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Background: Hepatic encephalopathy (HE) is a severe complication of acute hepatic failure requiring urgent critical care management. Branched-chain amino acids (BCAAs) such as leucine, isoleucine, and valine have been investigated as potential treatments to improve outcomes in patients with acute HE. However, the effectiveness of BCAA administration during the acute phase remains unclear. This study aimed to evaluate the effect of intravenous BCAA (IV-BCAA) treatment on clinical outcomes in patients with acute HE by systematically reviewing and analyzing randomized controlled trials (RCTs). Methods: We conducted a comprehensive literature search of MEDLINE, the Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi (ICHUSHI), a Japanese database for medical literature. We included RCTs involving adult patients with acute HE who received IV-BCAA or placebo during the acute phase after admission (< 7 days). Two reviewers independently screened the citations and extracted data. The primary "critical" outcomes were mortality from any cause and improvement in disturbance of consciousness. The secondary "important" outcome included the incidence of complications such as nausea and diarrhea. Risk ratios (RRs) were calculated using random effects models with inverse variance weighting. Results: Among the 2073 screened records, four met the criteria for quantitative analysis. The analysis included 219 patients: 109 received IV-BCAA, and 110 received placebo. Improvement in the disturbance of consciousness and mortality were not significantly different between the two groups (RR, 1.26; 95% confidence interval [CI], 0.96–1.66; RR, 0.90; 95% CI 0.70–1.16, respectively). Following IV-BCAA administration, the absolute differences of improvement in the disturbance of consciousness and mortality were 118 more per 1000 (95% CI 18 fewer–300 more) and 55 fewer per 1000 (95% CI 165 fewer–88 more), respectively. No significant differences were observed in the incidence of nausea or diarrhea between the two groups. Conclusions: Our meta-analysis demonstrates that all outcomes were not significantly different between IV-BCAA treatment and placebo for acute HE. Further RCTs are required to better understand IV-BCAA treatment potential in patients with HE. [ABSTRACT FROM AUTHOR]

BackgroundPurposeMethodsResultsConclusionsFalls are a significant concern for hospitals and patients. The risk of falls is particularly heightened around the period of hospitalization. Physical therapy (PT) is commonly consulted for hospitalized patients at-risk for falls, yet it is unknown how the hospital context influences fall prevention practice among physical therapists.To explore the perspectives of acute care physical therapists on fall prevention practices within hospital settings and examine how specific contextual factors influence their practice patterns and the effectiveness ofPT interventions.A prospective qualitative study using collaborative qualitative data analysis was conducted through semi-structured interviews with acute care physical therapists nationwide. Interviews focused on therapists’ perceptions of fall prevention practices, PT intervention effectiveness, and the influence of hospital context.We derived three primary themes and ten subthemes. First, mobility promotion was identified as central to fall prevention, requiring a system-wide culture involving multidisciplinary teams, particularly nursing staff. Second, systemic factors, such as time constraints, institutional priorities, high patient volumes, staff availability, equipment availability, and the physical environment, were found to limit optimal PT practice for fall prevention. Third, the effectiveness of PT interventions was context-dependent, with therapists adapting their practices to maximize impact within systemic constraints. Notably, clinical experience seemed to mitigate some practice limitations.Despite the acknowledged benefits of PT, systemic factors often prevent therapists from implementing effective fall prevention interventions. Addressing these contextual barriers and developing standards of practice may enhance patient safety and the overall success of fall prevention efforts in hospitals. [ABSTRACT FROM AUTHOR]

Background: Emerging evidence suggests that virtual patient observation (VPO) may help promote patient safety. Purpose: The purpose of this study was to examine and describe the demographic and clinical characteristics of patients who incurred VPO. Methods: A retrospective analysis was conducted. Differences in total VPO hours between groups were examined, followed by a hierarchical regression to investigate the effect of predictor variables on VPO utilization variance. Results: A total of 286 patient charts were reviewed. Mean VPO hours were higher in patients with an intensive care unit admission history. Adjusted for gender and history of dementia/Alzheimer's/memory impairment, the prediction of total VPO hours increased with the patient's intensive care unit admission history and overall hospital length of stay. Conclusions: Examining the prevalence and variability in the pattern of VPO utilization by specific patient characteristics is essential for identifying what patients could best benefit from this technology. [ABSTRACT FROM AUTHOR]

Abstract Background Hepatic encephalopathy (HE) is a severe complication of acute hepatic failure requiring urgent critical care management. Branched-chain amino acids (BCAAs) such as leucine, isoleucine, and valine have been investigated as potential treatments to improve outcomes in patients with acute HE. However, the effectiveness of BCAA administration during the acute phase remains unclear. This study aimed to evaluate the effect of intravenous BCAA (IV-BCAA) treatment on clinical outcomes in patients with acute HE by systematically reviewing and analyzing randomized controlled trials (RCTs). Methods We conducted a comprehensive literature search of MEDLINE, the Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi (ICHUSHI), a Japanese database for medical literature. We included RCTs involving adult patients with acute HE who received IV-BCAA or placebo during the acute phase after admission (

Objectives: Telemedicine use increased substantially with the COVID-19 pandemic. Understanding of the impact of telemedicine modality (video vs. phone) on post-telemedicine acute care for higher risk conditions is limited. Methods: We conducted a retrospective study of telemedicine visits, comparing video with telephone, for selected diagnoses with potentially higher illness acuity, evaluating post-telemedicine emergency department (ED) and hospitalization rates. In a large, multicenter cohort of adult patient-initiated primary care telemedicine visits from March 1, 2020, to July 31, 2021, we evaluated 7-day ED and hospitalization rates for higher acuity diagnostic categories (cardiac, gastrointestinal, and respiratory) by telemedicine modality, provider familiarity, and patient sociodemographic and clinical characteristics. Results: Among 431,705 telemedicine encounters, 128,129 (29.7%) were video visits and 303,576 (70.3%) were telephone visits. Adjusting for patient and appointment factors, telephone encounters for cardiac conditions were associated with significantly higher 7-day ED visit rates than video encounters (5.5% vs. 4.9%, respectively) but similar hospitalization rates (0.7% vs. 0.8%, respectively); for gastrointestinal conditions, post-telemedicine adjusted ED and hospitalization rates were comparable between telemedicine modalities (4.0% for ED and 1.2% vs. 1.3% for hospitalization, respectively); among respiratory conditions, video encounters were associated with higher ED and hospitalization rates than telephone encounters (ED: 5.9% after video vs. 5.2% after phone; hospitalization: 1.9% after video vs. 1.5% after phone). Telemedicine encounters with patients' own primary care provider (PCP) were associated with lower adjusted rates of ED use across all conditions and modalities. Conclusions: Short-term ED and hospitalization rates following primary care video or telephone visits for selected acute, high-risk conditions varied by condition and PCP familiarity. Nuanced use of video visits may confer benefits triaging to downstream acute care.

Aim: To explore the role of nurse practitioners (NPs) in delivering models of acute and urgent care in local communities informing the development of NPs as a solution to providing sustainable and effective healthcare in these settings., Design: Descriptive qualitative multicase study., Methods: The study population comprised NPs, clinic managers and general practitioners from NP-led acute and urgent care clinics across urban and rural Aotearoa New Zealand. Data were gathered from 20 semistructured interviews across seven sites. Data were thematically analysed to identify themes. Clinic-level operational data relating to the governance, team structures, and service delivery models were also collated and content from these data was integrated into the analysis and findings., Results: Five key themes were identified: meeting the needs of the community; development of NP-led acute care services; NPs as part of the healthcare team; training and support systems and supporting junior NPs and NP candidates., Conclusion: Nurse practitioners have a valuable role to play in delivering acute and urgent care services to local communities. Increasing awareness of the NP role, the prioritisation of community needs and strengthening training and support structures at both a workforce and clinic level were key findings from this research., Implications for the Profession And/or Patient Care: Findings from this research guided the development of a set of recommendations which consider community, clinic and wider national perspectives and aim to support the future growth of NP-led community acute/urgent care., Reporting Method: This research has adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines., Patient or Public Contribution: The authors have nothing to report., (© 2025 John Wiley & Sons Ltd.)

Background: The global trend of emergency department (ED) crowding can be mitigated with outreach care. The Mobile Hospital is an outreach acute care service in Espoo, Finland. This study describes the results of the Mobile Hospital intervention to nursing homes in a pre-post study setting with benchmarking validation data., Methods: We compared Emergency Medical Services (EMS) missions, ED visits, hospitalisations and their estimated costs from two 6-month periods in 2018-2019 (1325 nursing home beds). Benchmarking control data for ED visits were obtained from health records of the 10 largest Finnish cities., Results: The number of EMS missions to nursing homes decreased by 16% (720 vs 604), ED visits decreased by 22% (801 vs 622), there was no significant difference in specialised inpatient episodes (178 vs 162) and primary hospital inpatient episodes were fewer (285 vs 178, decreased 38%). Annual estimated savings per resident were 686 euros (decreased 14%). Annual estimated total savings were 934 908 euros. In the benchmarking analysis, the number of ED visits and acute hospitalisations amongst the older population decreased in Espoo, while in the other cities it increased., Conclusions: The Mobile Hospital seems to reduce nursing home residents' ED visits, hospitalisations and overall costs. Advance care planning and on-call physician telephone consultations may be useful components of the service.Implications to practice: This study adds to the growing evidence that outreach care to nursing homes is cost-effective in suburban areas with universal healthcare funding, at least as part of other developments in the acute care pathway., (© The Author(s) 2025. Published by Oxford University Press on behalf of the British Geriatrics Society.)

Purpose: Major depressive disorder with acute suicidal ideation or behavior (MDSI) is a substantial humanistic, economic, and clinical burden on patients. Data on health care resource use (HRU) and costs among patients with MDSI initiated on esketamine nasal spray relative to traditional treatments are limited. This study sought to describe HRU and medical costs of patients with MDSI initiated on esketamine, electroconvulsive therapy (ECT), antidepressant with second-generation antipsychotic (SGA) augmentation, and antidepressant monotherapy in the United States., Methods: Adults with MDSI from Merative® MarketScan® Commercial Databases (January 2016 to January 2022) were categorized into esketamine, ECT, SGA augmentation, and antidepressant monotherapy cohorts based on treatments initiated on or after August 5, 2020 (index date). Baseline period spanned 12 months before index date; follow-up period spanned from the index date till the end of data/health plan eligibility. Acute care HRU (inpatient and emergency department days) and medical costs excluding index treatment costs were described per-patient-per-month among all cohorts., Findings: The number of patients in the respective cohorts was 122 for esketamine, 336 for ECT, 9958 for SGA augmentation, and 4496 for antidepressant monotherapy. Across cohorts, mean patient age ranged from 29.1 to 41.2 years, and the majority of patients were female (range, 57.2%-65.6%). During the follow-up period, mean all-cause acute care HRU was 0.59 days in the esketamine cohort, which trended lower than in the ECT (3.17 days) and SGA augmentation (0.92 days) cohorts, and higher than in the antidepressant monotherapy cohort (0.32 days). Mean acute care HRU decreased from baseline in the esketamine, SGA augmentation, and antidepressant monotherapy cohorts by 58%, 21%, and 37% and increased in the ECT cohort by 44%. Mean follow-up medical costs per-patient-per-month were $1869 in the esketamine cohort, which trended lower than in the ECT ($4624) and SGA augmentation ($2163) cohorts, and higher than in the antidepressant monotherapy ($863) cohort. Relative to baseline, medical costs decreased in all cohorts (esketamine, 50%; ECT, 22%; SGA augmentation, 17%; antidepressant monotherapy, 32%)., Implications: Acute care HRU and medical costs trended lower among patients with MDSI initiated on esketamine nasal spray versus ECT or SGA augmentation; HRU and costs reduced most from pretreatment levels among patients treated with esketamine nasal spray versus patients treated with ECT, SGA augmentation, and antidepressant monotherapy. Results of this study may aid physicians in determining optimal treatments for the vulnerable MDSI population., Competing Interests: Declaration of competing interest Lisa Harding was compensated for being part of advisory panels for the following: Janssen Neuroscience Advisory Panel on Mood Disorders and Speaker Bureau, Compass Pathways Advisory Panel on Mood Disorders, and Takeda Pharmaceuticals Advisory Panel on Mood Disorders. Maryia Zhdanava, Aditi Shah, Porpong Boonmak, and Dominic Pilon are employees of Analysis Group, Inc., a consulting company developed the article as work made for hire for the sponsor of the underlying study, Janssen Scientific Affairs, LLC, a Johnson & Johnson Company. Amanda Teeple and Kruti Joshi are employees and stockholders of Johnson & Johnson., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: Acute appendicitis and acute cholecystitis are two of the most commonly encountered surgical entities. Multiple hypotheses are behind their coexistence, which include pathogen predilection, and mucosal ischemia inducing portal vein bacteremia as the management of uncomplicated acute cholecystitis and acute appendicitis is surgical, for which a single operation for synchronous presentation is effective. Here, we report a case with coexistent acute cholecystitis and acute appendicitis managed at our institution., Case/technique Description: A 30-year-old female presented with right upper quadrant abdominal pain for four days. The pain was radiating to the right shoulder, not related to fatty foods, associated with vomiting, anorexia, and burning micturition. On examination, she was vitally stable and afebrile with soft nondistended abdomen, a negative Murphy's sign, right lower quadrant rebound tenderness, and suprapubic tenderness. Laboratory tests showed leukocytosis (17.59 × 10 9 ) and high ALT (40 IU/L) and AST (32.5 IU/L). Ultrasound showed a distended gallbladder with two echogenic intraluminal nonshadowing echogenicity, the largest measuring 0.57 cm. Due to the vague presentation we elected to go for computed tomography of the abdomen which showed a distended gallbladder with adjacent fat stranding, subhepatic appendix with distended tip and no surrounding fat stranding. She underwent diagnostic laparoscopy with cholecystectomy and appendectomy. The patient had an uneventful postoperative course and was discharge home on day 1., Conclusion: We aim to shed light on the rare, but possible, synchronous coexistence of these diseases, raise the index of clinical suspicion. Management options for synchronous presentation can follow their asynchronous guidelines such as Tokyo and WSES., Competing Interests: Conflict of interests: none., (© 2024 by SLS, Society of Laparoscopic & Robotic Surgeons.)

Objective: To develop a set of pediatric acute care hospital referral regions for use in studying pediatric acute care delivery and test their utility relative to other regional systems., Study Design: We used state-level administrative databases capturing all pediatric acute care in 8 states to construct novel referral regions. We first constructed pediatric hospital service areas (PHSAs) based on 5 837 464 pediatric emergency department encounters. We then aggregated these PHSAs to pediatric hospital referral regions (PHRRs) based on 344 440 pediatric hospitalizations. Finally, we used 3 measures of spatial accuracy (localization index, market share index, and net patient flow) to compare this novel region system with the Dartmouth Atlas, designed originally to study adult specialty care, and the Pittsburgh Atlas, designed originally to study adult acute care., Results: The development procedure resulted in 717 novel PHSAs, which were then aggregated to 55 PHRRs across the included states. Relative to hospital referral regions in the Dartmouth and Pittsburgh Atlases, PHRRs were fewer in number and larger in area and population. PHRRs more accurately captured patterns of pediatric hospitalizations, (eg, mean localization index: 69.1 out of 100, compared with a mean of 58.1 for the Dartmouth Atlas and 62.4 for the Pittsburgh Atlas)., Conclusions: The use of regional definitions designed specifically to study pediatric acute care better captures contemporary pediatric acute care delivery than the use of existing regional definitions. Future work should extend these definitions to all US states to enable national analyses of pediatric acute care delivery., Competing Interests: Declaration of Competing Interest Prof. Kurland has received compensation for textbook authorship from Esri, Inc, the maker of ArcGIS software used in this project. Dr Joseph was supported by a grant from the National Institutes of Health (5T32HL007820). The NIH had no role in the study design, data analysis, manuscript preparation, or decision to submit the manuscript for publication., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)