Search

Introdução: As instituições de longa permanência para idosos oferecem muitas vantagens para essas pessoas, mas também podemos observar alguns problemas, causados principalmente pela mudança radical em sua rotina, o que pode levar a alterações em seus hábitos, principalmente nos hábitos alimentares. Objetivo: Avaliar o estado nutricional da população idosa institucionalizada no município de Praia Grande/SP. Métodos: A amostra foi composta por 391 sujeitos: 109 homens e 282 mulheres. A avaliação nutricional foi realizada através da Mini Avaliação Nutricional. A avaliação antropométrica consistiu em medidas de massa corporal, estatura, índice de massa corporal, circunferência do braço e circunferência da panturrilha. Resultados: Os resultados revelaram que 49,6% dos idosos avaliados apresentam risco de desnutrição ou desnutrição. Conclusão: Os dados reunidos são preocupantes e refletem a necessidade de construir novas políticas relativas às questões relacionadas ao cuidado no envelhecimento saudável, incluindo assistência qualificada em instituições de longa permanência.

Mandatory restrictions on social activities and access to services during the COVID-19 pandemic prevented discharge into the community of consumers from an extended-stay, hospital-based rehabilitat...

BACKGROUND: Despite so much research in high altitude area, our existing knowledge is still lacking on otological effects of long-term stay in high altitude. This pilot study was conducted to compare the hearing thresholds of army soldiers at induction and after completion of one year in high altitude area (HAA). METHODS: Hearing thresholds of 433 soldiers posted in HAA were recorded using pure tone audiometry at the time of induction and second thresholds after one year of stay in high altitude for frequencies of 500Hz, 1KHzs, 2 KHzs and 4 KHzs. The two sets of hearing thresholds for air conduction were compared using paired “t” test for any statistical significance. RESULTS: The mean Pure Tone Audiometry (PTA) thresholds for 433 left ears worsened from 9.43dB to 9.65dB at 500 HZs ; 14.02dB to 14.32dB at 1 KHZs ; 15.04dB to 16.09dB at 2KHzs and 18.63dB to 22.59dB at 4 KHZs. Similarly for right ear, PTA thresholds worsened from 9.43dB to 9.69dB at 500HZs; 13.95dB to 14.34dB at 1 KHZs; 15.38dB to 17.26dB at 2 KHZs and from 18.59dB to 23.06dB at 4KHZs. These results are found to be statistically significant (p

Background Overactive bladder (OAB) is a prevalent condition commonly treated with anticholinergic medications. The extent to which anticholinergic burden is associated with costs and healthcare resource use (HCRU) in the long-stay nursing home (LSNH) setting is currently unknown. Objectives This research evaluated the impact of anticholinergic burden on HCRU and related costs among LSNH residents with OAB. Methods This was a cohort study based on 2013–2015 Minimum Data Set-linked Medicare claims data involving LSNH residents aged ≥ 65 years with OAB and having Parts A, B and D coverage 6 months pre- and ≥ 12 months post-nursing home admission date (index date). Cumulative anticholinergic burden was determined using the Anticholinergic Cognitive Burden scale and defined daily dose. Direct medical costs related to HCRU were examined. HCRU included inpatient, outpatient, emergency room (ER), and physician office visits. Costs and HCRU associated with levels of anticholinergic burden were evaluated using generalized linear models. Results A total of 123,308 LSNH residents with OAB were included in this study. Most residents (87.2%) had some level (12.8%, none; 18.0%, low; 41.9%, moderate; and 27.3%, high) of cumulative anticholinergic burden. Results indicate that all types of resource utilization were higher among those with any level of anticholinergic burden than those with no burden. The outpatient, ER, and physician costs tended to be higher with increasing anticholinergic burden. Conclusions Costs and HCRU patterns reflected increasing trends with anticholinergic burden. Targeted efforts towards reducing anticholinergic burden among LSNH residents with OAB may result in decreases in costs and HCRU. Supplementary Information The online version contains supplementary material available at 10.1007/s41669-021-00281-8.

Objective Excluded from reporting to CMS's Percentage of long-stay residents who got an antipsychotic medication quality-measure are antipsychotics prescribed to nursing home patients with schizophrenia, Tourette's, or Huntington's. Over the 4 years following its 2012 debut, the quality-measure calculated a 27% reduction in inappropriate antipsychotic use but also an 18.3% increase in exclusion claims. This study evaluated the impact of these exclusions on the measure's findings. Methods Claims data for the years 2011–2016 retrospectively identified the prevalence of schizophrenia, Tourette's, and Huntington's in quarterly cohorts of Virginia long-stay residents prescribed antipsychotics. Annualized diagnoses in 2011 were compared with subsequent years using simple logistic regression. Results In 2016, 29% of the antipsychotics prescribed in Virginia nursing homes were to residents with diagnoses of schizophrenia, Tourette's, and Huntington's, a significant 32% increase from 2011. Conclusion Almost 30% of the antipsychotics employed in Virginia nursing homes are excluded from CMS's long-stay antipsychotic quality-measure.

Medicare provides skilled nursing facility (SNF) coverage for short-stay rehabilitation in nursing homes (NHs) at a better rate than Medicaid covers long-term NH care. National trends of increasing Medicare days culminated in 2010/2011 with a reduction to the SNF rates. Before the cuts, NHs that increased SNF days also improved outcomes for long-stay residents, including pain, pressure ulcer, and functional decline outcomes, suggesting spillover effects of SNF days. We replicated the prior study to determine how changes in SNF days and long-stay outcomes related following the rate cut. From 2011 to 2014, SNF days decreased and all three study outcomes improved. Spillover effects were not consistently observed. Decreasing SNF days was associated with increasing percentages of long-stay residents with daily pain and with decreasing percentages of long-stay residents getting pressure ulcers. Research on these associations in more recent years is needed to determine whether they persist and to inform practice.

The characteristics of transformation of the psychophysiological state of servicemen during a long stay in the combat zone have been studied. The psychophysiological status of servicemen, muscular strength and endurance of right and left arms were assessed. The obtained results indicate that the studied contingent was heterogeneous in its psychophysiological status and was divided into two subgroups «better» and «worse». It was found that the studied psychophysiological parameters are described by two orthogonal factors (65%) - the «activation and stress of the body» factor (38%) and the «quality of cognitive processes» factor (27%). The first factor is the most powerful, this indicates a significant role of a serviceman’s stress-resistance in the conditions of long stay in the combat zone. It was found that this factor is also the leading one in the «worse» subgroup, this to a lesser extent can prevent disorder and unpredictability of behavioral reactions of combatants. In the «better» subgroup «quality of cognitive processes» was the leading factor. It plays a significant role in the balanced activity of functional systems of the body responsible for formation of adaptive behavioral responses during long-term action of high-level stressors. The decisive rules for selection of servicemen best suited for carrying out official duties in conditions of high-risk activities have been developed.

Background: One of the main objectives of hospital managements is to control the length of stay (LOS). Successful control of LOS of inpatients will result in reduction in the cost of care, decrease in nosocomial infections, medication side effects, and better management of the limited number of available patients’ beds. The length of stay (LOS) is an important indicator of the efficiency of hospital management by improving the quality of treatment, and increased hospital profit with more efficient bed management. The purpose of this study was to model the distribution of LOS as a function of patient’s age, and the Diagnosis Related Groups (DRG), based on electronic medical records of a large tertiary care hospital. Materials and Methods: Information related to the research subjects were retrieved from a database of patients admitted to King Faisal Specialist Hospital and Research Center hospital in Riyadh, Saudi Arabia between January 2014 and December 2016. Subjects’ confidential information was masked from the investigators. The data analyses were reported visually, descriptively, and analytically using Cox proportional hazard regression model to predict the risk of long-stay when patients’ age and the DRG are considered as antecedent risk factors. Results: Predicting the risk of long stay depends significantly on the age at admission, and the DRG to which a patient belongs to. We demonstrated the validity of the Cox regression model for the available data as the proportionality assumption is shown to be satisfied. Two examples were presented to demonstrate the utility of the Cox model in this regard.

AIM To review the literature of the benefits of enteral zinc supplementation in preterm population

OBJECTIVES: To longitudinally examine the latent statuses of depressive symptoms and their association with cognitive impairment in older U.S. nursing home (NH) residents. METHOD: Using Minimum Data Set 3.0, newly-admitted, long-stay, older NH residents with depression in 2014 were identified (n = 88,532). Depressive symptoms (Patient Health Questionnaire-9) and cognitive impairment (Brief Interview of Mental Status) were measured at admission and 90 days. Latent transition analysis was used to examine the prevalence of and the transition between latent statuses of depressive symptoms from admission to 90 days, and the association of cognitive impairment with the statuses at admission. RESULTS: Four latent statuses of depressive symptoms were identified: ‘Multiple Symptoms’ (prevalence at admission: 17.3%; 90 days: 13.6%), ‘Depressed mood’ (20.0%; 19.5%), ‘Fatigue’ (27.4%; 25.7%), and ‘Minimal Symptoms’ (35.3%; 41.2%). Most residents remained in the same status from admission to 90 days. Compared to residents who were cognitively intact, those with moderate impairment were more likely to be in ‘Multiple Symptoms’ and ‘Fatigue’ statuses; those with severe impairment had lower odds of belonging to ‘Multiple Symptoms’, ‘Depressed Mood’, and ‘Fatigue’ statuses. CONCLUSION: By addressing the longitudinal changes in the heterogeneous depressive symptoms and the role of cognitive impairment, findings have implications for depression management in older NH residents.

The purpose of this study is to examine Physical Therapy (PT) and Occupational Therapy (OT) staffing patterns in nursing homes and understand their relationship with quality performance. Bivariate analyses between PT/OT staffing and facility characteristics were performed to understand staffing patterns and random effects regressions were run to explore the link between therapy staff and quality. Findings suggest PT/OT staff have a positive influence on resident outcomes and therapy staffing patterns significantly differ across provider attributes, including size, profit status, and occupancy rate, among others. The findings can be used to inform policymakers about potential unintended consequences resulting from changes to Medicare reimbursement policies.

Aim To present the European Society of Clinical Oncology current recommendations for the gynecological cancer treatment on the background of the COVID-19 pandemic Materials and methods A literature search was carried out for the most modern literary sources available, published in March and April 2020, based on the experience of several European communities of gynecological oncology We have compiled guidelines from several international communities working with oncological patients for consideration and possible practical application during the ongoing COVID-19 pandemic Results Recommendations for sanitary - epidemiological activities aimed at reducing the risk of infection, as well as the sequence of therapeutic and diagnostic actions in oncogynecological patients, depending on the disease and stage of the tumor process, were presented Factors influencing treatment planning were indicated;a system of measures to provide palliative care for this category of patients was developed Conclusion In the face of the ongoing pandemic, these recommendations can help to choose the optimal tactics for gynecological cancer patients management, and also to ensure the safety of both patients and the medical staff involved in treatment process It is necessary to adhere to preventive and protective measures in conditions of a high infection risk for medical personnel and patients at the stage of outpatient and inpatient care It is necessary to reduce or postpone extended, combined or simultaneous surgical interventions that involve a long stay on the ventilator in the intensive care unit Consideration of alternative methods of conservative therapy is possible In addition, the use of remote consultations helps to resolve tactical issues, avoiding additional infection risks Введение В 2019 -2020 гг мир столкнулся с кризисом вследствие нарастающей пандемии, связанной с разрушительным воздействием коронавирусной инфекциии (COVID-19) Цель исследования Представить современные рекомендации европейского общества клинической онкологии по лечению гинекологического рака в условиях пандемии COVID-19 Материалы и методы Проведен поиск доступных самых современных литературных источников, опубликованных в марте и апреле 2020 года в базах PubMed (https://www ncbi nlm nih gov/pubmed/), Научной электронной библиотеки Elibrary ru (https://elibrary ru/) и сайтах нескольких европейских онкогинекологических сообществ профессиональных Поиск в базах данных проводили по ключевым словам «COVID-19», «cervical cancer», «endometrial cancer», «ovarian cancer», «vulvar cancer» и «vaginal cancer» Мы отобрали и объединили рекомендации, подготовленные несколькими международными сообществами, занимающихся лечением пациентов с онкогенитальной патологией, и предназначенные для рассмотрения и возможного применения на практике во время пандемии COVID-19 Результаты Изложены рекомендации по санитарно-эпидемиологическим мероприятиям, направленным на снижение риска инфицирования;последовательности лечебно-диагностических мероприятий у онкогинекологических больных в зависимости от нозологии и стадии опухолевого процесса Подробно описаны рекомендации при лечении больных с раком шейки матки, раком эндометрия, раком яичников, раком вульвы, раком влагалища Обозначены факторы, влияющие на планирование лечения;предложена система мероприятий по оказанию паллиативной помощи данной категории больных Заключение В условиях продолжающейся пандемии данные рекомендации помогут выбрать оптимальную тактику ведения пациенток с гинекологическим раком, обеспечить безопасность как пациентам, так и участвующему в лечении медперсоналу Необходимо соблюдение мер профилактики и защиты в условиях высокого риска инфицирования медицинским персоналом и пациентами на этапе амбулаторной и стационарной помощи Необходимо сократить либо отложить расширенные, комбинированные или симультанные хирургические вмешательства, предполагающие длительное нахождение наискусственной вентиляции легких (ИВЛ) в условиях реанимационного отделения Возможно рассмотрение альтернативных методов консервативной терапии Кроме того, использование дистанционных консультаций в режиме онлайн, помогает разрешить тактические вопросы, избежав дополнительных рисков инфицирования

Objectives From 2013 to 2016, the Centers for Medicare and Medicaid Services Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents (“the Initiative”) tested a series of clinical interventions and care models, through organizations called Enhanced Care and Coordination Providers (ECCPs), with the goal of reducing avoidable inpatient hospital admissions among long-stay nursing home residents. We identify the effect of the Initiative on the probability and count of acute care transfers [capturing any transfer to the hospital, including hospitalizations (inpatient stays), emergency department visits, and observation stays]. Design We evaluate the effect of the Initiative on the probability and count of all-cause acute care transfers and potentially avoidable acute care transfers and estimate the average effect of the Initiative per resident per year. Setting and Participants We use 2011–2016 data from the Centers for Medicare and Medicaid Services Minimum Data Set, version 3.0, nursing home resident assessments linked with Medicare eligibility and enrollment data and Medicare inpatient and outpatient hospital claims. Our sample is limited to Medicare fee-for-service beneficiaries in participating ECCP facilities and a comparison group of long-stay nursing facility residents. Methods We evaluate the effect of the Initiative on both the probability and count of all-cause acute care transfers and potentially avoidable acute care transfers using difference-in-differences regression models controlling for both resident-level clinical and demographic characteristics as well as facility-level characteristics. Results We found statistically significant evidence of a reduction in both the probability and count of all-cause and potentially avoidable acute care transfers among long-stay nursing facility residents who participated in the Initiative, relative to comparison group residents. Conclusions and Implications The clinical interventions and care models implemented by the ECCPs show that by using staff education, facility leadership and physician engagement, and/or clinical assessment and treatment of residents who experienced a change in condition, it is possible to reduce acute care transfers of nursing facility residents. This could lead to better outcomes and reduced cost of care for this vulnerable patient population.

Background: Psychotropic drugs are essential but not devoid of adverse drug reactions (ADRs), which lead to non-compliance and further failure of therapy, hampering the patient’s quality of life. Methods: A cross-sectional, observational study was carried out in a residential nursing home in Pune, India, from October 2018 to March 2019. Psychiatric inpatients of both genders and all ages receiving psychotropic drugs for at least one month were enrolled. Patients who were not alert or oriented enough to give a detailed history and response to a questionnaire, including dementia patients, and those who were not willing to give informed consent were excluded. The ADRs were categorized, and their management was documented using the Udvalg for Kliniske Unders gelser (UKU) side effect rating scale. ADRs were assessed for causality and severity using the WHO-Uppsala Monitoring Centre (WHO-UMC) causality assessment scale and the Modified Hartwig and Siegel scale. Results: In our study, 115 patients (76.6%) experienced 273 adverse drug events. Atypical antipsychotics accounted for the maximum number of ADRs (54.94%; n = 150). The most common ADRs were weight gain, constipation, and tremors. The majority of ADRs were “mild” and had a “possible” causality relationship. Conclusion: The study demonstrated a high incidence of ADRs, which was primarily managed either by reduction of dose or continued drug use with the treatment of side effects.

Background/Objectives: While malnutrition is prevalent in hospitals, little is known about patients who first become malnourished during the hospital stay. This study aimed to determine the incidence and describe the characteristics of patients who developed hospital-acquired malnutrition (HAM) across five Australian public hospitals. Subjects/Methods: A retrospective clinical audit of hospital data was conducted. Adult patients (aged ≥ 18 years) with a length of stay (LOS) > 14 days in a Metro South Health hospital between July 2015 and January 2019 were eligible. Demographic and clinical data were sourced from hospital data and medical records. Dietitians reviewed the medical records of patients clinically coded with malnutrition to determine HAM incidence. Univariate and logistic regression analyses were used to determine patient descriptors associated with HAM, compared with those not malnourished or those malnourished on admission. Results: A total of 17,717 patients were eligible (45% F, 63 ± 20 years, LOS 24 (15–606) days). HAM incidence in long-stay patients was 1%, with an overall malnutrition prevalence of 18%. Patients with HAM had an ~26 days longer LOS than patients who were malnourished on admission or not malnourished (p 14 days after admission, was in the low end of the published range. HAM was significantly associated with long LOS, transferring between hospitals and developing a cognitive impairment, pressure injury or fall during admission.

Summary Background and aims Children with extended hospital stays are at risk of nutritional deterioration making regular nutrition screening throughout their admission an integral part of the nutrition care pathway. The purpose of this study was to design and validate a simple, quick and universal weekly rescreening tool to identify hospital acquired nutritional deterioration during a child's hospital stay. Methods A prospective, longitudinal sample of children aged 0–16 years admitted to a paediatric tertiary hospital with a length of stay ≥7 days were included in the study. Agreement between nutritional deterioration markers of reduction in weight (kg), body mass index (kg/m2), energy intake (kcal/day) and protein intake (g/day) over a 7-day period and two proposed rescreening questions was determined using sensitivity, specificity, area under the curve and positive and negative predictive values. Results Sixty-one children were included in the study with 224 full 7-day datasets. The sensitivity and specificity of the rescreening question ‘Has the child had reduced nutritional intake in the last 7 days’ for identifying children with a ≥25% reduction in energy intake over the previous 7-day period were 61.9% (95% CI 41.1–82.7) and 82.2% (95% CI 76.9–87.5) respectively. The sensitivity of ‘Has the child lost weight or had poor weight gain’ at detecting weight loss was 71.4% (95% CI 54.7–88.2) and specificity 87.8% (95% CI 83.1–92.5). Conclusion The paediatric nutrition rescreening questions provide a valid and simple tool to detect nutritional deterioration in long stay paediatric patients and should be an integral part of the nutrition care process.

During lockdown due to virus SARS-CoV-2 (COVID-19) pandemic, the Royal College of Obstetricians and Gynecologist (RCOG) proposed an alternative to oral glucose tolerance test (OGTT) to diagnose hyperglycaemia in pregnancy (HIP) to avoid a long stay in laboratory centres. The intention was not aimed at identifying an equivalent group of women as those detected by OGTT, but rather to identify pregnant women with the highest glucose levels for whom specialist management remained essential throughout the pandemic. The definition of HIP proposed by the RCOG includes fasting plasma glucose (FPG) ≥ 5.6 mmol/L and/or HbA1c ≥ 39 mmol/mol (5.7%) and/or random plasma glucose ≥ 9.0 mmol/L (1).

Chienhsiu Huang Department of Internal Medicine, Division of Chest Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, TaiwanCorrespondence: Chienhsiu HuangDepartment of Internal Medicine, Division of Chest Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, NO. 2, Min-Sheng Road. Dalin Town, Chiayi County, Chiayi, TaiwanTel +886-9-21552418Email hgssport@yahoo.com.twBackground: Worldwide, a certain proportion of patients stay for long periods. Reduction of length of stay is a critical intervention to optimize in-hospital resource utilization. Length of stay itself is a reliable quality index for healthcare systems. Interventions to reduce long hospital stays require understanding organizational and individual factors that affect the length of stay. The purposes of this study are to attempt to reduce long stays (defined as > 30 days) by identifying the causes and preventing such situations.Methods: This was a retrospective observational study of patients who stayed in the hospital for long periods (> 30 days) between 1 January 2018 and 31 December 2018. We identified subgroups of patients with long stays, evaluated their associations with baseline variables, relevant discharge departments, and causes of long stays. We proposed improvement plans.Results: There were 446 long-stay patients (mean age 66.7 years; 37.7% females), including 158 undergoing prolonged mechanical ventilation, 109 with diseases requiring hospitalization, 93 due to nosocomial infection, 31 with delayed discharge, 20 with iatrogenic complications, and 35 patients with long stays for various causes. There were 9331 hospital days associated with 158 patients with prolonged mechanical ventilation. The number of hospital days for those undergoing prolonged mechanical ventilation was significantly different from that of patients who did not undergo prolonged mechanical ventilation. Depending on the causes of long stay, we could reduce the length of stay in 188 (42.1%) of patients using an aggressive management strategy.Conclusions: Setting a ventilator weaned unit for prolonged mechanical ventilation patients in a tertiary-level hospital is essential to reduce long stay of intensive care unit. Aggressive management strategies can reduce long stays.Keywords: long stay, length of stay, respiratory care center, weaning units in acute care hospital

Patient long-stay is one of the main causes of inefficient resource management in the National Health Service. Similarly, delays in treatment and access to social care contributes to the trust’s economic burden but also causes a significant delay in care for society's most vulnerable. A single-centre evaluation of patient long stay was performed in a tertiary spinal unit in Greater Manchester. The top 50 patients who stayed the longest in an acute spinal bed between 2018 and 2019 were selected for analysis. Demographics, indication for transfer from another trust, overall length of stay, and the main reasons for such were evaluated. Of the 50 assessed, there was an average length of stay of 46.9 days and the majority were comprised of patients with metastatic spinal cord compression. 74% had delays to surgery due to poor medical optimisation pre-transfer. 41% remained as an inpatient longer than necessary due to non-medical concerns. The main reasons included awaiting placement in a rehabilitation facility, social care issues and delays in repatriation back to their referring trust for ongoing care. Delays in treatment and length of stay were found to be increased in patients who were poorly optimised pre-operatively and who required complex social and medical care post-operatively.

The main method of joining the wound edges in surgery remains suturing with the help of threads. Unfortunately, suture materials used in surgery have a number of disadvantages. The percentage of postoperative wound complications remains high. One of these consequences is the failure of the seam, depending also on the material used in the operation. Suture material, as a genetically alien object, that is a foreign body, with a long stay in the tissues can lead to the development of complications: causes suppuration of wounds, formation of abscesses, peritonitis. Materials and methods: The analysis of modern Russian-language and foreign literature, also Internet sources devoted to the issue of issues and modern developments of antiseptic suture material. As a result, the choice and development of an ideal suture material that meets all the requirements, remains an unsolved and socially significant problem in surgery. Despite the variety of variations already offered, there is currently no suture material with antimicrobial activity on the market that would fully reduce the risk of developing infections in the surgical area. But the achievements of modern chemical production make it possible to develop biologically active suture materials that have the ability to resist the development of infectious complications in a wound and improve tissue regeneration without adversely affecting the body. In addition, the analysis showed an increased interest of developers to chitosan, due to its exceptional biocompatibility, bioresorbability, non-toxicity, antibacterial properties and hemostaticity.

Background: For patients with a mental disorder facing lengthy stays in secure forensic care, the role and experiences of their carers has only recently started to be explored in research.Aims: To ...

Introduction: a gap between evidence-based recommendations for prescribing antipsychotics and its implementation in practice could be overcome by local guidelines. Aim: the aim of our study was to locally adapt the national guideline for schizophrenia and evaluate its impact on prescribing practice as well as on clinical and humanistic outcomes in a long-stay psychiatric hospital Dobrota in Kotor, Montenegro. Subjects and Methods: This was academic, prospective, IV phase interventional study, which measured outcome before and after investigators intervention within healthcare system. The study was conducted in two six-months phases separated by implementation of the local guidelines. Prescribing practices and treatment outcomes were monitored in both phases of the study. Results: Study included 111 patients. Although the guidelines did not influence total volume of prescribed antipsychotics, social functioning and environmental aspects of quality of life were improved. Conclusions: Writing and adopting the guidelines for local use might be associated with some benefit in humanistic outcomes, but multi-faceted intervention should be considered in order to achieve more substantial impact on prescribing practices and clinical outcomes.

INTRODUCCIÓN: la neumonía adquirida en la comunidad (NAC) es una de las principales enfermedades infecciosas que afecta principalmente a la población geriátrica y que puede ser potencialmente una causa de mortalidad asociada con el desarrollo de sepsis pulmonar. Por tanto, el presente estudio tiene como objetivo evaluar los índices predictivos CURB-65, Quick-SOFA y el índice de Charlson en la asociación de mortalidad y estancia hospitalaria en pacientes con NAC.MATERIALES Y MÉTODOS: se realizó un estudio observacional, analítico y retrospectivo en el Hospital Regional de Duitama, de junio a diciembre de 2016. Se incluyeron los pacientes con diagnóstico clínico, paraclínico y radiológico de NAC. Se tuvo en cuenta la asociación de variables demográficas, comorbilidades, condiciones clínicas y resultados clínicos frente a la mortalidad y estancia hospitalaria según los índices CURB-65, q-SOFA e índice de Charlson.RESULTADOS: se obtuvo una muestra de 116 pacientes. El 77,5 % eran mayores de 75 años. Los puntajes de CURB-65 y q-SOFA se asociaron con mortalidad (CURB-65 AUC: 0,75 [0,61 %-0,88 %]; q-SOFA AUC: 0,73 [0,59-0,88 %]). El puntaje de CURB-65 ≥ 3 tiene una S: 64 % E: 79 %, y el q-SOFA ≥ 2 tiene una S: 64 % E: 85 %. El índice de Charlson no tiene un buen poder de predicción de la mortalidad en el manejo agudo. Los tres índices no se asociaron con una buena predicción de la estancia hospitalaria o del uso de antibiótico de amplio espectro.CONCLUSIONES: los índices q-SOFA y CURB-65 son escalas que pueden ser utilizadas en el manejo agudo de la NAC para estimar la mortalidad del paciente.

BACKGROUND Early postmastectomy discharge with a drain in place is standard practice in most developed countries. Its feasibility has not been evaluated in low resource settings like Nigeria. METHODS Consenting patients undergoing mastectomy were discharged on the third postoperative day and assessed as outpatients for wound complications as well as their experience at home. Wound outcomes were compared with patients who had traditional long stay. RESULTS Forty-five of the 58 patients who had a mastectomy during the study period participated in the early discharge program (77.6%). Of these, four patients (8.9%) had drain malfunction, seroma occurred in eight patients (17.8%), eight patients (17.8%) had wound infection, and six patients (13.3%) had flap necrosis. There was no readmission. Compared with long stay patients, postoperative stay was significantly shorter (3 vs 11 days; P

OBJECTIVES:To develop a pragmatic method of identifying long-stay patients (LSPs) in the PICU.METHODS:We surveyed 40 expert stakeholders in 14 Canadian PICUs between February 2015 and March 2015 to identify key factors to use for defining LSPs in the PICU. We then describe a pragmatic method using these factors to analyze 523 admissions to an academic, tertiary-care PICU from February 1, 2015, to January 31, 2016.RESULTS:The overall response rate was 70% (28 of 40). Of respondents, 75% (21of 28) stated that it was important to define LSPs and identified present and future resource consumption (18 of 21 [86%] and 16 of 21 [76%], respectively) as the key reasons for defining LSPs. Respondents valued a definition that was consistent and ranked a percentile cutoff as the preferred analytic method for defining LSPs. Of respondents, 86% (24 of 28) though the LSP definition should include factors other than length of stay. We developed a surrogate marker for LSPs using mechanical ventilation and presence of a central venous catheter in our sample population to compare to varying percentile cutoffs. We identified 108 patients at the 80th percentile as LSPs who used 67% of total bed days and had a median length of stay of 11.3 days.CONCLUSIONS:We present a pragmatic method for the retrospective identification of LSPs in the PICU that incorporates unit- and/or patient-specific characteristics. The next steps would be to validate this method using other patient and/or unit characteristics in different PICUs and over time.

During the last decades, the number of patients with long stay admissions (LSA) in PICU has increased. The purpose of this study was to identify factors associated with PICU LSA, assessing healthcare resources use and changes in the profile of these patients. A retrospective, observational, single-center study was carried out. Characteristics of LSA were compared between two periods (2006–2010 and 2011–2015). During the earlier period there were 2,118 admissions (3.9% of them LSA), whereas during the second period, there were 1,763 (5.4% of them LSA) (p = 0.025). LSA accounted for 33.7% PICU stay days during the first period and 46.7% during the second (p p = 0.001) and high-flow oxygen therapy (68.8% vs. 37.8%, p = 0.005) was observed in the 2011–2015 cohort, whereas the use of arterial catheter (77.1% vs. 92.6%, p = 0.005), continuous infusion of adrenaline (55.2% vs. 75.9%, p = 0.004), and hemoderivative transfusion (74% vs. 89.2%, p = 0.010) was less frequent. In the 2006–2010 cohort, hospital-acquired infections were more common (95.2% vs. 68.8%, p p = 0.026). The number of long-stay PICU admissions have increased entailing an intensive use of healthcare resources. These patients have a high risk for complications and mortality.

Prolonged length of stay (LOS) is a significant financial burden to the hospitals. Although Physiotherapists (PT) are expanding their role in different areas of health care, including Emergency Care (EC), the impact of late shift PT input on LOS is not yet known. The objective was to determine the impact of the late shift Rapid Response Team (RRT) input on LOS and discharge destination. Patients who are referred to the RRT Physiotherapy/Occupational Therapy (PT/OT) include those with musculoskeletal conditions, cardio-respiratory and neurological problems. The therapists establish patient’s premorbid mobility level, social status and complete mobility and balance assessments. The outcome measures considered for this study was LOS and discharge destination. A total of 131 patients were assessed during 2016/2017. Out of 131, 72 patients were discharged on the day of treatment. Out of 138 patients referred during 2017/2018, 79 patients were discharged on the day of assessment. Most patients had significant comorbidities when admitted as the number of comorbidities is approximately four conditions for both durations. The discharge destination included from patients own home, rehabilitation hospital, long stay wardand interim placementfrom ward and this has saved 151 bed days in the hospital. Late shift RRT service in the ED resulted in reduced LOS and improved discharge destination.

Despite the growing ubiquity of televisions in hospital wards in the UK and America from the 1950s, little in-depth research has been conducted by historians on the relationality between the new technology, the long-term ward space, and its occupants. In this essay, I draw mainly on studies into the effects of the ward environment on patients. While long-stay psychiatric and 'mental handicap' wards were occupied by people with different mental and physical abilities and needs, often at different stages of their lives, I want to demonstrate how the mutable ontology of the television set could affect the lived experiences of vulnerable patients. How, I ask, did the television as an object in and of itself gain agency and influence the rhythms, routines and social relationships within different spatial and temporal contexts? Contrasting the ways in which the activity of television watching was constituted by perceptions of patients’ cognitive, intellectual, sensory, and physical abilities in different ward spaces reveals much about attitudes and practices of the time.

BACKGROUND As the population with human immunodeficiency virus (HIV) continues to age, the need for nursing home (NH) care is increasing. OBJECTIVES To assess whether NH's experience in treating HIV is related to outcomes. RESEARCH DESIGN We used claims and assessment data to identify individuals with and without HIV who were admitted to NHs in 9 high HIV prevalent states. We classified NHs into HIV experience categories and estimate the effects of NH HIV experience on patient's outcomes. We applied an instrumental variable using distances between each individual's residence and NHs with different HIV experience. SUBJECTS In all, 5,929,376 admissions for those without HIV and 53,476 admissions for residents with HIV. MEASURES Our primary outcomes were 30-day hospital readmissions, likelihood of becoming a long stay resident, and 180-day mortality posthospital discharge. RESULTS Residents with HIV tended to have poorer outcomes than residents without HIV, regardless of the NH they were admitted to. Residents with HIV admitted to high HIV experience NHs were more likely to be readmitted to the hospital than those admitted to NHs with lower HIV experience (19.6% in 0% HIV NHs, 18.7% in 05% HIV NHs and 22.9% in 5%-50% HIV NHs). CONCLUSIONS Residents with HIV experience worse outcomes in NHs than residents without HIV. Increased HIV experience was not related to improved outcomes.

Deinstitutionalization in psychiatry led to a decrease in hospital beds, short hospital admissions focussed on symptoms reduction, and the development of ambulatory care. However, the needs of patients who despite symptoms reduction do not display the minimal competencies to live alone or in a sheltered accommodation, are not met in such a context. They usually go through long admissions and fail to improve. In 2016, we implemented a new inpatient program focused on fostering the development of the competencies needed to adapt to living outside the hospital; the aim of this study was to evaluate if it lead to the resolution of these situations or in contrary if it turned into a long stay unit. 116 patients admitted to the program between 2016 and 2018 were included in the study. They were psychiatric inpatients who had no home, did not find a place in a sheltered accommodation and couldn't be discharged. In the majority of cases, the situation was resolved within 180 days and the majority of patients was referred to a sheltered accommodation. Functional and symptom levels improved significantly over time. A specific focus on restoring competencies to live outside of hospital allows complex patients to improve their functional level and to find a place to live in the community within a relatively short time. While deinstitutionalization has been beneficial to the vast majority of patients, denying the specific needs of a minority of patients leads to unnecessary long and inefficient hospital admissions.

Background/objectives Nursing facility (NF) residents are commonly hospitalized, and many of these hospitalizations may be avoidable. A Centers for Medicare & Medicaid Services (CMS) initiative enables participating NFs to bill Medicare for providing on-site acute care to long-stay residents diagnosed with one of six ambulatory care sensitive conditions (pneumonia, congestive heart failure, chronic obstructive pulmonary disease, dehydration, skin infection, and urinary tract infection) that account for many avoidable hospitalizations. This study describes the frequency of initiative-related treatment for the six conditions, both on site and in the hospital, and the health status of residents who were treated. Design We used the Minimum Data Set V3.0 and Medicare data to identify eligible residents, detect on-site treatment under the initiative as well as in-hospital treatment both before and during the initiative, and measure health status. Setting Participating NFs during fiscal years 2017 to 2018. Participants There were 47,202 long-stay NF residents from 260 facilities in seven states. Intervention CMS initiative to reduce avoidable hospitalizations among NF residents-payment reform. Measurements Percentage per year who received on-site treatment (2017-2018), and who received in-hospital treatment (2014-2018), for the six conditions. Results Each year, approximately 20% of residents received treatment on site during 2017 to 2018, and under 10% received treatment in the hospital during 2014 to 2018, with little change over these years. Residents treated on site had less chronic illness than those treated in the hospital. Conclusion Although the initiative sought to reduce hospitalizations, in-hospital treatment for the six conditions did not substantially change after initiative implementation, despite substantial new billing for on-site treatment for those conditions. These findings suggest that many residents treated on site would likely not have been hospitalized even absent the initiative. The residents treated on site tended to have fewer chronic conditions than those treated in the hospital.

Background: Elderly patients who spend long periods hospitalized or those who are in a situation of institutionalization represent a risk group in this regard, as many of them suffer a degree of dependence and need help to perform the basic tasks of personal care. It is therefore important to learn more of the oral health status of this group of patients in order to make a proper assessment of the situation and to develop protocols for its management. The purpose of the study was to conduct a systematic review to ascertain the oral health status of elderly patients admitted to institutions or hospitalized for a long period of time.Methods: a systematic review of the literature published in two different databases (PubMed, Embase and Cochrane Library) was carried out, with 12 different combinations of keywords based on the following selection criteria: studies published in the last 5 years, in English and/or Spanish and/or Portuguese, with samples of ≥30 patients, performed in patients older than 65 years, admitted to any type of institution and/or hospital center for at least 7 days and in which the state of hard and/or soft tissues of the oral cavity were evaluated in some way. The selected articles were subjected to a thorough analysis.Results: The search strategy covered 1,014 articles: 689 from Pubmed and 325 from Cochrane Library. After applying the eligibility criteria, five articles were selected for our review. The level of evidence of the articles was3, a sample of 773 patients most of them were women with an average age older than 70 years old.Conclusions: the oral health of patients aged more than 65 is worse than that of the rest population. Long hospital stays or being institutionalized in a residence makes this group susceptible to a worsening of their oral health status. It is necessary to develop protocols for the oral health care of these patients, accompanied by training programs for the personnel responsible.

Objective We aimed to evaluate the impact of the European Medicines Agency (EMA) and Food Drug and Administration (FDA) alerts on the use of effective contraceptive method in women of childbearing age undergoing valproic acid treatment in a long-stay psychiatric center. Material and methods An interrupted time-series analysis of women of childbearing age admitted in a long-stay psychiatric center (2013–2019), according to the EMA/FDA restrictions dates (October 2014 and February 2018). Results Of the 82 cases included, 50 (61.0%) had an ‘off-label’ prescription. The percentage of cases with a contraceptive method before October 2014 (31.6%) increased to 61.5% after October 2014, p = 0.004. Women with an ‘off-label’ prescription after 2018 were more likely to use a contraceptive method than those before 2014, and there were not statistically significant differences in women with an ‘under indication’ prescription. Conclusions The recent regulatory restrictions on the use of a contraceptive method had a positive effect, mainly in women with an ‘off-label’ prescription. No effect was seen in women with epilepsy, probably because the intervention had started long before.

BACKGROUND/OBJECTIVES The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project is a successful, multicomponent demonstration project to reduce potentially avoidable hospitalizations of long-stay nursing facility residents. To continue to reduce hospital transfers, a more detailed understanding of these transfer events is needed. The purpose of this study was to describe differences in transfer events that result in treatment in the hospital versus emergency department (ED) only. DESIGN OPTIMISTIC project nurses collected data on residents who transferred. Transfer events that resulted in treatment in ED versus hospitalization were compared using t-tests and chi-square tests. A generalized estimating equations regression model was used to assess the associations between hospital admission and transfer characteristics. PARTICIPANTS A total of 867 long-stay nursing facility residents enrolled in OPTIMISTIC, January 2015 to June 2016. MEASUREMENTS Resident and transfer characteristics from Minimum Data Set and project REDCap (Research Electronic Data Capture) database, including demographics, cognitive status, comorbidities, symptoms at time of transfer, and diagnoses. RESULTS The most common symptoms associated with treatment in the ED only were falls, trauma, or fracture (38% vs 10% admitted). Residents with cognitive impairment were more likely to be admitted to the hospital (odds ratio (OR) = 1.47; 95% confidence interval (CI) = 1.09-1.98; P = .011). Residents with respiratory complaints were more likely to be admitted (OR = 2.098; 95% CI = 1.198-3.675; P = .009); residents with hematological/bleeding (nongastrointestinal) (OR = 0.23; 95% CI = 0.107-0.494; P = .0002), pain (OR = 0.421; 95% CI = 0.254-0.698; P = .0008), or fall/trauma/fracture (OR = 0.181; 95% CI = 0.12-0.272; P

Aggressive behaviour is highly prevalent in long-term psychiatric inpatient care. We aimed to estimate the overall incidence of aggression, the time staff took to handle aggression incidents, and the weighted average financial costs thereof. A random sampling procedure was conducted at long-term psychiatric inpatient care facilities. Nurses were asked to recall all incidents (i.e., verbal, physical towards objects, self, or others) of their shift. For the time spent on each type of incident, staff were monitored in real-time. Estimated costs were calculated by the time spent multiplied by hourly wages in addition to material-related costs. Incidence rates were 90 incidents per patient year. The average time spent per incident was 125 min but differed for each type of incident. Almost 80% of this time was consumed by nursing staff. The average cost per aggression incident was ���78; extrapolated per patient year, the total costs were approximately ���7000. The current study found a high rate of aggression incidents in closed long-stay psychiatric wards. Reports of aggression on these types of wards are scarce. Nevertheless, aggression seems to have a severe impact on invested time and related costs, which suggests a need for aggression-prevention and de-escalating programs.Key pointsAggression incidents are highly prevalent and are accompanied by high costs.The effect of aggression incidents on the workload for staff members is high, especially for nursing staff.Studies across countries on the incidence and the costs of aggression among psychiatric inpatients are needed to help model the effects of (new) strategies for aggression reduction. Aggression incidents are highly prevalent and are accompanied by high costs. The effect of aggression incidents on the workload for staff members is high, especially for nursing staff. Studies across countries on the incidence and the costs of aggression among psychiatric inpatients are needed to help model the effects of (new) strategies for aggression reduction.

BACKGROUND Long-stay nursing home (NH) residents are at high risk of having emergency department (ED) visits, but current knowledge regarding risk-adjusted ED rates is limited. OBJECTIVES To construct and validate 3 quarterly risk-adjusted rates of long-stay residents' ED use: any ED visit, ED visits without hospitalization or observation stay (outpatient ED), and potentially avoidable ED visits (PAED). RESEARCH DESIGN The authors calculated quarterly NH risk-adjusted ED rates from 2011 Q2 to 2013 Q3 national Medicare claims and Minimum Data Set data. Using random-effect linear regressions, the authors validated these rates against Nursing Home Compare overall 5-star quality ratings and examined their associations with hospitalization rates to provide a quality context. SUBJECTS Resident-quarter observations (7.3 million) from 15,235 unique NHs. RESULTS Risk-adjusted rates of any ED, outpatient ED, and PAED averaged 9.7%, 3.4%, and 3.2%, respectively. Compared with NHs with 1 or 2 stars overall rating, NHs with ≥3 stars were significantly associated with lower rates of any ED visit, outpatient ED, and PAED (β, -0.23%, -0.16%, and -0.11%, respectively; all P

Objective Succinct and timely discharge summaries (DSs) facilitate ongoing care for patients discharged from acute care settings. Many institutions have introduced electronic DS (eDS) templates to improve quality and timeliness of clinical correspondence. However, significant intrahospital and intraunit variability and application exists. A review of the literature and guidelines revealed 13 key elements that should be included in a best practice DS. This was compared against our pediatric institution's eDS template—housed within an integrated electronic medical record (EMR) and used across most inpatient hospital units. Methods Uptake and adherence to the suggested key elements was measured by comparing all DSs for long stay inpatients (> 21-day admission) during the first year of the EMR eDS template's usage (May 2016–April 2017). Results A total of 472 DSs were evaluated. Six of 13 key elements were completed in > 98.0% of DSs. Conversely, only Conclusion Uptake and adherence to an EMR eDS template designed to meet best practice guidelines in a pediatric institution was strong, although significant improvements in specific data elements are needed. Strategies can include a modification of existing eDS templates and junior medical staff education around best practice.

Long duration of hospitalisation has been associated with negative consequences of isolating the patients from their social network, initiating maladaptive patterns in the patients and worsening the burden of care on the relatives. In this particular study, we were interested in determining factors that correlate with length of stay on admission among in-patients receiving psychiatric services in North-Central Nigeria. The prospective study was part of a larger in-patients study conducted on 112 consenting patients admitted in the psychiatric wards of Benue State University Teaching Hospital Makurdi, Federal Medical Centre Makurdi and Jos University Teaching Hospital Jos during the study period. Patients who stayed on hospital admission for more than twenty-eight (28) days were classified as ‘long stay’, conversely, those who were discharged from admission after spending 28 days or less were referred to as ‘short stay’ patients. A total of 112 subjects were recruited for the study, 67(59.8%) were female while 45(40.2%) were male, the mean age was 36.98±11.09 years and 54(48.2%) subjects were still married at the time of the study. Forty-two representing 37.5% of the respondents stayed on admission for more than 28 days. The mean duration of stay was 28.8±24.5 days. Long duration of stay was found to be significantly associated with the quality of intimate partner relationship (p=0.001), years of completed education (p=0.021), age group (p=0.001), nature of psychiatric diagnosis (p=0.014), pharmacotherapy (p=0.001), comorbid physical condition (p=0.001), previous admission (p=0.001), defaulted treatment (p=0.001), frequency of previous episodes (p=0.001) and the number of years a patient has had the mental disorder (p=0.001). We concluded that, assessing duration of stay on admission among in-patients treatment for psychiatric disorders is very necessary.

BACKGROUND A significant percentage of patients admitted in the hospital for some other ailments for duration longer than their expectations may suffer from depression during their hospitalization. Aim of the study is to assess the prevalence of depression in patients hospitalized for long duration. MATERIALS AND METHODS Patients admitted in indoor wards of different departments of the hospital fulfilling selection criterion were recruited for the purpose of the study. The recruited persons who were likely to have to stay for 3 weeks or more were interviewed in detail at time of admission and after 3 weeks of hospitalization by using the special proforma prepared for the study and were administered Brief Assessment Scale (BAS) for Depression & Hamilton’s Depression Rating Scale (HDRS). The data collected from the patients was entered in Excel sheet & then tabulated and analysed. RESULTS Initially about 100 patients were recruited for the study; out of which 70 patients from different wards were admitted for 21 days or more. About 39 patients i.e. 55.71% were found to be suffering from depression at the end of 3 weeks of hospital stay as compared to just 12% at the time of admission. Also, the severity of depression found to be more in patients after 3 weeks of hospital stay. CONCLUSION This study shows us that depression can be a negative outcome of patients hospitalized for long duration. One needs to keep that in mind while treating patients on indoor basis.

IntroductionThe COVID-19 pandemic has required services to evolve quickly to continue routine care and telemedicine has been rapidly implemented to facilitate this. Older persons are at high risk of serious complications of COVID-19 and it is essential that their exposure to COVID-19 is minimized.ObjectivesOur aim was to assess staff and patient satisfaction with remote psychiatric assessments using mobile tablets in long-stay facilities.MethodsRemote clinics using Skype video on mobile tablets were conducted with patients in long-stay facilities attending psychiatry in rural North-West Ireland between April and July 2020. At each review, a satisfaction survey was administered to the patient, their keyworker and the clinician. The patient/keyworker survey instrument had four yes/no statements and the clinician survey had four statements with 5-point likert scale responses (1=very low to 5=very high). Open feedback was also obtained for thematic analysis. Descriptive analyses were completed using SPSS software.Results23 patients (mean age 80.9yrs) were assessed in 10 long-stay facilities. All patients were agreeable to participating in video consultation although only 13 patients were able to respond to survey due to cognitive impairment. There was a 92.3% positive patient response (12/13) and 95.7% positive keyworker response (N=22/23) for all statements. The mean score on the assessor response ranged from 3.43 to 4.04 with the lowest rate for quality of transmission. The main themes identified were related to the quality of connection and sensory difficulties.ConclusionsVideo consultations using mobile tablets offer an acceptable form of remote psychiatry assessment for older persons in long-stay facilities.

Este trabalho apresenta um relato de experiência essencialmente prática vivenciada por discentes de Terapia Ocupacional, em uma Instituição de Longa Permanência para Idosos (ILPI) no interior do Rio Grande do Sul. O objetivo foi a experienciação dos discentes na compreensão do vínculo e do contexto institucional. Esse trabalho reafirma a importância do vínculo entre profissional e paciente, para que a aderência às propostas terapêuticas tenha maior compreensão e acolhimento, atuando como facilitadores da funcionalidade do cotidiano dos pacientes.

Background Patients admitted to acute care hospitals may have multiple co-morbidities, and a small proportion may stay a protracted period. Aims To assess the proportion of hospital patients who are long stay (≥14 days), evaluate associations with baseline variables and subsequent in-patient morbidity and mortality. Methods Retrospective observational study of patients aged ≥ 18 years staying in hospital for at least 24 hr between 1-7-2013 and 30-6-2014. Results There were 22,094 admissions in 15,623 patients. The median (IQR) length of stay was 4 (2–8) days, and 10% had a length of stay > 16 days. Long stay admissions comprised 13.1% of admissions but used 49.1% of bed days. Long stay admissions were more likely to be associated with intensive care unit admission (21.2% vs 6.0%), medical emergency team review (20.5% vs 4.3%), and a longer duration of mechanical ventilation (p