI.