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This review evaluates the published studies on how postacute care collaboration ensures a continuum of care and reduces heart failure (HF) readmissions.An integrated literature review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement. PubMed and Cumulative Index to Nursing and Allied Health were searched for the keywords heart failure AND (post-acute care OR transitional care OR skilled nursing facility OR rehabilitation facility OR home health agency) AND (readmission) AND (care coordination OR collaboration OR interprofessional OR partnerships). Seventy-nine studies were returned, and a reverse reference search yielded four studies. Of those studies, 14 were selected for critical appraisal of evidence. The practice settings of these studies were hospitals, homes, home health agencies, and skilled nursing facilities.Multidisciplinary management of HF patients, high-impact transitional care interventions, and integration with postacute care facilities decreased HF 30-day readmissions. Collaborative models involving a skilled HF team, primary care physicians, and postacute care partners, and targeting postdischarge follow-ups positively impacted outcomes. Bundling interventions, such as home visits, follow-ups (telephone and/or clinic follow-up), and telecare, significantly impacted outcomes compared with their delivery in isolation.Case management leaders are vital decision-makers and key stakeholders in building the collaboration with community partners. As case management roles extend to outpatient and ambulatory care, better opportunities emerge to coordinate services across settings. Key takeaways for the case management practice is to build a robust case management program spanning postacute care facilities, evidence-based treatment protocols, and infrastructure that supports seamless information sharing between sites.

Stigmatizing anyone during a pandemic poses a threat to everyone and can be an obstacle to disease treatment. The stigma around COVID-19 stems from the fact that it is a life-threatening disease and a lot is unknown about it.This study was conducted with the aim of analyzing and clarifying the concept of stigma in the context of COVID-19; determining its psychological and socio-psychological outcomes; enhancing understanding and recognition of features, antecedents, and consequences of the concept; and proposing an adequate definition for use in clinical practice or research.Rodgers' evolutionary concept analysis was used.Stigma in the context of COVID-19 has antecedents, which include informational and psychological issues, media performance, and some governments' policies and actions to control COVID-19 pandemic. The attributes of COVID-19 stigma are subjective and variable, perceived, and/or experienced with interrelated intrapersonal, interpersonal, and structural or institutional dimensions that can be summarized as social stigma and self-stigma. The consequences of COVID-19 stigma are social isolation and psychological burden, physical and mental violence and harassment, hiding disease, and reduced care-seeking behavior. These results will extend the body of knowledge on theory and practice and also assists future researchers in many folds.These findings will be a major tool for the case manager/health care team, policy makers, and other human resource planning professionals to develop plans for preventing, combating, and stopping the COVID-19-related stigma.

Objective: We aimed to find the parameters that can change during herpes zoster infection and observe the relationship of these parameters throughout the disease. Material and Methods: We compared 40 herpes zoster patients and 2 separate control groups, who were healthy and had comorbidities similar in age and gender. Patient files were retrospectively analyzed, and laboratory parameters were compared between groups. The laboratory values of the patient group with herpes zoster were evaluated among themselves according to the duration of the symptoms. Results: Fasting glucose, creatinine, aspartate aminotransferase values, the percentage and the absolute number of monocytes, red blood cell distribution width-coefficient of variation, and C-reactive protein levels of the patients with herpes zoster were significantly higher, and the absolute number of lymphocytes, mean corpuscular volume and platelet distribution width levels were lower than the control groups. The percentage of monocytes in the first 5 days was significantly higher than in the following days, and hematocrit values were lower in the last days. Conclusion: Examining routine laboratory values during diseases may help diagnose the disease, especially in patients with faint clinical signs and zoster sine zoster. In addition, it may be useful to question patients with herpes zoster for renal dysfunction, rheumatological diseases, and malignancy., Amaç: Herpes zoster enfeksiyonu sırasında değişebilen parametreleri bulmayı ve bu parametrelerin hastalık süresi ile ilişkisini gözlemlemeyi amaçladık. Gereç ve Yöntemler: Herpes zosterli 40 hasta ile yaş ve cinsiyetleri benzer sağlıklı ve ek hastalıkları olan 2 ayrı kontrol grubu karşılaştırıldı. Hasta dosyaları geriye dönük olarak incelendi ve gruplar arasında laboratuvar parametreleri değerlendirildi. Herpes zosterli hasta grubunun laboratuvar değerleri, semptomların süresine göre kendi aralarında değerlendirildi. Bulgular: Herpes zosterli hastaların açlık glukozu, kreatinin, aspartat aminotransferaz değerleri, monosit mutlak sayısı ve yüzdesi, kırmızı kan hücresi dağılım genişliği-varyasyon katsayısı ve C-reaktif protein düzeyleri kontrol gruplarına göre anlamlı olarak yüksek; lenfosit mutlak sayısı, ortalama korpüsküler hacim ve trombosit dağılım genişliği düzeyleri ise daha düşüktü. İlk 5 gündeki monosit yüzdesi sonraki günlere göre anlamlı derecede yüksekti. Sonuç: Hastalıklar sırasında rutin laboratuvar değerlerinin incelenmesi, özellikle silik klinik bulguları olan ve zoster sine zoster olan hastalarda hastalığın teşhisine yardımcı olabilir. Ayrıca herpes zosterli hastaların böbrek fonksiyon bozukluğu, romatolojik hastalıklar ve malignite açısından sorgulanması faydalı olabilir.

The advent of cellular network technology has increased the use of photography in the clinical setting. This article reviews several areas regarding protected health information (PHI) and the use of video: the 1996 Health Insurance Portability and Accountability Act (HIPAA); The Joint Commission requirements for the use of images; areas of concern for exchanging PHI with law enforcement at the bedside, and the need for the development of formal guidelines regarding the use of video in the clinical setting.

© 2022 Elsevier B.V.Objective: Objective methods to monitor the sleep of preterm infants at the neonatal intensive care unit (NICU) are required to prevent potentially adverse neurodevelopmental outcomes. This study aimed to determine the concordance of actigraphy and amplitude-integrated electroencephalogram (aEEG) against gold standard direct observation (DO) in assessing sleep/wake states of typically developing preterm infants. Methods: This prospective observational study was conducted in a single center level III NICU. Sleep variables were measured using Philips Respironics Mini-Mitter® Actiwatch-2 for 24 h and compared with 8-h matched data of aEEG and DO. Sensitivity-specificity analysis, Cohen's kappa, prevalence-adjusted and bias-adjusted kappa (PABAK), and Bland Altman plots were generated. Results: Seventeen preterm infants were recruited. A total of 11252 epochs were studied. Sensitivity (86.4%), agreement rate (67.9%), and predictive value for wake (47.9%) for the actigraphy were highest at the automatic activity threshold whereas specificity (54.5%) and predictive value for sleep (75.5%) were highest at low threshold. The sensitivity of aEEG was 79.3% and the specificity was 54.3%. At all thresholds, the agreement was largely equivalent with low kappas (0.14–0.17) and PABAK coefficients (0.22–0.35) for actigraphy and DO. Moderate agreement was observed between aEEG and DO according to the PABAK coefficient (0.44). Mean differences in sleep parameters were not different between DO and aEEG as well as DO/aEEG and actigraphy at medium threshold (p > 0.05). Conclusions: Actigraphy at medium threshold can be used in depicting sleep in typically developing preterm infants at NICU. aEEG may be an alternative adjunctive method to actigraphy for the evaluation of sleep/wake states in the NICU setting. Clinical trial registration number: NCT04145362

Objective: The aim of this study was to evaluate the ameliorative effects of swimming training on renal and bladder damage caused by a highfat diet (HFD) using morphological and biochemical measurements. Methods: Sprague Dawley rats were fed either standard chow (CONT, 6% fat) or HFD (45% fat) for 18 weeks, these rats were divided into two subgroups at the last 6 weeks of the experiment. The exercise groups (CONT+EXC, HFD+EXC) were trained daily swimming sessions (1 h per day for 5 days/week) during the last 6 weeks. Kidney and bladder samples were prepared for light and electron microscopic examination at the end of experiment. Malondialdehyde, glutathione, interleukin-6, and tumor necrosis factor-α were measured by biochemically. Results: Regular morphology of the renal cortex and bladder mucosa was observed in the CONT and CONT +EXC groups. Degenerated renal corpuscles and proximal tubules in the kidney and degenerated urothelium with leaky tight junctions and mast cell increase in the bladder mucosa were observed in the HFD group. Ameliorated renal cortex and bladder mucosa were observed in the HFD+EXC group. In addition, malondialdehyde, glutathione, interleukin-6, and tumor necrosis factor-α levels were also consistent with the histological findings. Conclusion: HFD-induced renal and bladder damage may be related to increased oxidative damage. It was observed that the histological damage and altered oxidative stress parameters could be reversed by swimming training, and it is thought that moderate swimming exercise may play a role in regulating oxidative stress.

Previous research demonstrates an association between opioid prescribing at hospital discharge and future chronic opioid use. Various opioid guidelines and policies contributed to changes in opioid prescribing practices. How this affected hospitalized patients remains unknown.Externally validate a prediction model to identify hospitalized patients at the highest risk for future chronic opioid therapy (COT).Retrospective analysis of health record data from 2011 to 2022 using logistic regression.Hospitalized adults with limited to no opioid use 1-year prior to hospitalization.A statewide healthcare system.Used variables associated with progression to COT in a derivation cohort from a different healthcare system to predict expected outcomes in the validation cohort.The derivation cohort included 17,060 patients, of whom 9653 (56.6%) progressed to COT 1 year after discharge. Compared to the derivation cohort, in the validation cohort, patients who received indigent care (odds ratio [OR] = 0.40, 95% confidence interval [CI] = 0.27-0.59, p .001) were least likely to progress to COT. Among variables assessed, opioid receipt at discharge was most strongly associated with progression to COT (OR = 3.74, 95% CI = 3.06-4.61, p .001). The receiver operating characteristic curve for the validation set using coefficients from the derivation cohort performed slightly better than chance (AUC = 0.55).Our results highlight the importance of externally validating a prediction model prior to use outside of the derivation population. Periodic updates to models are necessary as policy changes and clinical practice recommendations may affect model performance.

Orthostatic hypotension (OH) which diagnosis is based on the measurement of the blood pressure response to orthostatism (BPRO) is a common condition associated with adverse cerebrovascular and cognitive prognosis. It is likely that the single measurement might underestimate the true prevalence of OH. This study investigated the prevalence and reproducibility of the diagnosis of OH and related risk factors in hospitalized acute ischemic stroke (AIS) patients with multiple measurements.This study was a prospective cohort analysis of consecutive AIS patients admitted to the hospital. A total of 211 patients were included. BPRO was assessed five times at the same time on different days.OH was found in 33 cases (15.6%) in the initial set of measurements of the first day. A cumulative diagnosis of OH after five BPRO tests was found in 75 cases (35.5%). The reproducibility of the diagnosis of OH was mild or poor. In patients with a cumulative diagnosis of OH, 29 (38.7%) patients had orthostatic hypertension (OHTN). In multivariate analysis, the Fazekas scale (odds radio = 1.28, 95% confidence interval (CI), 1.04-1.59, P = 0.023) and extracranial carotid stenosis (≥70%) (odds radio = 3.64, 95% CI, 1.19-11.13, P = 0.023) were independent risk factors for OH.The reproducibility of OH is poor and the concurrent appearance of OH and OHTN is common in hospitalized AIS patients. Multiple measurements should be taken in hospitalized AIS patients when screening for OH especially patients with higher Fazekas scale and extracranial carotid stenosis (≥70%).

Children with neurologic impairment (NI) are frequently hospitalized for infectious and noninfectious illnesses. The early period of the COVID-19 pandemic was associated with overall lower pediatric hospitalization rates, particularly for respiratory infections, but the effect on utilization for children with NI is unknown.This multicenter retrospective cohort study included hospitalizations of children 1-18 years of age with NI diagnosis codes from 49 children's hospitals. We calculated the percent change in the median weekly hospitalization volumes and the hospitalization resource intensity score (H-RISK), comparing the early-COVID era (March 15, 2020 to December 31, 2020) with the pre-COVID era (same timeframe of 2017-2019). Percent change was calculated over the entire study period as well as within three seasonal time periods (spring, summer, and fall/winter). Differences between infectious and noninfectious admission diagnoses were also examined.Compared with the pre-COVID era, there was a 14.4% decrease (interquartile range [IQR]: -33.8, -11.7) in the weekly median number of hospitalizations in the early-COVID era; the weekly median H-RISK score was 11.7% greater (IQR: 8.9, 14.9). Hospitalizations decreased for both noninfectious (-11.6%, IQR: -30.0, -8.0) and infectious (-35.5%, IQR: -51.1, -31.3) illnesses in the early-COVID era. This decrease was the largest in spring 2020 and continued throughout 2020.For children with NI, there was a substantial and significant decrease in hospitalizations for infectious and noninfectious diagnoses but an increase in illness severity during the early-COVID era compared with the pre-COVID era. Our data suggest a need to reconsider current thresholds for hospitalization and identify opportunities to support and guide families through certain illnesses without hospitalization.

This article describes a quality improvement project that assessed nurses' knowledge and practices for patients admitted with a blunt chest wall injury and utilized interactive learning to revive the use of the protocol.

Hereditary angioedema is a rare and commonly misdiagnosed disease characterized by recurrent, painful, nonurticarial, and nonpruritic deep tissue swelling attacks, including potentially life-threatening asphyxiation. Nurses can assist in identifying disease hallmarks and provide emergency care, patient support, and education about injectable or infused medications.

With nursing burnout on the rise, effective self-care interventions such as gratitude journals are needed to help nurses cope with symptoms of burnout. Gratitude journals can support nurses' emotional health by improving stress management and offering an opportunity for overall self-reflection.

The question of anticoagulant dosing in hospitalized patients with coronavirus disease-2019 (COVID-19) is unresolved, with randomized trials showing mixed results and heterogeneity of treatment effects for in-hospital death.To examine the association between the intensity of anticoagulation and clinical outcomes in hospitalized patients with COVID-19.Retrospective cohort study of patients with COVID-19 and respiratory impairment who were hospitalized between 3/1/2020-12/31/2020 in two Kaiser Permanente regions.We fit propensity score models using categorical regression to estimate the probability of receiving standard prophylactic, intermediate, or full-dose anticoagulation beginning on the day of admission or on the day of first respiratory deterioration. Exposure was defined by the highest dose on the day of admission or within 24 hours after deterioration. The primary outcome was in-hospital death.We included 17,130 patients in the day of admission analysis and 4,924 patients who experienced respiratory deterioration. There were no differences in propensity score-adjusted odds of in-hospital death for patients who received either intermediate (odds ratio [OR]: 1.00, 95% confidence intervals [CI] 0.89-1.12) or full anticoagulation (OR: 1.00, 95% CI: 0.85-1.17) compared with standard prophylaxis beginning on the day of admission. Similarly, there were no differences in in-hospital death for either intermediate (OR: 1.22, 95% CI: 0.82-1.82) or full anticoagulation (OR: 1.50, 95% CI: 0.90-2.51) compared with standard prophylaxis on the day of deterioration.Results of this real-world, comparative effectiveness study showed no differences in in-hospital death among newly admitted or deteriorating patients with COVID-19 who received intermediate-dose or full anticoagulation compared with standard prophylaxis.

Introduction: Neoadjuvant chemotherapy (NAC) is used with increasing frequency in breast cancers. Various clinicopathological parameters predict treatment response (TR). Tumor budding (TB), which is a prognostic parameter in many cancers, can be considered the first stage of the metastatic process. In our study, the relationship between TR and clinicopathological parameters and TB in core biopsy samples of patients before NAC was investigated.

Children in mental health crises are increasingly admitted to children's hospitals awaiting inpatient psychiatric placement. During hospitalization, patients may exhibit acute agitation prompting pharmacologic restraint use.To determine hospital-level incidence and variation of pharmacologic restraint use among children admitted for mental health conditions in children's hospitals.We examined data for children (5 to ≤18 years) admitted to children's hospitals with a primary mental health condition from 2018 to 2020 using the Pediatric Health Information System database. Hospital rates of parenteral pharmacologic restraint use per 1000 mental health bed days were determined and compared after adjusting for patient-level and demographic factors. Cluster analysis (k-means) was used to group hospitals based on overall restraint use (rate quartiles) and drug class. Hospital-level factors for pharmacologic restraint use were compared.Of 29,834 included encounters, 3747 (12.6%) had pharmacologic restraint use. Adjusted hospital rates ranged from 35 to 389 pharmacologic restraint use days per 1000 mental health bed days with a mean of 175 (standard deviation: 72). Cluster analysis revealed three hospitals were high utilizers of all drug classes. No significant differences in pharmacologic restraint use were found in the hospital-level analysis.Children's hospitals demonstrate wide variation in pharmacologic restraint rates for mental health hospitalizations, with a 10-fold difference in adjusted rates between highest and lowest utilizers, and high overall utilizers order medications across all drug classes.

Patterns in access to specialists among patients in skilled nursing facilities (SNFs) have not been previously described.To measure access to outpatient specialty follow-up and subsequent emergency department (ED) visits by patient characteristics, including race/ethnicity and those who received specialty care during the hospitalization that preceded the SNF stay.This retrospective cohort study used the minimum data set and 100% Medicare fee-for-service claims for beneficiaries admitted to an SNF between 2012 and 2014. Hospital stays for surgical procedures were excluded.The associations between ED visits, follow-up, and race/ethnicity were measured using logistic and linear regression, adjusting for patient demographic and clinical characteristics.The sample included 1,117,632 hospitalizations by Medicare beneficiaries ≥65 with a consult by a medical subspecialist followed by discharge to SNF. Of the sample, 85.4% were non-Hispanic White (NHW) and 14.6% were Black, indigenous, and people of color (BIPOC), according to Medicare beneficiary records. During the SNF stay, BIPOC patients had lower odds of specialty follow-up compared to NHW patients (odds ratio [OR]: 0.96, 95% confidence intervals [CI]: 0.94-0.99, p = .004). BIPOC patients had higher rates of ED visits compared to NHW patients (with follow-up: 24.1% vs. 23.4%, and without follow-up: 27.4% vs. 25.9%, p .001). Lack of follow-up was associated with a 0.8 percentage point difference in ED visits between BIPOC and NHW patients (95% CI: 0.3-1.3, p = .003).There is a racial/ethnic disparity in subspecialty follow-up after hospital discharge to SNF that is associated with a higher rate of subsequent ED visits by BIPOC patients.

Although viral etiologies predominate, antibiotics are frequently prescribed for community-acquired pneumonia (CAP).We evaluated the association between antibiotic use and outcomes among children hospitalized with suspected CAP.We performed a secondary analysis of a prospective cohort of children hospitalized with suspected CAP.The exposure was the receipt of antibiotics in the emergency department (ED).Clinical outcomes included length of stay (LOS), care escalation, postdischarge treatment failure, 30-day ED revisit, and quality-of-life (QoL) measures from a follow-up survey 7-15 days post discharge. To minimize confounding by indication (e.g., radiographic CAP), we performed inverse probability treatment weighting with propensity analyses.Among 523 children, 66% were5 years, 88% were febrile, 55% had radiographic CAP, and 55% received ED antibiotics. The median LOS was 41 h (IQR: 25, 54). After propensity analyses, there were no differences in LOS, escalated care, treatment failure, or revisits between children who received antibiotics and those who did not. Seventy-one percent of patients completed follow-up surveys after discharge. Among 16% of patients with fevers after discharge, the median fever duration was 2 days, and those who received antibiotics had a 37% decrease in the mean number of days with fever (95% confidence interval: 20% and 51%). We found no statistical differences in other QoL measures.

One-third of peripheral intravenous catheters (PIVCs) fail from inflammatory or infectious complications, causing substantial treatment interruption and replacement procedures.We aimed to compare complications between integrated PIVCs (inbuilt extension sets, wings, and flattened bases) and traditional nonintegrated PIVCs.A centrally randomized, controlled, superiority trial (with allocation concealment until study entry) was conducted in three Australian hospitals. Medical-surgical patients (one PIVC each) requiring intravenous therapy for24 h were studied.The primary outcome was device failure (composite: occlusion, infiltration, phlebitis, dislodgement, local, or bloodstream infection). Infection endpoints were assessor-masked. The secondary outcomes were: failure type, first-time insertion success, tip colonization, insertion pain, dwell time, mortality, costs, health-related quality of life, clinician, and patient satisfaction.Out of 1759 patients randomized (integrated PIVC, n = 881; nonintegrated PIVC, n = 878), 1710 (97%) received a PIVC and were in the modified intention-to-treat analysis (2269 PIVC-days integrated; 2073 PIVC-days nonintegrated). Device failure incidence was 35% (145 per 1000 device-days) nonintegrated, and 33% (124 per 1000 device-days) integrated PIVCs.Integrated PIVCs had a significantly lower failure risk (adjusted [sex, infection, setting, site, gauge] hazard ratio [HR]: 0.82 [95% confidence interval, CI: 0.69-0.96], p = .015). The per-protocol analysis was consistent (adjusted HR: 0.80 [95% CI: 0.68-0.95], p = .010). Integrated PIVCs had significantly longer dwell (top quartile ≥ 95 vs. ≥84 h). Mean per-patient costs were not statistically different.PIVC failure is common and complex. Significant risk factors include sex, infection at baseline, care setting, insertion site, catheter gauge, and catheter type. Integrated PIVCs can significantly reduce the burden of PIVC failure on patients and the health system.

Sepsis remains a life-threatening condition and leading cause of death in the United States despite vast efforts to understand and treat it. Successful sepsis treatment requires the timely implementation of the sepsis bundle to avoid multiple organ system failure; a key component of sepsis care is nursing surveillance. The purpose of this study was to explore nurses' knowledge of nursing surveillance related to the patient with sepsis and to describe barriers to the implementation of nursing surveillance for sepsis and the sepsis bundle.A qualitative descriptive design study used focus groups to elicit responses to open-ended questions.Focus group interviews with 28 registered nurses were conducted. All focus group participants had a minimum of 6 months' experience caring for patients with sepsis.Five themes emerged from the study: (1) knowledge deficit of the sepsis bundle and nursing surveillance, (2) uncertain and overwhelmed, (3) lack of resources, (4) in the dark, and (5) lack of partnership/respect. The notion of fearing the patient with sepsis and knowledge deficits of nursing surveillance and sepsis bundle were unique findings.Findings highlight the need for increased attention on the importance of nurse surveillance of the patient with sepsis.

This article describes current evidence-based approaches to the care and education of adults living with diabetes. It also highlights revisions in the 2022 Standards of Care and evidence-based strategies nurses can use to be more effective.