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Introduction: Hospitalized people living with HIV (PLWH) experienced extremely high mortality rates in the first year after an index hospitalization in the pre-Dolutegravir (DTG) era. We conducted a multi-center study in Mwanza, Tanzania to (1) describe causes of hospitalization for PLWH on DTG; (2) determine in-hospital and 3-month post-hospital mortality; (3) examine factors associated with overall mortality; and (4) determine changes in trends and predictors of mortality pre- and post-DTG era. Methods: Between August 2020 and February 2021, hospitalized PLWH on dolutegravir-based antiretroviral therapy were enrolled and followed for three months after hospitalization. The primary outcome was mortality within 3-months of hospitalization. Cox regression analysis was used to calculate hazard ratios to identify predictors of mortality. Results: Of the 154 enrolled patients, the median [interquartile range] age was 42 [33–50] years and 57% were female. Suspected immune reconstitution inflammatory syndrome (IRIS) and antiretroviral therapy (ART) non-adherence leading to an HIV-associated admission were common. The overall all-cause mortality was 42%. Male sex, using DTG-based regimen for < 3 months, diagnosis of suspected IRIS, diagnosis of ART side effect, advanced WHO clinical stage, CD4 count < 200 cells/mm3, hemoglobin level 7–11.9 gm/dl and hemoglobin level < 7 gm/dl were all independent risk factors for death. Conclusion: In conclusion, the mortality rate of hospitalized PLWH in Africa remains high in the DTG era. Clinical trials are urgently needed to test novel interventions for improving survival in this high-risk group. In the meantime, hospital clinicians should be aware of the very high mortality among PLWH with IRIS and those with ART side effect to ensure that all possible diagnostic and therapeutic options are explored. [ABSTRACT FROM AUTHOR]

Background: This study aims to determine the efficacy and safety of preoperative embolization in the management of Shamblin type III carotid body tumors (CBT). Method: In this retrospective study, patients with Shamblin type III CBT were included between January 2005 and January 2017. A total of 48 Patients were divided into preoperative embolization (SRE, n = 25) and non-preoperative embolization group (SR, n = 23). Result: Mean surgical time (145.24 ± 19.86 min vs 186.91 ± 17.808 min, P < 0.05) and intraoperative blood loss (271.4 ± 73.001 mL vs 380.36 ± 39.822 mL, P < 0.05) were markedly reduced in the SRE group compared with SR group. The preoperative tumor volume in the SRE group was larger than that in the SR group, but the volume was similar between the two groups after surgery. The number of tumor residual cases was higher in the SR group. The incidence of complications and duration of hospitalization were comparable between the two groups. Conclusion: This study demonstrates the efficacy of preoperative embolization in reducing the duration of surgery and volume of blood loss during the process of CBT resection. More prospective, well-designed studies are urgently needed to validate the current findings. [ABSTRACT FROM AUTHOR]

This paper is an examination of the relationship between continuity of care with home health physical therapists following hospitalization and the likelihood of readmission. We conducted a retrospective cohort study. Using rehospitalization as the dependent variable, a continuity of care indicator variable was analyzed with a multivariable logistic regression. The indicator variable was created using the Bice-Boxerman Index to measure physical therapist continuity of care. The mean of the index (0.81) was used to separate between high continuity (0.81 or greater) of care and low continuity of care (lower than 0.81). The sample included 90,220 patients, with data coming from the linking of the Outcome Assessment and Information Set (OASIS) and an administrative dataset. All subjects lived in the NYC metro area. Inclusion criteria was a patient's admission to their first home health care site following discharge occurring between 2010 and 2015, and individuals who identified as Male or Female. In comparison to low continuity of physical therapy, high continuity of physical therapy significantly decreased hospital readmissions (OR = 0.74, 95% CI 0.71-0.76, p ≤.001, AME = −4.28%). Interpersonal continuity of physical therapy care has been identified as a key factor in decreasing readmissions from the home care setting. The research suggests an increased emphasis in preserving physical therapist continuity following hospitalization should be explored, with the potential to reduce hospital readmissions. [ABSTRACT FROM AUTHOR]

Objective: Observational studies show the correlation between COVID-19 and venous thromboembolism (VTE) risk. However, the causal effects remain uncertain. We aimed to explore the potential causal association between COVID-19 and VTE using Mendelian randomization (MR) design. Methods: Two-sample MR was used to evaluate the potential causality between COVID-19 and VTE by selecting single-nucleotide polymorphisms (SNPs) as instrumental variables (IVs) from genome-wide association studies (GWAS). The weighted median, MR-Egger, simple mode, and weighted mode were employed as supplementary methods for MR estimations, with the inverse-variance weighted (IVW) method serving as the principal analysis. In addition, we took sensitivity analyses, including Cochran's test, MR-Pleiotropy Residual Sum and Outlier (MR-PRESSO), and leave-one-out analysis to ensure that we obtained stable and reliable results. Results: Our study selected 26 COVID-19 severity, 31 COVID-19 hospitalization, and 13 COVID-19 susceptibility SNPs as instrumental variables. The IVW analysis results revealed that there was no causal relationship between COVID-19 severity, hospitalization, or susceptibility and VTE, with odds ratios of 0.974 (95%CI: 0.936-1.013, p = 0.19), 0.976 (95%CI: 0.918-1.039, p = 0.447), and 0.908 (95%CI: 0.775-1.065, p = 0.235), respectively. The IVW approach yielded consistent results with MR-Egger, Weighted Median simple mode, and weighted mode. MR-PRESSO and sensitivity analysis further confirmed the stability and consistency of the MR results. Conclusions: This study did not find evidence to support a causal relationship between COVID-19 and VTE at the genetic level. Further investigation is warranted to determine if the significant association reported in previous observational studies between the two is due to confounding factors. [ABSTRACT FROM AUTHOR]

Aims Sex-specific low flow was recently defined as stroke volume index (SVi) ≤ 40 mL/m² in men and ≤32 mL/m² in women. We tested the prognostic association of these cut-offs in patients with aortic stenosis (AS) with concordantly and discordantly graded AS [concordantly graded AS by energy loss (CGASEL) and discordantly graded AS by energy loss (DGASEL)] based on pressure recovery adjusted aortic valve area [energy loss (EL)]. Methods and results Data from 1351 patients with asymptomatic AS, peak jet velocity <4 m/s, and preserved left ventricular ejection fraction enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study were used. DGASEL was defined as EL <1.0 cm² with mean aortic gradient <40 mmHg and CGASEL as EL ≥1.0 cm² with mean aortic gradient <40 mmHg. Patients were further grouped into normal and low flow. The outcome was combined all-cause death and hospitalization for heart failure (HF). CGASEL with normal/low flow was present in 915/253 patients, and DGASEL with normal/low flow was present in 57/126 patients. During a median follow-up of 4.3 years, event-free survival was lower in patients with DGASEL irrespective of flow compared to CGASEL with normal flow (P < 0.05). In Cox regression analysis, DGASEL with normal or low flow were both associated with increased risk of all-cause death and hospitalization for HF after adjustment for age, sex, heart rate, randomized study treatment, hypertension, aortic valve replacement, and aortic valve calcification (P < 0.05). No survival difference was found between patients with normal vs. low flow within groups of DGASEL or CGASEL. Conclusion Identification of low flow by the proposed sex-specific thresholds of SVi needs more prognostic validation before application in clinical practice. ClinicalTrials.gov identifier NCT00092677. [ABSTRACT FROM AUTHOR]

Background: Dependence on gamma-hydroxybutyrate (GHB) is an emerging substance use disorder which can be life-threatening in overdose and withdrawal. The aim of this study was to describe rising GHB-related hospitalizations amidst the ongoing COVID-19 pandemic. Methods: A retrospective consecutive case series of adults admitted to hospitals in South Western Sydney Local Health District was identified with clinical coding of GHB-related disorder between March 20 2019 and March 20 2021. Morbidity outcomes and multivariable Kaplan–Meier survival analysis on length of hospital stay were described. Results: Sixty-nine of 84 included admissions, (82%) occurred in the 12 months following COVID-19 related border closure. Of 47 admissions for withdrawal, fifteen of 47 (32%) required intensive care, 6 (13%) intubation, 4 (9%) one-to-one ward observation, and 8 (17%) emergency calls for agitated delirium, fall, or seizure. Five cofactors were associated with longer hospital stay in the multivariable analysis: age 30 or older (p <.05), 6 months of regular GHB use (p <.01), and elective admission (p <.05), and diagnosis of psychosis rather than withdrawal (p <.05) or overdose (p <.001). Conclusions: Development of a validated GHB withdrawal severity scale based on these risk factors could help identify patients requiring close monitoring for complicated withdrawal and escalation of care. [ABSTRACT FROM AUTHOR]

Background: Since the declaration of the COVID-19 pandemic in March 2020 and throughout the health crisis, health authorities recommended restriction measures to minimize the risk of contagion and avoid the collapse of health centers. The restrictive health and safety measures conditioned the way in which patients were cared for, as well as their social and family life. The purpose of the study was to explore patients and caregivers' perception of family care and support during hospitalization in the context of the COVID-19 pandemic in a Manacor hospital. Method: From an interpretive phenomenological approach, data was collected through the first author's field diary and 30 semi-structured interviews with patients and family caregivers. Thematic analysis was used to identify themes and subthemes, and rigor was achieved through multiple coding and systematic comparisons. Results: The findings underscore the profound emotional toll that restrictive visitation policies during the pandemic took on patients and their family caregivers. Limited family support led to feelings of loneliness, isolation, and emotional distress among patients, exacerbating their vulnerability. Participants highlighted the critical role of family presence in improving emotional stability and physical recovery, hinting at the importance of fostering psychological resilience in healthcare settings. Additionally, the study revealed inconsistencies in the communication and dissemination of information, which aggravated stress and confusion among participants. Clear, consistent, and empathetic communication strategies were considered essential for patient care and satisfaction. Participants expressed gratitude toward healthcare professionals and advocated for a person-centered approach that addresses not only clinical, but also emotional and psychological needs. Conclusions: The study highlights the need to improve care for vulnerable populations, such as those at the end of life, to ensure dignified and compassionate care. It also points at the importance of post-discharge support for patients recovering from serious illnesses. The findings provide valuable information to improve person-centered care and the communication of future healthcare protocols amid health crises such as COVID-19. [ABSTRACT FROM AUTHOR]

Purpose: Health-related quality of life (HRQoL) is a key component of evaluating outcome after mild traumatic brain injury (mTBI). As outcome is heterogeneous following mTBI, it is relevant to examine individual differences in HRQoL. This study investigated whether multiple homogenous subgroups could be meaningfully identified, 10 weeks after hospitalised mTBI with systemic injury, on the basis of HRQoL profiles. Methods: Ninety-one adults were assessed for HRQoL, pain, fatigue, sleep quality, psychological distress, cognition and post-concussion symptoms. Results: Cluster analyses revealed three separate subgroups based on physical, mental, social and energy HRQoL. One group (42%) demonstrated normative levels of HRQoL on all subdomains. The remaining two groups demonstrated significantly reduced HRQoL on all subdomains. These groups had equivalently poor mental, social and energy HRQoL, but the smallest group (27%) had significantly poorer physical HRQoL. Multinomial logistic regression revealed that pain significantly and independently predicted group membership for the particularly poor physical HRQoL group. Fatigue was the only significant independent predictor of group membership for the remaining group with reduced HRQoL. Conclusion: These findings suggest more than 50% of hospitalised individuals with mTBI and systemic injury, have reduced HRQoL, 10 weeks after mTBI. Pain and fatigue warrant clinical attention in these individuals. IMPLICATIONS FOR REHABILITATION: Mild traumatic brain injury is a common event that has been shown to be associated with persistently reduced health-related quality of life in approximately 50% of individuals 6 to 12 months after injury. Health-related quality of life likely varies between individuals after injury Relative to the "normal" population, most individuals in this cohort of individuals with mTBI and systemic injury had reduced mental, social and energy quality of life 10 weeks after injury. Fatigue and pain are important factors in reduced health-related quality of life after mTBI with systemic injury. Further research is needed to determine whether these fatigue and pain issues are related to mTBI-factors, such as headache, and/or related to systemic injury factors, which are common in the mTBI population. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the implementation of a self-management program, My Therapy, designed to increase inpatient rehabilitation therapy dosage via independent practice. Materials and methods: A process evaluation of My Therapy for adult patients admitted for rehabilitation for any condition supervised by physiotherapists and occupational therapists across eight rehabilitation wards compared usual care. Outcomes included reach, dosage, fidelity and adaptation. Results: The mean (SD) age of the process evaluation sample (n = 123) was 73 (11) years with a mean (SD) length of stay of 14.0 (6.6) days. The My Therapy program reached 68% of participants (n = 632/928), and resulted in an average increase in therapy dosage of 26 (95% CI 12 to 40) minutes/day of independent practice. All My Therapy audited programs (n = 28) included body function/structure impairment-based exercises, and half (n = 13/28) included activity/participation-based exercises. On average, participants completed programs 1.8 (SD 1.2) times/day, which were prescribed in accordance with the My Therapy criteria, demonstrating fidelity. There were no between-group differences in daily steps or standing time, however, My Therapy participants spent more time sitting (p ≤ 0.05). Implementation adaptations were minimal. Conclusion: A self-management rehabilitation program was implemented with fidelity for two in three rehabilitation patients, resulting in increased therapy dosage with minimal adaptations. IMPLICATIONS FOR REHABILITATION: The My Therapy self-management program was implemented with good reach (68% of participants received My Therapy) across four public and private inpatient rehabilitation services. Under My Therapy conditions, the dosage of inpatient rehabilitation therapy participation increased by an average of 26 minutes per day, which will help close the evidence-practice gap between the current rehabilitation dosage of about 1-hour per day, and the recommended rehabilitation dosage of 3-hours per day. My Therapy programs most frequently included impairment-based exercises that were completed in sitting, and did not increase time spent standing and walking. Consideration should be given to prescribing My Therapy (content and dosage) at an optimal level to promote patient functional independence, while maintaining safety. [ABSTRACT FROM AUTHOR]

Background: Epilepsy is a common neurological disorder in children, associated with significant morbidity and socioeconomic burden. The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare delivery, potentially exacerbating seizure control among pediatric epilepsy patients. This study aimed to evaluate the pandemic's impact on seizure characteristics and identify risk factors contributing to seizure exacerbation in children with epilepsy. Methods: A retrospective cohort study was conducted using medical records of 84 pediatric epilepsy patients at The Catholic University of Korea Yeouido St. Mary's Hospital from July 2019 to July 2022. Data were collected on demographics, epilepsy characteristics, and healthcare accessibility. Changes in seizure outcomes were analyzed alongside potential risk factors, including infections and socioeconomic variables. Statistical analyses assessed correlations between these factors and seizure exacerbations. Results: Among the 84 pediatric epilepsy patients, 25% experienced significant seizure exacerbations during the COVID-19 pandemic. These included increased seizure frequency (18%), prolonged duration (13%), emergence of new seizure types (4%), and status epilepticus requiring hospitalization (5%). Multivariate analysis identified recent epilepsy diagnosis (<1 year) and low socioeconomic status as independent predictors of seizure worsening (p < 0.05). Infections with non-COVID-19 respiratory viruses, such as RSV and influenza, were strongly associated with exacerbated seizure activity (p < 0.001). Dissatisfaction with access to epilepsy care further increased the risk of poor seizure control, reflecting the challenges posed by disrupted healthcare systems. Notably, no significant relationship was observed between SARS-CoV-2 infection and seizure outcomes, suggesting that indirect factors, rather than direct viral effects, were primary contributors to seizure exacerbation. Conclusions: This study highlights the compounded impact of disrupted healthcare access, socioeconomic challenges, and respiratory viral infections on seizure control during the COVID-19 pandemic. Strategies such as telehealth expansion, regular monitoring, and vaccination against respiratory pathogens are essential to optimize seizure management in future health crises. [ABSTRACT FROM AUTHOR]

Objectives: This study identified profiles of outpatient physician follow-up care and other practice features, mostly after detection of incident mental disorders (MD), and associated these profiles with patient characteristics and subsequent adverse outcomes. Methods: A cohort of 170,957 patients age 12 + with a new or recurrent MD detected in 2019-20 was investigated based on data from the Quebec Integrated Chronic Disease Surveillance System. Latent class analysis was performed to identify follow-up care profiles, mostly within one year of MD detection. Bivariate analyses tested associations between profiles and patient characteristics; logistic regressions examined relationships between profiles and adverse outcomes after one year. Results: Five profiles were identified: Profiles 2 and 5 (64%) offered low mental health (MH) outpatient follow-up care, while the others dispensed higher MH follow-up care. Profiles differed in patient characteristics and related outcomes. Labelled "Follow-up care by usual psychiatrist", Profile 1 (1% of sample) included younger patients with the most health and social issues. Profile 2 (50%), "Low MH follow-up care but high prior consultations for physical reasons", mostly integrated older patients with chronic physical illnesses. Profile 3 (11%), "Follow-up care by general practitioners (GP) and psychiatrists", referred to physicians other than the usual ones (e.g., walk-in practice) and encompassed patients with severe MD conditions. Profile 4 (23%), "High follow-up care by usual GP and prior consultations for physical reasons", showed the typical characteristics of patients treated in primary care (more common MD, women, less materially and socially deprived). Profile 5 (15%), "Low MH follow-up care and prior consultations for physical reasons", integrated more younger men, materially deprived patients, and with substance-related disorders (SRD) or co-occurring MD-SRD. More Profile 1 and 3 patients lived in university regions – those of Profile 4 were the least numerous in such regions. More Profile 5 patients lived in metropolitan and rural areas. Risk of death was higher in Profiles 5, 2, 3, and risk of frequent ED use and hospitalization higher in Profiles 1, 3, and 5 – patients with severe health and social issues. Conclusion: The study confirmed the need to improve prompt, adequate and continuous follow-up care for patients with incident MD. [ABSTRACT FROM AUTHOR]

Introduction: Nondilated left ventricular cardiomyopathy (NDLVC) is a newly defined category of cardiomyopathy. We sought to evaluate and compare the phenotype of NDLVC with DCM using cardiac magnetic resonance (CMR) imaging and to investigate the prognostic significance of these conditions. Methods: One hundred and fifty patients suspected of having cardiomyopathy referred for CMR were recruited. We considered 3 groups; Group 1: NDLVC‐reduced EF, (NDLVC‐REF), LVEF ≤ 40%, Group 2: NDLVC‐mildly reduced EF(NDLVC‐MREF), 40 < LVEF < 50, Group 3: Dilated cardiomyopathy (DCM). All selected patients were followed up for a median of 24 months to determine the composite cardiac endpoint consisting of mortality and/or hospitalization for cardiovascular reasons (composite cardiac event (CCE)) as the primary endpoint. Results: The mean age (SD) was 42.6 (13.7) years (range: 18–77 years). There was no association between the presence of myocardial LGE and the development of atrial and/or ventricular arrhythmias. Atrial fibrillation was most common in the NDLVC groups during the follow‐up period. Myocardial late gadolinium enhancement (LGE) was also more pronounced in the DCM group. Most patients in the NDLVC groups had no LGE. LGE in the midwall was the most common LGE pattern in all three groups and the septal wall was the most commonly affected area of the LV. There was no significant difference between the CMR findings of patients with and without CCE in each subgroup. However, the presence of myocardial replacement fibrosis was higher in patients with a CCE in total study population, (n = 144, 68% versus 32%, p = 0.03), but the difference was not significant in subgroup analyzes. Conclusion: NDLVC has a relatively good prognosis in recent times. The consideration of NDLVC in a spectrum with DCM can be reasonable. However, the prognostic risk factors need to be investigated in more detail. [ABSTRACT FROM AUTHOR]

Purpose: Eosinophilic esophagitis (EoE), a chronic immune-mediated progressive disease, causes dysphagia, food impaction, abdominal pain, vomiting, and heartburn. EoE requires long-term monitoring and can affect quality of life owing to its symptoms and associated emotional and social burden. This study aimed to understand patients' experiences with EoE. Methods: Semi-structured longitudinal interviews were conducted with patients from MESSINA, a phase 3 placebo-controlled trial evaluating benralizumab for EoE. Interviews were held at two different times to assess the impact of EoE on patients' lives before and during trial participation. Data were analyzed qualitatively to develop detailed patient profiles. Results: The MESSINA trial was terminated prematurely. Of the 34 patients recruited for the first interview, 15 (44%) completed the second interview and 11 patient profiles were developed. Patients were a demographically diverse group with varying experiences. The primary reported symptom was difficulty swallowing (n = 11), leading to serious consequences like choking and hospitalization (n = 2). Other symptoms included pain when swallowing (n = 7), reflux (n = 6), and stomachache (n = 6). In the second interview, most (n = 9) patients reported moderate improvements in symptoms, while others experienced symptom recurrence or worsening. EoE had a significant negative impact on social and emotional well-being, and professional lives. Trial participation improved emotional well-being for some; however, concerns about the need for ongoing treatment were noted. Conclusion: This study highlighted emotional and social burdens of EoE. The encouraging feedback on study participation underscores the importance of patient insights in developing holistic management strategies for EoE. [ABSTRACT FROM AUTHOR]

This study investigated inpatient acceptance of a unique telemedicine clinical service piloted from December 2022 to June 2025 in 3 rural acute wards in Victoria, Australia. The use of virtual care was complementary to the visiting general practitioner (GP) model common in rural hospitals. The qualitative study employed 3 researcher-designed questions: Did you feel safe using the virtual healthcare doctor?; Did you feel the care you experienced was as it should be? And; If you were offered virtual care again, would you use it? Participants (n = 38) were predominantly over 65 years (95%). Findings describe safe care as being able to understand the virtual doctor, be listened to, and ask questions. Participants affirmed that the care experienced was helpful due to prompt in-hospital clinical interventions organized by the virtual weekend coverage. Most were first-time users of virtual care and recognized that rural doctors need a break. Barriers to acceptance of the service were concerns about the loss of in-person visits with their local doctor and that virtual care could replace local GPs. [ABSTRACT FROM AUTHOR]

Introduction: Clinicians are the conduits of high-quality care delivery. Clinicians have driven advancements in pharmacotherapeutics, devices, and related interventions and improved morbidity and mortality in patients with congestive heart failure over the past decade. Yet, the management of congestive heart failure has become extraordinarily complex and has fueled recommendations from the American Heart Association and the American College of Cardiology to optimize the composition of the care team to reduce the health, economic, and the health system burden of high lengths of stay and hospital charges. Therefore, the purpose of this study was to identify the extent to which specific care team configurations were associated with high length of stay and high-charge hospitalizations of patients with congestive heart failure. Methods: This study performed a retrospective analysis of data extracted from the electronic health records of 3,099 patients and their hospitalizations from the Arkansas Clinical Data Repository. The data was analyzed using binomial logistic regression in which adjusted odds ratios reflected the association of specific care team configurations (i.e., combination of care roles) with length of stay and hospital charges. Results: Team configurations that included a nurse practitioner, registered nurse, care manager, and social worker were generally above the median length of stay and median charges when compared to team configurations that did not collectively include all of these roles. Patients with larger configurations (i.e., four or more different care roles) had higher length of stays and charges than smaller configurations (i.e., two to three different care roles). The results also validated the Van Walraven Elixhauser Comorbidity Score by finding that its quartiles were associated with length of stay and charges, an indicator of care demand based on patient morbidity. Conclusions: Cardiologists, alone, cannot shoulder the burden of improving patient outcomes. Care team configuration data within electronic health record systems of hospitals could be an effective method of isolating and tracking high-risk patients. Registered nurses may be particularly effective in advancing real-time risk stratification by applying the Van Walraven Elixhauser Comorbidity Score at the point of care, improving the ability of health systems to match care demand with workforce availability. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease is on the rise globally, with ischemic heart disease being the leading cause of mortality and morbidity. While sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to improve cardiovascular outcomes in patients with heart failure, evidence is limited in guiding initiation in post-acute myocardial infarction (post-AMI) patients. Hence, this study aimed to appraise the current literature on the effect of SGLT2i on the clinical outcomes of post-AMI patients. Methods: A comprehensive search of PubMed, EMBASE, SCOPUS, and ClinicalTrials.gov was conducted up to 1 May 2024. Only randomized controlled trials studying the use of SGLT2i in post-AMI patients were included. We included adult patients aged 18 years old and older diagnosed with AMI and initiated on SGLT2i in the acute post-AMI setting. SGLT2i studies solely in heart failure settings were excluded. Results: Eight clinical trials were included in the systematic review, comprising 11,436 patients. Compared with placebo, SGLT2i initiation in post-AMI patients significantly reduced total number of heart failure hospitalizations (risk ratio [RR] 0.74, 95% confidence interval [CI] 0.62–0.90) and was associated with a lower N-terminal pro-B-type natriuretic peptide (NT-proBNP) level (− 26.67 pg/ml, 95% CI − 41.74 to − 11.59). There was no difference in all-cause mortality (RR 1.02, 95% CI 0.81–1.28), cardiovascular mortality (RR 1.03, 95% CI 0.83–1.28), change in left ventricular ejection fraction, and glycated hemoglobin (HbA1c), as compared with placebo. Conclusion: SGLT2i use in patients with AMI was associated with a reduction in heart failure hospitalizations and a decrease in NT-proBNP. There were no significant differences in mortality outcomes. Registration: PROSPERO identifier number CRD42024540843. [ABSTRACT FROM AUTHOR]

Background: One of the challenges when transitioning from International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) to International Classification of Diseases, 11th Revision (ICD-11) is to ensure clinical coding accuracy. Objective: To determine the accuracy of clinical coding with ICD-11 in comparison with ICD-10 and identify causes of coding errors in real clinical coding environments. Method: The study was conducted prospectively in two general hospitals. Medical records of discharged inpatients were coded by hospital clinical coders with both ICD-11 and ICD-10 on different days. These medical records were recoded by five mentors. Codes assigned by mentors were used as the gold standard for the evaluation of accuracy. Results: The accuracy of ICD-10 and ICD-11 coding for 1578 and 2168 codes was evaluated. Coding accuracy was 89.1% and 74.2% for ICD-10 and ICD-11. In ICD-11, the lowest accuracy was observed in chapters 22 (injuries), 10 (ear) and 11 (circulatory) (51.1%, 53.8% and 62.7%, respectively). In both ICD-10 and ICD-11, the most important cause of the coding errors was clinical coders' mistakes (79.5% and 81.8% for ICD-10 and ICD-11, respectively). Conclusion: Accuracy of clinical coding with ICD-11 was lower relative to ICD-10. Hence, it is essential to carry out initial preparations, particularly the training of clinical coders based on their needs, as well as the necessary interventions to enhance the documentation of medical records according to ICD-11 before or simultaneous with the country-wide implementation. Implications: Clinical coders need complete training, especially in using extension codes and post-coordination coding. Local ICD-11 guidelines based on the needs of local users and reporting policies should be developed. Furthermore, documentation guidelines based on ICD-11 requirements should be developed. [ABSTRACT FROM AUTHOR]

Background: The severe health challenge and financial burden of drug-resistant tuberculosis (DR-TB) continues to be an impediment in China and worldwide. This study aimed to explore the impact of Diagnosis-related group (DRG) payment on medical expenditure and treatment efficiency among DR-TB patients. Methods: This retrospective cohort study included all DR-TB patients from the digitized Hospital Information System (HIS) of Wuhan Pulmonary Hospital and the TB Information Management System (TBIMS) with completed full course of National Tuberculosis Program (NTP) standard treatment in Wuhan from January 2016 to December 2022, excluding patients whose treatment spanned both before and after the DRG timepoint. These patients are all receiving standardized treatment specified by the NTP in designated tuberculosis hospitals. We performed the difference-in-differences (DID) model to investigate 6 primary outcomes. The cost-shifting behaviors were also examined using 4 outpatient and out-of-pocket (OOP) indicators. In the DID model, the baseline period is set from January 2016 to December 2020 before the DRG payment reform, while the treatment period is from January 2021 to December 2022. The payment reform only applied to individuals covered by Wuhan Municipal Medical Insurance, so the treatment group consists of patients insured by this plan, with other patients serving as the control group. Results: In this study, 279 patients were included in the analysis, their average treatment duration was 692.79 days. We found the DRG payment implementation could effectively reduce the total medical expenditure, total inpatient expenditure, and inpatient expenditure per hospitalization by 28636.03RMB (P < 0.01), 22035.03 RMB (P < 0.01) and 2448.00 RMB (P < 0.05). We also found a reduction in inpatient frequency and inpatient length of stays per hospitalization by 1.32 and 2.63 days with significance. The spillover effects of the DRG payment on outpatient and OOP expenditure were statistically insignificant. Conclusions: The DRG payment method can effectively control the increase of DR-TB patients' medical expenditure and improve treatment efficiency with the guarantee of care quality. Furthermore, there was no evidence of spillover effects of DRG payment on outpatient and out-of-pocket expenditures. [ABSTRACT FROM AUTHOR]

Aim: This study explored the impact of different care modes on the outcome of hospitalized patients with acute ischaemic stroke (AIS) during hospitalization and 3 months after discharge. Methods: This was a prospective cohort study comparing the outcomes at hospitalization, at discharge, and at 3 months post discharge among AIS patients with different caregiving arrangements from 9, December 2022 to 20, August 2023. The general information questionnaire, Modified Barthel Index, Shortened General Comfort Questionnaire, Perceived Social Support scale, Herth Hope Index, modified Rankin scale and EQ‐5D‐5L were utilized for the investigation. Results: The psychological evaluation scores during hospitalization, including comfort, perceived social support, and hope, did not significantly differ between the two groups of AIS patients (p >.05). Moreover, there were no significant impacts observed in terms of length of stay (LOS) at the hospital or hospitalization expense (p >.05). The proportion of patients with intact functionality was greater in the family caregiver group 3 months after discharge (16.5%). However, when stratified based on prognosis, the difference in outcomes between the two groups of patients did not reach statistical significance (p >.05). The analysis of ADL, quality of life and stroke recurrence in 276 surviving ischaemic stroke patients 3 months post discharge indicated no differences between the two groups across all three aspects (p >.05). Conclusion: Older and divorced or widowed AIS patients tend to prefer professional caregivers. The psychological state during hospitalization, length of hospital stay and hospitalization expenses are not influenced by the caregiving model. Three months post discharge, a greater proportion of patients in the family caregiving group had intact mRS functionality, but this choice did not impact patient prognosis, stroke recurrence, quality of life or independence in ADL. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the frailty status of inpatients with chronic heart failure (CHF) and analyse its influencing factors, so as to provide evidence for the early identification of high‐risk groups and frailty management. Background: Early identification of frailty can guide the development and implementation of holistic and individualized treatment plans. However, at present, the frailty of patients with CHF has not attracted enough attention. Design: A cross‐sectional study. Methods: From June 2022 to June 2023, a convenience sample of 256 participants were recruited at a hospital in China. Multivariate logistic regression analysis was used to explore the influencing factors of frailty in patients with CHF, and an ROC curve was drawn to determine the cut‐off values for each influencing factor. STROBE checklist guides the reporting of the manuscript. Results: A total of 270 questionnaires were sent out during the survey, and 256 valid questionnaires were ultimately recovered, resulting in an effective recovery rate of 94.8%. The incidence of frailty in hospitalized patients with CHF was 68.75%. Multivariable logistic regression analysis showed that age, self‐care ability, nutritional risk, Kinesiophobia and NT‐proBNP were risk factors for frailty, while albumin and LVEF were protective factors. Conclusion: Multidimensional frailty was prevalent in hospitalized patients with CHF. Medical staff should take measures as early as possible from the aspects of exercise, nutrition, psychology and disease to delay the occurrence and development of frailty and reduce the occurrence of clinical adverse events caused by frailty. Relevance to Clinical Practice: This study emphasizes the importance of the early identification of multidimensional frailty and measures can be taken to delay the occurrence and development of frailty through exercise, nutrition, psychology and disease treatment. Patient or Public Contribution: Patients contributed through sharing their information required for the case report form and filling out questionnaires. [ABSTRACT FROM AUTHOR]

Aims: To investigate the prevalence of anxiety and depression symptoms in intensive care unit (ICU) patients with cardiovascular disease (CVD) and to explore which elements are risk factors for the development of anxiety and depression symptoms. Design: A cross‐sectional study. Methods: A total of 1028 ICU patients with CVD were enrolled in this cross‐sectional study. Logistic regression was used to assess risk factors and associations between anxiety and depression symptoms, and mediation analysis was used to explore the effect of risk factors on the association between anxiety and depression symptoms. Reporting of the study followed the STROBE checklist. Results: The results showed that among ICU patients with CVD, 38.1% had anxiety symptoms, 28.7% had depression symptoms and 19.3% had both anxiety and depression symptoms, and there was a significant association between anxiety and depression symptoms. We also identified female gender, hypertension, hyperlipidemia and cardiac function class IV as independent risk factors for anxiety and depression symptoms. Importantly, these factors also mediated the association between anxiety and depression symptoms, emphasising their role in the psychological well‐being of this patient group. Conclusion: ICU patients with CVD were prone to anxiety and depression symptoms. Female gender, hypertension, hyperlipidemia and cardiac function class IV were identified as independent risk factors that also served as mediators in the relationship between anxiety and depression symptoms. Especially, cardiac function class IV emerged as a critical factor in this association. Relevance to Clinical Practice: It is imperative for critical care professionals to recognize the elevated risk of depression and anxiety among ICU patients with severe CVD, especially those with cardiac function class IV, hypertension, hyperlipidemia and females. Proactive and supportive measures are essential for this vulnerable group during their ICU stay to safeguard their mental health and prevent negative outcomes. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Objective: To identify associations between inpatient hospital design features and empirical patient clinical outcomes as well as changes over time. Background: A growing body of literature has emerged evaluating the association of hospital design features with measurable clinical outcomes during inpatient hospital admissions. However, there has been limited effort to evaluate the scope and quality of studies examining individual, inpatient hospital design features on empirical patient clinical outcomes. Methods: Primary research articles published in English between 1980 and 2021 evaluating inpatient clinical outcomes were included. Key terms for hospital designs and clinical outcomes were used. Ovid Medline, Embase, CINAHL, Web of Science, Scopus, Cochrane Library, Elsevier Embase, and Google Scholar were searched on May 28, 2021. Data were independently extracted by two authors, with arbitration from the third author. Results: Forty-six research articles were included for analysis. Predominantly studied inpatient hospital design features included: single versus multibedded rooms/wards, windows, furnishings, installed lighting, ward size and spatial arrangement, noise level, air ventilation, and patient visibility. Although nearly half (43%) of the articles lack appropriate methods to account for residual confounding, a trend of improvement in the use of appropriate methods was identified with 68% of studies in the last decade having appropriate methods. Studies demonstrating positive associations were more likely to be cited than those with negative associations (average citation per article, 508 vs. 27). Conclusion: Our study demonstrates the use of empirical patient clinical outcomes as a feasible approach to evaluate hospital design features, and identified an incremental improvement in the methods being applied. [ABSTRACT FROM AUTHOR]

Background: Prader–Willi syndrome (PWS) is a genetic disorder characterised by hyperphagia, intellectual disability and increased propensity to a range of medical disorders. To better characterise the clinical presentation of PWS across the lifespan, this study reports on the demographics and clinical diagnosis of individuals with PWS hospitalised in the United States. Methods: The National Inpatient Sample, an all‐payor administrative claims database of hospitalisations in the United States, was queried for patients with a coded diagnosis of PWS from October 2019 through December 2021. Hospitalisations for patients with PWS were matched to five non‐PWS hospitalisations based on age, sex, year and hospital characteristics. Results: There were 4400 (95% CI: 3,885 to 4,915) PWS hospitalisations, with a median age of 24. Compared to controls, PWS hospitalisations had longer hospital stays (median 5 vs. 3 days) and higher in‐hospital mortality (2.2% vs. 1.3%). Infectious (19.0%) and respiratory (16.2%) diagnoses were most common for PWS patients. Codes for overweight or obesity were present in 38.1% of PWS hospitalisations, with Hispanic ethnicity was associated with a higher odds of overweight/obesity in PWS patients (aOR 1.73; 95% CI: 1.11–2.71). Conclusions: PWS hospitalisations are characterised by higher healthcare utilisation and complexity compared to matched controls. The high prevalence of obesity and significant rates of infectious and respiratory conditions highlight specific health challenges for PWS patients. Validation of the Q87.11 administrative claims code is an essential step for ongoing health services research in this condition. [ABSTRACT FROM AUTHOR]

Aims: This study aims to investigate the epidemiological characteristics of COVID‐19 infection among healthcare workers, including the severity, duration of infection, post‐infection symptoms and related influencing factors. Methods: A self‐administered questionnaire was utilized to assess the post‐infection status of primary healthcare workers in Jiangsu Province. The questionnaire collected information on demographic characteristics, lifestyle habits, post‐infection clinical manifestations, work environment and recovery time of the respondents. Customized outcome events were selected as dependent variables and logistic regression models were employed to analyse the risk factors. Phi‐coefficient was used to describe the relationship between post‐infection symptoms. Results: The analysis revealed that several factors, such as female, older age, obesity, previous medical history, exposure to high‐risk environments and stress, were associated with a higher likelihood of experiencing more severe outcomes. On the other hand, vaccination and regular exercise were found to contribute to an earlier resolution of the infection. Among the post‐infection symptoms, cough, malaise and muscle aches were the most frequently reported. Overall, there was a weak association among symptoms persisting beyond 14 days, with only cough and malaise, malaise and dizziness and headache showing a stronger correlation. Conclusion: The study findings indicate that the overall severity of the first wave of infection, following the complete lifting of restrictions in China, was low. The impact on primary healthcare workers was limited, and the post‐infection symptoms exhibited similarity to those observed in other countries. It is important to highlight that these conclusions are specifically relevant to the population infected with the Omicron variant. Impacts: This study helps to grasp the impacts of the first wave of COVID‐19 infections on healthcare workers in China after the national lockdown was lifted. Patients: Primary healthcare workers in Jiangsu Province, including doctors, nurses, pharmacists and other personnel from primary healthcare units such as community health service centres and health centres. [ABSTRACT FROM AUTHOR]

Objectives: Coordinated care plans (CCPs) for high-cost health care system users aim to improve system-level performance. We evaluated health care resource use and costs among CCP patients (enrollees) versus a control group that did not receive coordinated care (comparators) in Southeastern Ontario. Methods: A difference-in-differences analysis of a quasi-experimental, double propensity score-matched and adjusted cohort was conducted. Linked population-based administrative data were used to measure health care utilization and costs and to identify comparators for two enrollee groups who began CCPs between April 1, 2013, and March 31, 2019. Enrollees were recruited from hospitals in Quinte or community care centres in Rural Hastings/Thousand Islands, and were 1:1 propensity score matched to comparators. Difference-in-differences estimates were calculated using generalized estimating equations for hospitalization rates, homecare visits, primary care visits, other health care resources and total costs. Results: A total of 558 enrollees in Quinte and 538 in Rural Hastings/Thousand Islands were identified and matched to comparators. Difference-in-differences estimates were significant in both enrollee groups for number of homecare visits ([IRR 1.72; 95% CI (1.44, 2.06)] and [IRR 1.73; 95% CI (1.45, 2.06)], respectively). Number of primary care visits were 1.76 times greater for Rural Hastings/Thousand Islands enrollees versus comparators [IRR 1.76; 95% CI (1.32, 2.35)]; total costs increased by 23% ([IRR 1.23; 95% CI (1.09,1.39)]. Conclusions: Homecare use significantly increased for enrollees versus comparators, indicating specific priority areas of Ontario CCPs were met. However, no reductions were shown for other health system performance indicators. We also showed increased 7-day primary care follow-up visits for community care centre-recruited patients, but not for hospital-recruited patients. Decision-makers may wish to target patients who are less advanced in their chronic disease trajectory. [ABSTRACT FROM AUTHOR]

Intrahospital transport of critically ill patients for diagnostic or therapeutic procedures can be compromised by patient instability, equipment problems or inexperienced teamworking. This quasi-experimental study aimed to assess the effectiveness of an in-situ interprofessional simulation-based training (IIST) model for junior member transport teams. Newly registered postgraduate physicians, nurses and respiratory therapists underwent the IIST. The technical skills (TS) of each participant and non-technical skills (NTS) of each interprofessional team were assessed using well-validated checklists. Thirty-six participants enrolled and were randomly assigned to six experimental and six control teams. Most participants achieved a significantly higher level of both TS and NTS. Both the control and experimental teams overvalued their NTS in the pretest, while the posttest self-assessment scores among the experimental groups more closely matched the expert assessments. Despite challenges in scheduling and the setting, the IIST was successfully conducted in a crowded hospital, which enabled trainees to optimize their learning in a real-life environment. In conclusion, the IIST model can facilitate the development of both TS and NTS for transport team members. Transport teams made up of newly registered staff from different disciplines may lack insight into their NTS in critical patient transfer management, but simulation training may cause improvements. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Type 1 diabetes is an autoimmune disease that destroys insulin-producing cells in the pancreas. Education is the cornerstone of effective diabetes care. In this implementation project, we aimed to improve compliance with best practices regarding type 1 diabetes educational interventions for adult hospitalized patients. Methods: This project was guided by the JBI Evidence Implementation Framework. A baseline audit was conducted involving 20 nurses and 20 type 1 diabetes patients who received regular educational measures. Areas of non-compliance were identified and an improvement strategy was implemented. A follow-up audit was then conducted to evaluate the effectiveness of the improvement strategy. The project was conducted in Poland in 2021 in a tertiary referral unit that specializes in the diagnosis and treatment of diabetes. Results: Substantial improvements were noted for all audit criteria after the implementation of strategies to address areas of non-compliance. Use of the education program improved from 0% to 100%. Compliance regarding patients receiving handouts and personalization of the program increased to 100%. We observed a significant improvement from 0% to 80% in the structuring of the program content. Conclusions: This project successfully improved the quality of education provided for type 1 diabetes patients in all relevant areas. We devised an education program, covering important aspects of diabetes education, with the patients reporting increased satisfaction with the personalized educational measures during their hospital stay. http://links.lww.com/IJEBH/A215 [ABSTRACT FROM AUTHOR]

Goals: Advance care planning (ACP) procedure codes have been established to reimburse meaningful care goal discussions; however, the utilization frequency of these codes in neurological disease is unknown. The objective of this study is to identify the association between ACP codes and healthcare utilization in chronic neurodegenerative diseases. Methods: This is a multicenter cohort study using real-world electronic health data. Using the TriNetX database, we collected electronic health data from 92 institutions in the United States. We included patients aged 65 and older who had been diagnosed with one of four neurological diseases: Alzheimer's disease, Parkinson's disease, multiple sclerosis, or amyotrophic lateral sclerosis (ALS). Patients with congestive heart failure were included as a reference. From the 64,683,009 total patients in the database, 877,138 had Alzheimer's disease, 544,610 had Parkinson's disease, 208,341 had multiple sclerosis, 9,944 had amyotrophic lateral sclerosis, and 1,500,186 had congestive heart failure. For each disease, we compared hospitalizations and emergency department (ED) visits over a two-year period between patients with and without ACP codes documented. Then, in patients with ACP, we investigated the rates of hospitalizations and ED visits over the two years before ACP and two years after ACP to understand the impact of ACP on the healthcare utilization trend. All patients had records for at least two years after index. Principal Findings: The rate of ACP code documentation ranged from 1.8% of multiple sclerosis patients to 3.6% of Alzheimer's disease patients. After matching for demographic and health variables, usage of ACP codes was associated with significantly fewer hospitalizations for Alzheimer's disease patients. Across all diseases, there was a 20% to 30% decrease in ED visits, which was significant. Furthermore, there was a significant change in the trend of hospitalizations and ED visits for patients after ACP documentation. Patients went from increasing utilization before ACP documentation to decreasing utilization after documentation. Practical Applications: ACP billing codes are used infrequently in neurological disease, which may indicate that reimbursement alone is not sufficient to drive code usage. Usage of ACP billing codes was associated with decreased healthcare utilization, particularly in terms of ED visits. Beyond the primary objective of providing goal-concordant care, ACP may impact the economic burden of chronic neurodegenerative disease, which has high costs of care in our aging society. There may be particular benefits with Alzheimer's disease, which had an impact on both hospitalizations and ED visits and is the most prevalent neurodegenerative disease. Future work is needed to better understand the best implementation strategy for ACP in a multifaceted approach that emphasizes patient care preferences for their illness. [ABSTRACT FROM AUTHOR]

Objective: To investigate the application value of arthroscopic channel modification in meniscal injury repair. Methods: We retrospectively analyzed the data of 100 patients with meniscus injuries treated with knee arthroscopy from December 2022 to December 2023 and divided them into a control group and a modified group according to the application of "arthroscopic access modification technology". We compared the operation time, postoperative hospitalization time, VAS score, Lysholm knee function score, postoperative complications, and postoperative images of the patients in these two groups. We compared the operation time, postoperative hospitalization time, pre- and postoperative VAS scores, Lysholm knee function scores, postoperative complications and postoperative imaging indices of the patients in the two groups. Results: All patients successfully underwent surgery and were followed up without intraoperative vascular or nerve injury or postoperative complications such as infection, wound necrosis or thrombosis. The average follow-up time was 16.03 ± 3.69 months; the average operation time and postoperative hospitalization time of the modified group were significantly better than those of the control group were (P < 0.05); the pain and knee function of the two groups significantly improved over time (P < 0.05); and, compared with those of the control group, the modified group could obtain a more satisfactory score at an early stage of the postoperative period (P < 0.05), and the comparison of the intermediate and long-term scores of the two groups was not statistically significant (P > 0.05). There was no statistically significant difference (P > 0.05). Conclusion: The improved arthroscopic access technique can make the entry and exit of instruments into and out of the joint cavity smoother, improve the surgical field of view, significantly shorten the operation time, reduce the occurrence of intraoperative complications, improve the function of patients' knee joints earlier, and increase their satisfaction with the operation. [ABSTRACT FROM AUTHOR]

Background: Pain is common among patients with heart failure but has not been examined with short-term discharge outcomes. The purpose was to examine whether pain at discharge predicts return to community status and 90-day mortality among hospitalized patients with heart failure. Methods: Data from medical records of 2169 patients hospitalized with heart failure were analyzed in this retrospective cohort study. The independent variable was a diagnosis of pain at discharge. Outcomes were return to community status (yes/no) and 90-day mortality. Logistic regression was used to address aims. Covariates included age, gender, race, vital signs, comorbid symptoms, comorbid conditions, cardiac devices, and length of stay. Results: The sample had a mean age of 66.53 years, and was 57.4% women and 55.9% Black. Of 2169 patients, 1601 (73.8%) returned to community, and 117 (5.4%) died at or before 90 days. Patients with pain returned to community less frequently (69.6%) compared with patients without pain (75.2%), which was a statistically significant relationship (odds ratio, 0.74; 95% confidence interval, 0.57–0.97; P =.028). Other variables that predicted return to community status included age, comorbid conditions, dyspnea, fatigue, systolic blood pressure, and length of stay. Pain did not predict increased 90-day mortality. Variables that predicted mortality included age, liver disease, and systolic blood pressure. Conclusion: Patients with pain were less likely to return to community but did not have higher 90-day mortality. Pain in combination with other symptoms and comorbid conditions may play a role in mortality if acute pain versus chronic pain can be stratified in a future study. [ABSTRACT FROM AUTHOR]

Aims Patients with moderate aortic stenosis (AS) show a poor prognosis if they have high-risk features. We investigated herein the incremental prognostic value of left ventricular (LV) and left atrial (LA) strain in patients with moderate AS. Methods and results In a cohort of 923 patients with moderate AS (median age 74 years, men 55%, aortic valve area 1.18 [interquartile range (IQR) 1.08–1.30] cm2, mean pressure gradient 25 [IQR 23–30] mmHg), the LV global longitudinal strain (LV-GLS) and LA reservoir strain (LARS) were measured using speckle-tracking echocardiography. Absolute values of myocardial strain were used. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization. During a median of 5.9 years, the primary endpoint occurred in 186 patients (20.2%). The median LV-GLS and LARS were 17.7% (IQR 14.8–19.7%) and 24.5% (IQR 18.7–29.3%), respectively. LV-GLS [adjusted hazard ratio (HR) 0.92, 95% confidence interval (CI) 0.87–0.97] and LARS (adjusted HR 0.97, 95% CI 0.95–0.99) were significant predictors of the primary outcome, independent of clinical and echocardiographic variables, including LV ejection fraction. Notably, the prognostic value of LV-GLS was stronger than that of LARS, remaining significant after further adjustment for LARS. LV-GLS < 17% and LARS < 22% were identified as optimal cut-offs for the primary outcome. Patients with both reduced LV-GLS and LARS had the worst outcomes (log-rank P < 0.001). LV-GLS < 17% and LARS < 22% had incremental prognostic values on top of other clinical and echocardiographic variables. Conclusion In moderate AS, reduced LV-GLS and LARS have incremental prognostic values and can refine risk stratification to identify high-risk patients. [ABSTRACT FROM AUTHOR]

Background: Falls are common adverse events among hospitalized patients, affecting outcomes and placing a financial burden on patients and hospitals. This study investigated the relationship between nurse staffing/workload and patient falls during hospitalization. Methods: The patients studied were hospitalized in the general wards (excluding pediatrics and obstetrics/gynecology) of 11 National Hospital Organization institutions between April 2019 and March 2020. The data were obtained from the Diagnosis Procedure Combination Work Record and institutional fall reports. The variables used in the analyses included patient conditions, number of hospitalization cases, emergency hospitalizations, surgeries/examinations, disease composition ratio, patient attributes, hospital stay duration, hospital bed size, and nursing time per patient (day and night) on a ward-day basis. Multivariate analysis was performed to determine the effects of these factors on fall events. Results: A total of 36,209 ward days were analyzed, with falls reported on 2866 days (fall event rate of 9.0%). The mean nursing times per patient were 1.99 h (day) and 1.47 h (night). The nursing time per patient in the fall group compared to the non-fall group showed an odds ratio of 1.19 (p < 0.01) during day shifts and 0.17 (p < 0.02) during night shifts. An increase in nursing time per patient during the night was associated with fewer fall events, whereas during the day, increased nursing time appeared to contribute to more falls. Common background factors that increased nurse staffing and patient falls simultaneously could be suggested to exist during the day. Conclusions: Increased nursing time was correlated with reduced fall incidence, indicating the need for policy improvements in nurse staffing practices in Japan to enhance patient safety and outcomes. Further research is needed to accumulate evidence reflecting policies regarding nurse staffing. [ABSTRACT FROM AUTHOR]

Background & Objective: The aim of this study is to evaluate the clinical risk factors associated with maternal death in pregnant women infected by COVID-19. Materials & Methods: This is a multicenter prospective study in Indonesia, included all pregnant women with confirmed COVID-19. Participants were divided into two groups based on the final outcomes: maternal death group and survived group. The main outcomes evaluated were: maternal background, clinical risk factors, comorbidities, clinical characteristics, and laboratory results. Results: There were 89 participants in the maternal death group and, 1673 in the survived group. The maternal death group have an older maternal age (32 vs 31 years old, P=0.03) and earlier gestational ages during admission (33 vs 37 weeks, P=0.000). The maternal death group have a significantly higher rate of cardiac disease (6.5% vs 1.2%, P=0.004), acute kidney injury (5.2% vs 0.3%, P=0.000), coinfections (29.9% vs 10.8%, P=0.000), and anemia (14.3% vs 6.7%, P=0.012). The maternal death group have a higher level of maternal blood leukocyte (13970 vs 10345), netrofil 75.7 vs 70), ALT (47 vs 23), AST (26 vs 19), CRP (37.4 vs 0.7), and procalcitonin (0.27 vs 0.06) (P<0.05). The risk factors that independently related to maternal death are fever (Exp(B): 12.847, 95% CI: 5.638-29.277; P=0.000), pneumonia from chest x-ray (Exp(B): 2.524, 95% CI: 1.163-5.479; P=0.019), and ICU admission (Exp(B): 49.430, 95% CI: 21.024-116.215; P=0.000). Conclusion: Our research indicates that the presence of fever, pneumonia, and ICU hospitalization are independently associated with maternal death in COVID-19-infected pregnant women. [ABSTRACT FROM AUTHOR]

Background: Machine learning models could assist physicians in identifying high-risk COVID-19 patients. This study aimed to predict the Intensive Care Unit (ICU) admission in COVID-19 hospitalized patients by the Artificial Neural Network (ANN) model combined with Elastic Net algorithm. Methods: In this prospective study, the data of 139 COVID-19 patients admitted to Imam Reza Hospital in Tabriz between 20 March and 5 April 2020, were analyzed. The Elastic Net method was used to choose features with high importance. The chosen variables were standardized and ANN was fitted to the data with one hidden layer based on the descending gradient algorithm. To validate the model, the training and test group method with a ratio of 70 to 30 was used. The model's predictive power was reported by calculating the overall accuracy, sensitivity, specificity, and Area Under the ROC curve (AUC). Results: According to the results of the Elastic Net, the ANN model was constructed based on age, sex, body mass index, diabetes mellitus status, history of heart disease, and vital signs including systolic and diastolic blood pressure, saturated oxygen level, pulse rate, respiration rate, and body temperature. The overall accuracy of this model was 93.15%, sensitivity 80%, specificity 95.8%, and AUC 0.90. Saturated oxygen level, pulse rate, and age were the most important and predictive variables. Conclusion: In the investigated sample of patients admitted with COVID-19, the fitted ANN model had acceptable performance to predict the ICU admission. This finding could be useful for physicians and policy makers. [ABSTRACT FROM AUTHOR]

Objective: To explore the effects of subanesthetic dose of esketamine on serum inflammatory factor levels and depressive mood in elderly patients with sarcopenia postoperatively. Methods: This study retrospectively included 102 elderly patients who underwent elective total knee arthroplasty from April 2023 to June 2024 with skeletal muscle mass index (SMI) meeting the diagnostic criteria for sarcopenia (male SMI < 42.6 cm2/m2, female SMI < 30.6 cm2/m2). They were divided into two groups according to whether esketamine was used: esketamine group (ESK group, n = 51) and control group (CON group, n = 51). The Hamilton Depression Scale (HAMD) scores of the patients in the two groups were completed on preoperative day 1, postoperative day 1 and day 7, and serum ceramide (Cer), NOD-like receptor thermoprotein structural domain-related protein 3 (NLRP3) and interleukin-6 (IL-6) were detected. The length of hospital stay, time to first ambulation and pain VAS scores of 4 h, 8 h and 24 h after surgery were recorded. The incidence of adverse reactions was recorded in the postoperative period of 48 h. Results: There were no significant differences in HAMD scores, Cer, NLRP3 and IL-6 levels between the two groups preoperatively (P > 0.05). Compared with CON group, HAMD score, Cer, NLRP3 and IL-6 levels, and pain VAS scores (postoperative 4 h and 8 h) were significantly decreased in ESK group at postoperative day 1 and day 7 (P < 0.05). In addition, the number of postoperative remedial analgesia and length of hospital stay in the ESK group were significantly shorter than those in the CON group (P < 0.05). HAMD scores and levels of Cer, IL-6 and NLRP3 were higher at postoperative day 1 and day 7 than those preoperatively in both two groups (P < 0.05), and there was no statistically significant difference in the incidence of adverse reactions at postoperative 48 h between the two groups. Conclusions: The subanesthetic dose of esketamine can effectively reduce the serum Cer, NLRP3 and IL-6 levels after knee arthroplasty in elderly patients with sarcopenia, and may improve the patients' depression in the early postoperative period. [ABSTRACT FROM AUTHOR]

Patients with cirrhosis have high systemic inflammation (TNFα, CRP, and IL-6) that is associated with poor outcomes. These biomarkers need continuous non-invasive monitoring, which is difficult with blood. We studied the AWARE sweat-sensor to measure these in passively expressed sweat in healthy people (N = 12) and cirrhosis (N = 32, 10 outpatients/22 inpatients) for 3 days. Blood CRP, TNFα, IL6, levels, and liver function and quality of life were measured. We found that CRP, TNFα, and IL6 were correlated in sweat and serum among both groups and were evaluated in inpatients versus outpatients/controls. IL6 is associated with lower transplant-free survival. Sweat monitoring nocturnal CRP/IL6 elevations in cirrhosis versus controls. Outpatients with cirrhosis had inflammation levels that elevated during the evening and peaked towards the early night periods. The levels start to fall much later at night and early morning. These data suggest that further investigation of continuous measurement of sweat biomarkers in cirrhosis is warranted. [ABSTRACT FROM AUTHOR]

Background: In countries where euthanasia and assisted suicide are not allowed, such as France, little is known about how a request for euthanasia and/or assisted suicide, expressed by an end-of-life patient, impacts their relatives. Aim: To understand the experiences of relatives of patients in the advanced stages of a serious illness, hospitalized in a Palliative Care Unit (PCU), and requesting euthanasia or assisted suicide in the French context where these practices are illegal. Design: We conducted a qualitative study in five French PCUs over the course of 1 year. Following the principles of grounded theory, semi-structured interviews were conducted with the relatives of patients who had explicitly requested euthanasia or assisted suicide to a healthcare professional. Two interviews were scheduled: the first within 48 h of the initial request (D1), and the second one a week later (D7). Methods: We conducted in-depth face-to-face interviews with relatives of patients requesting euthanasia or assisted suicide, in PCUs within a specific region of France, prior to the French Claeys-Leonetti Law. A thematic analysis of the data was performed. Results: Ten semi-structured interviews were conducted. Five families (patients and their relatives) were included, and eight relatives were interviewed. The discussions between patients and their relatives about requesting euthanasia or assisted suicide varied significantly from one family to another. Five main themes emerged: denouncing end-of-life conditions; the desire to have a peaceful death; the different levels of support and accompaniment for the request; values in favor of euthanasia and assisted suicide; boundaries and barriers. Conclusion: Requests for euthanasia and/or assisted suicide are generally understood by relatives. However, receiving and discussing such requests is a challenging and emotionally demanding task, generating significant suffering. All relatives seem to experience some degree of suffering, although its expression varies greatly between individuals. We encourage healthcare professionals to identify the nature of this suffering and to invite patients and their relatives to openly discuss these issues and to proactively address the request. [ABSTRACT FROM AUTHOR]

Background: Cognitive frailty (CF), characterized by the coexistence of physical frailty and cognitive impairment, is linked to increased morbidity and mortality in older adults. While CF has been linked to multiple physiological and lifestyle factors, the underlying biological mechanisms remain poorly understood. This study investigated the risk factors for CF and explored the relationship between mitochondrial function and CF in hospitalized patients. Methods: A total of 279 hospitalized individuals were recruited from December 2020 to August 2022, conducted comprehensive clinical assessments, and collected peripheral blood samples. CF was evaluated using the Physical Frailty Phenotype and Montreal Cognitive Assessment scales. Nutritional status was assessed with the Mini Nutritional Assessment, and depression was measured using the Geriatric Depression Scale. DNA was obtained from the peripheral blood and interrogated for mitochondrial DNA copy number (mtDNAcn). Peripheral blood mononuclear cells isolated from peripheral blood were examined for respiratory function and reactive oxygen species (ROS) levels. Additionally, plasma samples were analyzed for inflammatory markers and Carnitine Palmitoyltransferase II (CPT2). Results: Among the participants, 90 were classified as CF and 46 as non- CF. Logistic regression analysis revealed that increased age (OR 1.156, 95% CI 1.064–1.255), lower educational attainment (OR 0.115, 95% CI 0.024–0.550), malnutrition (OR 0.713, 95% CI 0.522–0.973), and higher depression scores (OR 1.345, 95% CI 1.065–1.699) were significantly associated with CF. The independent t tests and Mann–Whitney U tests showed the CF group exhibited impaired mitochondrial function, characterized by reduced mtDNAcn and respiratory activity, coupled with elevated ROS, interleukin-6, and CPT2 levels compared with the non- CF group. After adjusted for age, sex, and BMI, compared with non- CF group, the OR values for the CF group of mtDNAcn and ROS were 0.234 (95% CI = 0.065–0.849) (p = 0.027) and 1.203 (95% CI = 1.075–1.347) (p = 0.001), respectively. The Sensitive analysis showed that the area under curve values for mtDNAcn and ROS were 0.653 and 0.925. Conclusion: Age, lower educational attainment, malnutrition, and depression are significant risk factors for CF. Moreover, mitochondrial dysfunction, characterized by decreased mtDNAcn, impaired respiratory function and increased ROS levels appears to be a critical phenotype of CF. [ABSTRACT FROM AUTHOR]

Background: An elevated resting heart rate (RHR) is associated with poor outcomes in both healthy individuals and those with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). This study aimed to investigated the association between on admission resting heart rate (RHR) and 60-day mortality. Methods: This single-center retrospective cohort study evaluated the effect of RHR on the 60-day mortality of patient with AIDS in Southeast China. A total of 2188 patients with AIDS admitted for the first time between January 2016 and December 2021 were included. The RHR was categorized into tertiles. Disease progression was estimated using 60-day mortality rates. Cox proportional hazards regression models were used to evaluate the RHR with disease progression, and a two-piecewise Cox regression model was used to reveal the RHR effect at admission on 60-day mortality. Results: We observed a U-shape relationship between RHR and 60-day mortality. For a above 90 bpm, the 60-day mortality rose rapidly with a multivariable adjusted odds ratio (OR) of 1.032 (95% confidence interval [CI 1.016–1.048, P < 0.001). Below the threshold, 60 days mortality decreased as the RHR increased to 90 bpm with a multivariate-adjusted OR of 0.943 (95% CI 0.904–0.984, P = 0.0065). Conclusions: This study identified a U-shape relationship between RHR and 60-day mortality in HIV/AIDS patients. Further research is needed to characterize the role of RHR in the timely prevention of mortality in HIV/AIDS patients. [ABSTRACT FROM AUTHOR]

Background: We investigated the relationship between neighbourhood income quintile and mental health service use by immigration experience among youth and explored changes during the COVID-19 pandemic. Method: We used administrative data to examine mental health service use among youth aged 10 to 24 in British Columbia, Canada, between April 1, 2019, and March 31, 2022. We compared rates of community-based mental health service use, emergency department visits, and hospitalizations and the proportion of involuntary admissions by neighbourhood income quintile and immigration. We used models stratified by immigration to estimate the relationship with income. Results: Non-immigrant youth used substantially more services than immigrant youth. Service use increased following the pandemic's start and peaked between January and March 2021. We observed a clear income gradient for community-based service use among both immigrant and non-immigrant youth, but the direction of the gradient was reversed. Service use was highest among non-immigrant youth in lower-income neighbourhoods and lowest for immigrant youth in lower-income neighbourhoods. We observed similar patterns of income gradient for non-immigrant youth for emergency department visits and hospitalization. The proportion of involuntary admissions was higher for immigrant youth. Conclusions: Mental health service use was substantially lower among immigrant youth than non-immigrant youth, but higher proportions of immigrant youth were hospitalized involuntarily. The reverse income gradient patterns observed for community-mental health service use are noteworthy and suggest significant barriers to accessing preventable care among immigrant youth, particularly those living in lower-income neighbourhoods. [ABSTRACT FROM AUTHOR]

Background: Nearly half of subjects after COVID-19 still experience symptoms after 12 weeks, as described in the Post-Covid Syndrome (PCS). Other than the physical alterations perceived, mental health disorders have been frequently reported. Mindfulness-Based Interventions (MBIs) showed beneficial effects on psychological well-being in patients with respiratory dysfunctions, but they have been rarely tested in severe COVID-19 survivors. Objective: In a quasi-experimental study, test the clinical and psychological effects of a 12-week Tele–MBI in previously hospitalized COVID-19 patients and analyze the feasibility of the intervention. Methods: Subjects earlier hospitalized due to COVID-19 were enrolled 12 weeks after the infection onset, they were assigned to the intervention group (TG) or to the control one (n-TG). Subjects enrolled in the TG attended a 12-week home-based T-MBI and patients of both groups received multimodal rehabilitation interventions according to their own therapeutic needs. Mental health (anxiety, depression, post-traumatic stress disorder (PTSD) symptoms, sleep quality, self-efficacy, and resilience) and quality of life were detected before and after treatment. The feasibility of the T-MBI applied was also investigated. Results: A total of 88 subjects were included (44 in the TG and 44 in the n-TG; 63.6% males, mean age 64.4 ± 10.6). Most characteristics were similar between groups at the baseline; TG patients showed greater improvements in different psychological metrics (anxiety, depression, PTSD, resilience, and self-efficacy) compared to n-TG while no differences were found for perceived quality of life. T-MBI was well-accepted by patients. Conclusion: Tele-Mindfulness program seems effective in reducing anxiety, depression, and post-traumatic stress disorder symptoms and increasing resilience and self-efficacy in subjects who required hospitalization due to COVID-19. [ABSTRACT FROM AUTHOR]

Background: A prerequisite for understanding temporal changes in road crash severity is an unbiased description of this phenomenon. The aim of this study was to estimate the independent association trends of age, period and cohort with severity, encompassing the risk of death (RD) and the risk of death or hospitalisation (RDH) within 24 h, for drivers of passenger cars involved in road crashes with casualties in Spain from 1993 to 2020. Methods: The study population comprised 2,453,911 drivers of passenger cars aged 18 to 98 years involved in road crashes included in the registers of the General Directorate of Traffic. Crash- and driver-related variables with sufficient continuity over time were included, establishing RD and RDH as study outcomes. Temporal trends of both outcomes were analysed using multivariable Poisson regression and multivariable age-period-cohort intrinsic estimator models. An additional sensitivity analysis was performed for the subset of single crashes. Results: Severity estimates showed some variation across strategies. The APC model identified: (1) a J-shaped pattern for the effect of age on severity, (2) a decline in severity between 2001 and 2004 and 2013–2016, and (3) a birth cohort effect for both RD and RDH. In particular, the 1952–1958 cohort had the highest risk (RD = 1.17; 95%CI = 1.11–1.24 and RDH = 1.16; 95%CI = 1.13–1.19), followed by a decreasing trend in subsequent cohorts. Restricting the analysis to single crashes yielded similar results, with the exception of the age effect (severity increased with age). Furthermore, sex differences were observed–female sex was inversely associated with severity, especially for RD. Conclusions: RD and RDH decreased during the first decade of the 21st century, but seemed to stabilise from 2013 onwards. Evidence from this study support that birth cohort is associated with road crash severity, independent of age and period. This cohort effect might be due, at least partially, to improvements in general and road safety education. Further studies are needed to elucidate the causes of our findings and to identify factors accounting for sex differences. [ABSTRACT FROM AUTHOR]

In this study, we investigate the performance of computer vision AI algorithms in predicting patient disposition from the emergency department (ED) using short video clips. Clinicians often use "eye-balling" or clinical gestalt to aid in triage, based on brief observations. We hypothesize that AI can similarly use patient appearance for disposition prediction. Data were collected from adult patients at an academic ED, with mobile phone videos capturing patients performing simple tasks. Our AI algorithm, using video alone, showed better performance in predicting hospital admissions (AUROC = 0.693 [95% CI 0.689, 0.696]) compared to models using triage clinical data (AUROC = 0.678 [95% CI 0.668, 0.687]). Combining video and triage data achieved the highest predictive performance (AUROC = 0.714 [95% CI 0.709, 0.719]). This study demonstrates the potential of video AI algorithms to support ED triage and alleviate healthcare capacity strains during periods of high demand. [ABSTRACT FROM AUTHOR]

Simple Summary: In this study, we report on the safety and efficacy of initiating parenteral nutrition in the home setting (HomeStart PN) for patients with advanced peritoneal metastasis. This analysis provides data demonstrating that initiating TPN at home is as safe as initiating TPN in a hospital setting. In our retrospective review, we compared outcomes of patients who initiated TPN at home and those who was admitted to the hospital for acute conditions related to their cancer and started TPN who otherwise would have qualified for Home Start PN. These two groups had similar baseline weight and nutrition status prior to starting TPN, and following TPN nutritional support, achieved comparable weight gain/ weight stability and achievement of nutrition resuscitation goals and stability. The clinical course analysis revealed 35–45% of patients with advanced peritoneal metastasis experience hospital admission/readmissions due to the underlying cancer and therapies to treat disease for both home- and hospital-initiated TPN. Given the frequent hospitalizations for this patient population, a Home Start PN approach in this advanced oncologic patient population is advantageous and potentially reduces time spent in hospital and the associated costs. Background: Patients with peritoneal carcinomatosis often experience intestinal failure throughout the course of their disease, and total parenteral nutrition (TPN) can be used as a temporary solution or as a bridge to definitive cytoreductive surgery. Guidelines for TPN are well established for inpatients and in 2014, guidelines were established for the initiation of TPN for outpatients in a home setting. However, the safety and efficacy of home start TPN in advanced oncology patients remain unknown. This study aims to explore the safety and efficacy of starting TPN in the home setting for patients with peritoneal carcinomatosis. Method: Health records of advanced cancer patients receiving TPN during 2009–2020 were retrospectively reviewed. Data pertaining to diagnosis, demographics, nutritional parameters, and outcomes including hospital readmission rates were collected. Safety was measured based on catheter-related complications and hospital admissions related to electrolyte or fluid imbalance due to TPN. Efficacy was determined by weight gain/stability and pre-albumin and albumin levels. The Fisher's exact and Kruskal–Wallis tests were used to analyze the data. Results: Seventy TPN patients were identified, of which forty-two were home start (HS) and twenty-eight were in hospital (HP). The two groups were not significantly different in age, (HS: mean = 58.3 ± 13.9; HP: mean = 58.0 ± 13; p = 0.95), baseline body weight (p = 0.13), baseline albumin (p = 0.26) or pre-albumin (p = 0.48). At the end of treatment, the HS and HP groups had similar percentages of patients experiencing weight gain/stability (75% vs. 47%, p = 0.1), stable/increased pre-albumin (68% vs. 65%, p = 1), and stable/increased albumin levels (48% vs. 59%, p = 0.58). There was no difference in observed readmission between the groups (p = 0.79). At the end of treatment, 48% of the HS group and 36% of the HP group resumed an oral diet. Conclusions: This is the first study to present a comparison between home and hospital start TPN in advanced cancer patients, demonstrating that the initiation of outpatient TPN in the home setting is as safe and efficacious as TPN initiated in the hospital. [ABSTRACT FROM AUTHOR]

Background As coronavirus disease 2019 (COVID-19)–related mortality remains a concern, optimal management of patients hospitalized for COVID-19 continues to evolve. We developed a population model based on real-world evidence to quantify the clinical impact of increased utilization of remdesivir, the effectiveness of which has been well established in hospitalized patients with COVID-19. Methods The PINC AI healthcare database records for patients hospitalized for COVID-19 from January to December 2023 were stratified by those treated with or without remdesivir ("RDV" and "no RDV") and by supplemental oxygen requirements: no supplemental oxygen charges (NSOc), low-flow oxygen (LFO), and high-flow oxygen/non-invasive ventilation. Key vulnerable subgroups such as elderly and immunocompromised patients were also evaluated. The model applied previously published hazard ratios (HRs) to 28-day in-hospital mortality incidence to determine the number of potential lives saved if additional no RDV patients had been treated with remdesivir upon hospital admission. Results Of 84 810 hospitalizations for COVID-19 in 2023, 13,233 no RDV patients were similar in terms of characteristics and clinical presentation to the RDV patients. The model predicted that initiation of remdesivir in these patients could have saved 231 lives. Projected nationally, this translates to >800 potential lives saved (95% confidence interval, 469–1126). Eighty-nine percent of potential lives saved were elderly and 19% were immunocompromised individuals. Seventy-six percent were among NSOc or LFO patients. Conclusions This public health model underscores the value of initiating remdesivir upon admission in patients hospitalized for COVID-19, in accordance with evidence-based best practices, to minimize lives lost because of severe acute respiratory syndrome coronavirus 2 infection. [ABSTRACT FROM AUTHOR]

Background Coronavirus disease 2019 (COVID-19) remains a major public health concern, with continued resurgences of cases and substantial risk of mortality for hospitalized patients. Remdesivir has become standard-of-care for hospitalized COVID-19 patients. Given the continued evolution of the disease, clinical management of COVID-19 relies on evidence from the current endemic period. Methods Using the PINC AI Healthcare Database, remdesivir effectiveness was evaluated among adults hospitalized with primary diagnosis of COVID-19 between December 2021 and February 2024. Three cohorts were analyzed: adults (≥18 years), elderly (≥65 years), and those with documented COVID-19 pneumonia. Analyses were stratified by oxygen requirements. Patients who received remdesivir were matched to those who did not receive remdesivir using propensity score matching. Cox proportional hazards models were used to examine in-hospital mortality. Results 169 965 adults hospitalized for COVID-19 were included, of whom 94 129 (55.4%) initiated remdesivir in the first 2 days of hospitalization. Remdesivir was associated with significantly lower mortality rate compared to no remdesivir among patients with no supplemental oxygen charges (adjusted HR [95% CI]: 14-day, 0.75 [.69–.82]; 28-day, 0.77 [.72–.83]) and those requiring supplemental oxygen: 14-day, 0.76 [.72–.81]; 28-day, 0.79 [.74–.83]; P <.0001 for all). Similar findings were observed for elderly patients and those hospitalized with COVID-19 pneumonia. Conclusions This evidence builds on what has been learned from randomized controlled trials from the pandemic era to inform clinical practices. Remdesivir was associated with significant reduction in mortality for hospitalized patients including the elderly and those with COVID-19 pneumonia. [ABSTRACT FROM AUTHOR]

Background Reducing hospital readmission offer potential benefits for patients, providers, payers, and policymakers to improve quality of healthcare, reduce cost, and improve patient experience. We investigated effectiveness of remdesivir in reducing 30-day coronavirus disease 2019 (COVID-19)-related readmission during the Omicron era, including older adults and those with underlying immunocompromising conditions. Methods This retrospective study utilized the US PINC AI Healthcare Database to identify adult patients discharged alive from an index COVID-19 hospitalization between December 2021 and February 2024. Odds of 30-day COVID-19-related readmission to the same hospital were compared between patients who received remdesivir vs those who did not, after balancing characteristics of the two groups using inverse probability of treatment weighting (IPTW). Analyses were stratified by maximum supplemental oxygen requirement during index hospitalization. Results Of 326 033 patients hospitalized for COVID-19 during study period, 210 586 patients met the eligibility criteria. Of these, 109 551 (52%) patients were treated with remdesivir. After IPTW, lower odds of 30-day COVID-19-related readmission were observed in patients who received remdesivir vs those who did not, in the overall population (3.3% vs 4.2%, respectively; odds ratio [95% confidence interval {CI}]: 0.78 [.75–.80]), elderly population (3.7% vs 4.7%, respectively; 0.78 [.75–.81]), and those with underlying immunocompromising conditions (5.3% vs 6.2%, respectively; 0.86 [.80–.92]). These results were consistent irrespective of supplemental oxygen requirements. Conclusions Treating patients hospitalized for COVID-19 with remdesivir was associated with a significantly lower likelihood of 30-day COVID-19-related readmission across all patients discharged alive from the initial COVID-19 hospitalization, including older adults and those with underlying immunocompromising conditions. [ABSTRACT FROM AUTHOR]

Burns are injuries to the skin or the underlying tissue system caused by heat, radiation, electricity, friction or chemicals. Burns can cause pain and discomfort during dressing changes; a person's pain response varies depending on individual perception. The pain response can indicate tissue damage in the body, as pain causes a person to experience discomfort. Pain can be interpreted as a subjective sensory response and an unpleasant emotional experience associated with actual or potential tissue damage. Pain is usually managed with pharmacological and non-pharmacological therapy. An example of non-pharmacological therapy is the use of distraction techniques, such as virtual reality (VR). VR diverts pain by creating a 3D environment with a screen and VR glasses. It allows the patient to immerse themselves in a virtual world complete with sound and music. The volume can be adjusted as needed and the patient can interact with the virtual world. The purpose of this study is to determine the characteristics and effectiveness of VR pain management in burn patients. The method used in this study is a literature review using the Preferred Reporting Items For Systematic Review (PRISMA). The authors searched for journal articles using the Science Direct, PubMed, and Google Scholar databases, covering the period from 2015–2023. The keywords used were pain management, virtual reality and burn injury. Based on the predetermined inclusion criteria, 10 articles were selected for the review. The results of this study, based on the analysis of 10 articles, indicated that the distraction or transition method (non-pharmacological management using VR) was effective in reducing pain and discomfort during dressing changes in patients with mild to moderate burns, across various age groups from infants and children to adults. Clinicians can leverage VR technology to tailor interventions based on individual patient needs, across all age groups, enhancing patient comfort and engagement during procedures. [ABSTRACT FROM AUTHOR]

Objectives: The frailty index is widely used in clinical and community settings to assess health status. This study aimed to identify the potential phenotypes of frail older adults and examine their relationship with health consequences compared with existing frailty measures. Methods: The 11-year follow-up data from the Taiwan Longitudinal Study on Aging, covering 5,334 individuals aged ≥ 50 years, were analyzed using random-effects panel logit models. We identified three frailty phenotypes: energy-based frailty (EBF), sarcopenia-based frailty (SBF), and hybrid-based frailty (HBF). Existing frailty measures such as the Study of Osteoporotic Fractures (SOF), Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL), and Fried scales were applied. We examined their correlation with health outcomes, such as falls and fractures, depression, comorbidities, hospitalization, emergency department visits, and mortality, adjusting for individual-level characteristics. Results: Individuals with only EBF were found to be at a lower risk of falls and fractures than their counterparts with only SBF (adjusted odds ratio [AOR] = 0.13, 95% confidence interval [CI] = 0.03–0.46). Depression was less likely in the SBF group than in the EBF group (AOR = 0.02, 95% CI = 0.01–0.05). Hybrid-based frail older adults were more likely to be hospitalized (AOR = 1.84, 95% CI = 1.08–3.14) and have emergency department visits (AOR = 2.03, 95% CI = 1.15–3.58). Frailty assessed using existing measures was associated with adverse health outcomes. Conclusion: The proposed frailty phenotype classification differs from the existing frailty measures in its ability to distinguish the corresponding phenotypes underlying various health consequences. Governments may develop strategies based on frailty phenotypes to mitigate adverse health consequences. [ABSTRACT FROM AUTHOR]

Objective: To describe the rate, timing, and primary diagnosis codes for emergency care visits up to 8 weeks (56 days) after live birth among Medicaid beneficiaries in North Carolina (NC). Materials and Methods: Using a linked dataset of Medicaid hospital claims and certificates of live birth, which included Medicaid beneficiaries who had a live-born infant in NC between January 1, 2013, and November 4, 2019, and met inclusion criteria (n = 321,879), we estimated week-specific visit rates for emergency care visits that did not result in hospital admission (outpatient) and those that did (inpatient). We assessed the 10 leading diagnosis code categories for emergency care visits and described the characteristics of people with 0, 1, or ≥2 outpatient emergency care visits. Results: One in eight (12.4%) Medicaid beneficiaries had an emergency care visit that did not result in inpatient hospital admission during the first 8 weeks postpartum. Visit rates peaked in postpartum week 2. Diagnosis codes for nonspecific symptoms and substance use were the two leading diagnosis code categories for outpatient emergency care visits. Respiratory concerns and gastrointestinal concerns were the two leading diagnosis code categories for inpatient emergency care visits. Compared with those with zero outpatient emergency care visits, a greater proportion of people with ≥2 visits had less than a high school education, used tobacco during pregnancy, had Medicaid insurance outside of pregnancy, had mental health as a medical comorbidity, and/or had ≥2 medical comorbidities. Conclusions: These findings support scheduling health care visits early in the postpartum period, when emergency care visits are most frequent, and point to unmet needs for substance use support. [ABSTRACT FROM AUTHOR]