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Context: Lateral epicondylopathy (LE) is a common overuse injury affecting elbow, wrist, and hand function. It is characterized by weakness and pain in the muscles and tendons of the forearm responsible for the extension of your wrist and fingers. Trigger point dry needling is a technique reported to be beneficial in managing pain and dysfunction after LE diagnosis. LE is also commonly treated with conservative treatment, such as joint and soft tissue mobilization, self-care home programs, and anti-inflammatory use. We explored a different dry needling approach consisting of in situ dry needling with electric stimulation combined with targeted therapeutic exercise to treat LE in 3 cases. Case Presentation: Three patients were referred for dry needling once a week for 6 weeks and home-based exercise therapy for LE. They were clinically evaluated using grip strength, a visual analog scale to assess pain, and Patient-Rated Tennis Elbow Evaluation Test scores. These were measured at 4 time points (weeks 0, 2, 4, and 6). Management and Outcomes: The dry needling intervention incorporated 8 locations in the upper-extremity with 2 electric stimulation channels. The patients had reduced pain as measured by a visual analog scale, increased function as measured by the Patient-Rated Tennis Elbow Evaluation Test, and increased grip strength over 6 weeks. Conclusions: This case series illustrates the use of dry needling and a home exercise program to provide a favorable outcome in a patient with LE. Patients had an 80% to 100% reduction in pain and similar improvements in function that were significantly beyond the minimum clinically important difference. This dry needling approach is a safe and effective treatment of LE in the short term. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to evaluate factors associated with discharge to subacute care after surgery for degenerative cervical myelopathy. Design: This is a retrospective chart review of adults who underwent cervical spine surgery for degenerative cervical myelopathy between 2014 and 2020 (N = 135). Results: Patients discharged to a subacute setting were older (68.1 ± 8.6 vs. 64.1 yrs ± 8.8, P = 0.01), more likely to be unmarried (55.8% vs. 33.7% married, P = 0.01), and more likely to have Medicare or Medicaid (83.7% vs. 65.9% private insurance, P = 0.03) than patients discharged home. A posterior surgical approach was associated with discharge to a subacute setting (62.8% vs. 43.5% anterior approach, P = 0.04). A total of 87.8% of patients discharged to a subacute setting required moderate or maximum assistance for bed mobility versus 26.6% of patients discharged home (P < 0.0001). Compared with patients discharged home, patients discharged to a subacute setting ambulated a shorter distance in their first physical therapy evaluation after surgery (8.9 ± 35.8 vs. 53.7 ± 61.78 m in the home discharge group, P < 0.0001). Conclusions: Analysis of these factors may guide discussions about patient expectations for postoperative discharge placement. [ABSTRACT FROM AUTHOR]

Background: Prevention and Recovery Care services are residential sub-acute services in Victoria, Australia, guided by a commitment to recovery-oriented practice. The evidence regarding the effectiveness of this service model is limited, largely relying on small, localised evaluations. This study involved a state-wide investigation into the personal recovery, perceived needs for care, well-being and quality-of-life outcomes experienced by Prevention and Recovery Care services' consumers. Methods: A longitudinal cohort design examined the trajectory of self-reported personal recovery and other outcomes for consumers in 19 Victorian Prevention and Recovery Care services over 4 time points (T1 – 1 week after admission; T2 – within 1 week of discharge; T3 – 6 months after discharge; T4 – 12 months after discharge). T2–T4 time frames were extended by approximately 3 weeks due to recruitment challenges. The Questionnaire about the Process of Recovery was the primary outcome measure. Results: At T1, 298 consumers were recruited. By T4, 114 remained in the study. Participants scored higher on the Questionnaire about the Process of Recovery at all three time points after T1. There were also sustained improvements on all secondary outcome measures. Improvements were then sustained at each subsequent post-intervention time point. Community inclusion and having needs for care met also improved. Conclusion: The findings provide a consistent picture of benefits for consumers using Prevention and Recovery Care services, with significant improvement in personal recovery, quality of life, mental health and well-being following an admission to a Prevention and Recovery Care service. Further attention needs to be given to how to sustain the gains made through a Prevention and Recovery Care service admission in the long term. [ABSTRACT FROM AUTHOR]

Aim: The aim was to investigate factors influencing obesity among stroke survivors based on demographics and lifestyle behaviors. Background: Stroke survivors are more likely to experience stroke recurrence within a few years. As obesity is a traditional risk factor for stroke, obesity should be managed in stroke survivors to prevent stroke recurrence. Methods: A cross-sectional secondary data analysis analyzed data from the 2017 United States Behavioral Risk Factor Surveillance System (BRFSS) survey. Demographics, frequency of vegetable and fruit intake, smoking, alcohol use, physical activity, and sleep were examined. Results: Among 1032 stroke survivors, 57.8% were obese. Advanced age, female sex, veteran status, at least once-daily fruit intake, current smoking, and lack of physical activity were associated with obesity. Conclusion: Stroke survivors should be encouraged to pursue healthy behaviors to manage obesity. Appropriate transitional care, including diet education and tailored exercise, can be an effective strategy. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to describe clinical outcomes of bridled nasogastric tube (NGT) program implementation for infants requiring assisted home feeding (AHF) to discharge from the neonatal intensive care unit (NICU). Study Design This was a descriptive prospective analysis of a pilot cohort of infants after implementation of a bridled NGT AHF program to facilitate discharge from level III and IV NICUs from March 2019 to October 2020. Results Of 29 attempts in infants, 22 infants were discharged with bridled NGTs over 18 months. Bridle placement was unsuccessful in three patients, and four bridles were removed before discharge. Bridle use ranged from 7 to 125 days, with a median duration of 37 days. Dislodgement rate was 0.69 per 100 days. Seventeen infants (77%) achieved full oral feeds, while five (23%) discharged with bridled NGTs later converted to gastrostomy tubes. Conclusion Implementation of a bridled NGT program is feasible for level III and IV NICUs to facilitate discharging infants who require feeding support to transition home. Key Points Bridled NGT use after NICU is typically 1 month. Infants have low bridle NGT dislodgement. Most bridled NGT NICU grads attain full oral feeds. [ABSTRACT FROM AUTHOR]

The article focuses on ethical dilemmas surrounding adolescent boarding in Emergency Departments (EDs), specifically addressing autonomy, nonmaleficence, and distributive justice. Topics include whether minors such as Bethany can make their own medical decisions, the duty of caregivers to protect minors from potential harm upon discharge, and the responsibility for ongoing care and support for patients in similar situations.

Background: Parents of infants born with congenital heart disease (CHD) who require open heart surgery after birth are at risk for prolonged psychological distress. Even after their infants are discharged, parents may experience anxiety, depressive, and post−traumatic stress (PTS) symptoms; yet, it is unclear which parents are at greater risk for ongoing symptoms. The purpose of this study was to explore whether measures of the biomarker cortisol in parents during their infants' postoperative period were associated with subsequent psychological distress symptoms at three−month post discharge. Methods: This was a prospective, longitudinal exploratory study of 40 parents of infants with CHD after open heart surgery using consecutive enrollment. Parents provided diurnal saliva samples for two consecutive days in the postoperative period. Six predictors were summarized and generated including waking cortisol, bedtime cortisol, cortisol awaking response, area under curve with respect to the ground (AUCg), cortisol index, and cortisol slope. Self−report outcome measures on anxiety, depressive, and PTS symptoms were collected three−months post−discharge. Linear mixed models examined the associations between each predictor and each outcome while accounting for within−dyad variance using an unstructured covariance matrix. Results: Cortisol AUCg was a predictor of PTS at three−months post−discharge (β =.34, p =.03, Cohen's d = 2.05). No significant relationships were found with the other cortisol measures. Conclusions & Implications: Findings suggest that cortisol area under curve may help to identify parents at risk for increased PTS in the months following their infants' hospitalization for cardiac surgery, serving as a foundation for future study in this area. [ABSTRACT FROM AUTHOR]

Background: Determining appropriate extracorporeal membrane oxygenation (ECMO) candidacy ensures appropriate utilization of this costly resource. The current ECMO survival prediction scores do not consider clinician assessment of patient viability. This study compared clinician prediction of survival to hospital discharge versus prediction scores. Objectives: The aim of this study was to compare clinician prediction of patients' survival to hospital discharge versus prognostic prediction scores (Respiratory ECMO Survival Prediction [RESP] or Survival After Veno-Arterial ECMO [SAVE] score) to actual survival. Methods: This was an observational descriptive study from January 2020 to November 2021 conducted with interviews of nurses, perfusionists, and physicians who were involved during the initiation of ECMO within the first 24 hours of cannulation. Data were retrieved from the medical record to determine prediction scores and survival outcomes at hospital discharge. Accuracy of clinician prediction of survival was compared to the RESP or SAVE prediction scores and actual survival to hospital discharge. Results: Accurate prediction of survival to hospital discharge for veno-venous ECMO by nurses was 47%, 64% by perfusionists, 45% by physicians, and 45% by the RESP score. Accurate predictions of patients on veno-arterial ECMO were correct in 54% of nurses, 77% of physicians, and 14% by the SAVE score. Physicians were more accurate than the SAVE score, P =.021, and perfusionists were significantly more accurate than the RESP score, P =.044. There was no relationship between ECMO specialists' years of experience and accuracy of predications. Conclusion: Extracorporeal membrane oxygenation clinicians may have better predictions of survival to hospital discharge than the prediction scores. Further research is needed to develop accurate prediction tools to help determine ECMO eligibility. [ABSTRACT FROM AUTHOR]

The article focuses on considering liver abscess as a potential etiology for prolonged fever without an obvious cause in pediatric patients, especially those with acute changes in appetite, abdominal symptoms, or recent abdominal trauma. Topics include typical bacteria associated with liver abscesses, such as Staphylococcus aureus and Escherichia coli, as well as parasitic etiologies like Amebiasis and Human Echinococcosis, based on exposure history.

Congenital tracheo-esophageal fistula/esophageal atresia (TEF/EA) with concomitant pulmonary agenesis is exceedingly rare and has a high mortality rate. While there are several reported cases of successful repair, all but one patient had right-sided pulmonary agenesis. In the case of left-sided pulmonary agenesis, the patient had incomplete agenesis and underwent repair through a left thoracotomy. We present the first successful repair of TEF/EA with complete left-sided pulmonary agenesis. This patient also underwent elective pre-operative veno-venous extracorporeal membrane oxygenation (ECMO) and subsequent repair of the TEF/EA. We discuss the management, anesthesia risks, and role of periprocedural ECMO in pediatric patients who are high anesthetic risk. [ABSTRACT FROM AUTHOR]

Low-velocity penetrating brain injury (LVPBI) is a class of brain injury where a foreign object violates the skull and damages the brain. Such injuries are rare and consequently understudied. As such, we report an illustrative case of a 29-year-old female with a dense, plastic spike penetrating her right orbit and into her midbrain. After assessment with a CT scan and angiography, the object was removed with careful attention to possible vascular injury. The patient had an uncomplicated post-operative course and received antibiotic and antiepileptic prophylaxis. She was discharged on post-operative day 5, experiencing only mild left-sided weakness. Common concerns regarding LVPBI include infection, post-traumatic epilepsy, and vascular injury. A review of published LVPBI cases over the past 20 years demonstrated that most cases (55.2%) are due to accidents. Of patients undergoing surgery, 43.4% underwent a craniotomy, and 22.8% underwent a craniectomy. Despite the grave nature of LVPBI, only 13.5% of the patients died. Additionally, 6.5% of patients developed an infection over their clinical course. In all, more reported cases further paint a picture of the current state of management and outcomes regarding LVPBI, paving the way for more cohesive guidelines to ensure the best possible patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: This systematic review and meta-analysis aimed to analyze the published randomized controlled trials (RCTs) that investigated the effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness. Design: Systematic review and meta-analysis of RCTs. Data sources: We searched PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, PEDro data base, and SciELO (from the earliest date available to January 2023) for RCTs that evaluated the effects of physical rehabilitation interventions following hospital discharge for recovery from critical illness. Review methods: Study quality was evaluated using the PEDro Scale. Mean differences (MDs), standard MDs (SMD), and 95% confidence intervals (CIs) were calculated. Results: Fourteen studies met the study criteria, including 1259 patients. Exercise interventions improved aerobic capacity SMD 0.2 (95% CI: 0.03–0.3, I 2 = 0% N = 880, nine studies, high-quality evidence), and physical component score of health-related quality of life MD 3.3 (95% CI: 1.0–5.6, I 2 = 57%, six studies N = 669, moderate-quality evidence). In addition, a significant reduction in depression was observed MD −1.4 (95% CI: −2.7 to −0.1, I 2 = 0% N = 148, three studies, moderate-quality evidence). No serious adverse events were reported. Conclusion: Exercise intervention was associated with improvement of aerobic capacity, depression, and physical component score of health-related quality of life after hospital discharge for survivors of critical illness. [ABSTRACT FROM AUTHOR]

The health service access point (PASS) allows people in precarious situations to benefit from medical and social care. A mobile PASS service was set up in 2020 in Marseille for people seeking asylum (DA). The objective of our study was to describe the care pathways within the PASS for DA. We led a retrospective observational study of care pathways of the 418 DA included in the PREMENTADA study (ClinicalTrials number: NCT05423782) in the 3 months following their inclusion. We conducted a quantitative study, which ran from March 1, 2021, to August 31, 2021, to collect data from mobile and hospital PASS consultations, referrals following PASS consultations or hospitalizations, emergency room visits, hospitalizations, prescription, and dispensing of treatment following PASS consultations or on discharge from hospital, between D0 and M3. A total of 163 (39.0%) patients were lost to follow-up after an initial assessment of their health status. Overall, 74.4% of the patients were followed only by the mobile PASS for a mental health problem, and 57.4% were followed for a somatic problem until they obtained their rights. The mobile PASS referred 43.5% of patients to the hospital PASS for access to various technical facilities: medical imaging, pharmacy (63% of them benefited from the dispensing of health products), biological tests, and so on. The morbidities of the DAs were severe enough to require technical support that the mobile PASS could not provide, but recourse to the emergency department was fairly low (1.6%), testifying to the efficiency of the primary care provided by the mobile PASS. Our study provides the first data concerning the DA's healthcare pathway in France. Considering the health status of this population and the fact that early management of health problems allows for rationalization of costs, we can ask the question of the future of these patients in the absence of adapted care systems. The PASS and the hospitals to which they are attached will have to adapt their care offer to take into account the DA's specific problems. [ABSTRACT FROM AUTHOR]

In this Perspective, we contend bold action is needed to improve transitions from hospitals to home for aging patients and their family caregivers living in rural and underserved areas. The Caregiver Advise, Record, Enable (CARE) Act, passed in over 40 US states, is intended to provide family caregivers of hospitalized patients with the knowledge and skills needed for safe and efficient transitions. It has broken important ground for family caregivers who assist with transitions in patient care. It may fall short, however, in addressing the unique needs of family caregivers living in rural and underserved areas. We contend that to realize the intended safety, cost, and care quality benefits of the CARE Act, especially for those living in rural and underserved areas, states need to expand the Act's scope. We provide three recommendations: 1) modify hospital information systems to support the care provided by family caregivers; 2) require assessments of family caregivers that reflect the challenges of family caregiving in rural and underserved areas; and 3) identify local resources to improve discharge planning. We describe the rationale for each recommendation and the potential ways that an expanded CARE Act could reduce the risks associated with transitions in care for aging patients. Key Points: 1. Recent state laws aim to support family caregivers of hospitalized patients. 2. These laws do not account for the unique needs of rural caregivers. 3. Expanding laws to address rural caregiver needs may improve patient outcomes [ABSTRACT FROM AUTHOR]

Background: Respiratory syncytial virus (RSV) affects 60–80% of children below 1 year and it's the first cause of acute bronchiolitis. The aim of this study was to assess the trend and characteristics of hospitalizations for RSV infections in Italy. Methods: This is a retrospective study based on the Italian Hospital Discharge Record (HDR) database. We analysed HDRs from June 2015 to May 2019, considering two groups of infants: Group 1 had a confirmed diagnosis of RSV; Group 2 had a diagnosis of acute bronchiolitis not RSV-coded. Results: There were 67,746 overall hospitalizations (40.1% Group 1, and 59.9% Group 2). Hospitalization rate increased for Group 1 from 125 to 178 per 10,000 infants (+ 42.4%), and for Group 2 from 210 to 234 per 10,000 (+ 11.4%). The mean hospitalization length was 6.3 days in Group 1, longer than Group 2 (+ 1.0 day). A further analysis revealed that infants with heart disease or born premature had longer mean hospital stay compared to infants without risk factors (10.7 days versus 6.1 days, p < 0.0001; 34.0 days versus 6.1 days, p < 0.0001, respectively). Group 1 required more critical care (oxygen therapy and/or mechanical ventilation) than Group 2. We found that, in proportion to hospital admissions in pediatric and general hospitals, RSV was more frequently diagnosed in the first ones. The mean hospitalization cost increased for Group 1 (from € 2,483 to € 2,617) and Group 2 (from € 2,007 to € 2,180). Conclusions: Our results confirmed that RSV pulmonary disease in infants is seasonal and often requires hospitalization. Our study suggested that RSV is responsible for an increasing hospitalization rate and related costs during the study period. [ABSTRACT FROM AUTHOR]

Describe prevalence and severity of fatigue in children and adolescents with burns during six months after hospital discharge, identify potential explanatory variables, and examine the relationship with exercise capacity. Fatigue was assessed using the Pediatric-Quality-of-Life-Inventory-Multidimensional-Fatigue-Scale (PedsQL-MFS) at discharge, and six weeks, three-, and six months after discharge. PedsQL-MFS scores ≥1 SD below the age-group specific non-burned reference mean were considered to signify fatigue. Twenty-two children and adolescents (13 boys/9 girls, age 6–18 years, with burns covering 2–34% of total body surface area) were included. The prevalence of fatigue decreased from 65% (11/17) at discharge to 28% (5/18) six months after discharge. At group level, fatigue severity decreased over time, reaching healthy reference values from six weeks after discharge and beyond. At individual level, the course of fatigue severity varied widely. Fatigue severity at six months after discharge could not be predicted by age, sex, or burn severity (p = 0.51, p = 0.58, p = 0.95, respectively). The association with exercise capacity was weak (r = 0.062–0.538). More than a quarter of pediatric burn patients reported fatigue six months after discharge. Further research in larger populations is required, including also the impact of burn-related fatigue on daily functioning and quality of life.Trial registration number: OND1353942 Fatigue should be recognized as a potential consequence of (pediatric) burns, even several months post burn Fatigue should be assessed regularly after discharge in all children and adolescents with burns, as it seems not possible to predict its severity from age, sex, or burn severity characteristics The weak association between exercise capacity and self-reported fatigue suggests that burn-related fatigue is not simply a consequence of a reduced exercise capacity [ABSTRACT FROM AUTHOR]

To prioritize and achieve consensus on mobility determinant factors [cognitive, financial, environmental, personal, physical, psychological, social] considered critical to include in the COmprehensive Mobility Discharge Assessment Framework (COMDAF) for older adults transitioning from hospital-to-home. We conducted a three-round modified e-Delphi process with 60 international experts (seven older adults, nine family caregivers, 24 clinicians, and 20 researchers) from nine countries with universal or near-universal health coverage. Expert members rated 91 factors identified from scoping reviews using a 9-point scale: not important (1-3), important (4-6), and critical (7-9). A total of 41 of 91 factors (45.1%) met the a-priori consensus criterion after three rounds: five cognitive, five environmental, two personal, 19 physical, six psychological, and six social factors. No financial factors reached a consensus. The older adult steering committee member recommended the addition of two environmental factors, resulting in 43 mobility factors included in the COMDAF. We advanced a comprehensive mobility framework by developing, through consensus, 43 mobility factors to be assessed as part of a COMDAF. However, its use in hospital-to-home may not be feasible. Therefore, future research will determine the core mobility factors for COMDAF and which measurement instruments best measure these factors. An interdisciplinary discharge rehabilitation team can utilize the COMDAF during hospital-to-home transition. Mobility assessment following a hospital discharge is a complex process requiring an interdisciplinary discharge rehabilitation team. This study provided a comprehensive list of 91 factors across all seven mobility determinants (cognitive, environmental, financial, personal, physical, psychological, and social) for clinicians in other care settings to use as a starting point to determine which mobility factor should be assessed during older adults' hospital-to-home transition. This international e-Delphi study identified 43 factors within mobility determinants (cognitive, environmental, personal, physical, psychological, and social) to be included in a Comprehensive Mobility Discharge Assessment Framework to assess older adults' mobility during the hospital to home transition. Using these 43 factors, clinicians can identify which assessment tool is best suited to assess the factors while reflecting on the logistics and feasibility; this is the next phase of this project [ABSTRACT FROM AUTHOR]

Background: Patients who have benefited from specialist intervention during periods of acute/complex palliative care needs often transition from specialist-to-primary care once such needs have been controlled. Effective communication between services is central to co-ordination of care to avoid the potential consequences of unmet needs, fragmented care, and poor patient and family experience. Discharge communications are a key component of care transitions. However, little is known about the experiences of those primarily receiving these communications, to include patients', carers' and primary care healthcare professionals. This study aims to have a better understanding of how the discharge communications from specialist palliative care services to primary care are experienced by patients, carers, and healthcare professionals, and how these communications might be improved to support effective patient-centred care. Methods: This is a 15-month qualitative study. We will interview 30 adult patients and carers and 15 healthcare professionals (n = 45). We will seek a range of experiences of discharge communication by using a maximum variation approach to sampling, including purposively recruiting people from a range of demographic backgrounds from 4–6 specialist palliative care services (hospitals and hospices) as well as 5–7 general practices. Interview data will be analysed using a reflexive thematic approach and will involve input from the research and advisory team. Working with clinicians, commissioners, and PPI representatives we will co-produce a list of recommendations for discharge communication from specialist palliative care. Discussion: Data collection may be limited by the need to be sensitive to participants' wellbeing needs. Study findings will be shared through academic publications and presentations. We will draft principles for how specialist palliative care clinicians can best communicate discharge with patients, carers, and primary care clinicians. These will be shared with clinicians, policy makers, commissioners, and PPI representatives and key stakeholders and organisations (e.g. Hospice UK) and on social media. Key outputs will be recommendations for a specialist palliative care discharge proforma. Trial registration: Registered in ISRCTN Registry on 29.12.2023 ref: ISRCTN18098027. [ABSTRACT FROM AUTHOR]

The article focuses on congenital laryngeal webs, a rare malformation resulting from embryonic laryngeal recanalization failure, with less than 5 present of congenital laryngeal anomalies. Topics include the anatomical location and etiology of laryngeal webs, presenting symptoms such as hoarseness and respiratory distress, and a case report detailing a 6-year-old with unrecognized laryngeal web misdiagnosed as laryngopharyngeal reflux and vocal cord paresis.

Background Public health officials are responding to an outbreak of fungal meningitis among patients who received procedures under epidural anesthesia at 2 clinics (River Side Surgical Center and Clinica K-3) in Matamoros, Mexico, during 1 January to 13 May 2023. This report describes outbreak epidemiology and outlines interim diagnostic and treatment recommendations. Methods Interim recommendations for diagnosis and management were developed by the Mycoses Study Group Research Education and Consortium (MSGERC) based on the clinical experience of clinicians caring for patients during the current outbreak or during previous outbreaks of healthcare-associated fungal meningitis in Durango, Mexico, and the United States. Results As of 7 July 2023, the situation has evolved into a multistate and multinational fungal meningitis outbreak. A total of 185 residents in 22 US states and jurisdictions have been identified who might be at risk of fungal meningitis because they received epidural anesthesia at the clinics of interest in 2023. Among these patients, 11 suspected, 10 probable, and 10 confirmed US cases have been diagnosed, with severe vascular complications and 8 deaths occurring. Fusarium solani species complex has been identified as the causative agent, with antifungal susceptibility testing of a single isolate demonstrating poor in vitro activity for most available antifungals. Currently, triple therapy with intravenous voriconazole, liposomal amphotericin B, and fosmanogepix is recommended. Conclusions Efforts to understand the source of this outbreak and optimal treatment approaches are ongoing, but infectious diseases physicians should be aware of available treatment recommendations. New information will be available on the Centers for Disease Control and Prevention's (CDC's) website. [ABSTRACT FROM AUTHOR]

Death may be the only certainty in life, but for palliative care patients and their carers, it is anything but. How long is there left? Will a hospice bed be available? What new loss (big or small), will tomorrow bring? Research suggests that the poor management of uncertainty in palliative care can significantly impact patient outcomes as well as the experience of bereaved families. Social workers cannot mitigate this uncertainty, but they can support individuals to recognise and engage with it. Often, this can create tensions with their personal instinct to remove distress, as well as their professional drive to 'fix things'. By overcoming these challenges and embracing their ability to find ways forward 'in the midst of the messy stuff', they model a constructive mode of behaviour that patients and other multidisciplinary professionals can then mirror. [ABSTRACT FROM AUTHOR]

Background: This study investigated differences in the clinical and demographic characteristics of individuals with intellectual disabilities delayed in assessment and treatment hospitals versus individuals who were not delayed. The study further investigated the clinical outcomes of the individuals whose discharge from the hospital was delayed. Method: This was a cohort study using secondary data collected from patient records. Variables included age, ethnicity, levels of deprivation, areas of origin, diagnoses, and the provision of a care and treatment review. A comparison was made between individuals who became delayed despite being clinically ready for discharge and those who were discharged on time. Findings: Individuals with severe intellectual disabilities were more likely to experience delayed discharge from hospital (p = 0.001). Similarly, people who were admitted to hospitals away from their home areas were also more likely to experience delayed discharge (p < 0.001). There were no significant differences between the delayed and nondelayed groups for other factors such as age, deprivation or ethnicity. Individuals who experienced a delay in discharge did not experience an increased rate of adverse incidents compared to the period of active treatment and clinical improvements were maintained during the period of delay. There were low rates of completion of care and treatment reviews before admission, although people who were delayed were more likely to have received a review during admission (78.8% vs. 27.1%). Conclusion: It is important for clinicians and service development leads to be aware that people who are admitted away from their home area and people with severe intellectual disabilities may be at higher risk of experiencing significantly delayed discharge from the hospital. More broadly, many people remained in hospital for a substantial length of time after being assessed as clinically ready for discharge. Due to the low rates of completion before admission, the expansion of community‐based care and treatment reviews should also be explored. While people did not suffer increased rates of adverse incidents during their extended stay, their liberty was still restricted, hence there should be a focus on effective community provision. The current model of relying on the willingness of independent providers to support the care of complex individuals requires significant reform. Accessible summary: Some people stay in learning disability hospitals longer than they need to. This is because they do not have a home or a care team in their community.People with more severe disabilities, and people who are in a hospital a long way from home are more likely to stay in the hospital longer than they need to.Services need to make changes so that people with extra needs can be supported well at home. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To assess whether hospitals participating in Medicare's Bundled Payments for Care Improvement (BPCI) program for joint replacement changed their referral patterns to favor higher-quality skilled nursing facilities (SNFs). STUDY DESIGN: Retrospective observational study using 2009-2015 inpatient and outpatient claims from a 20% sample of Medicare beneficiaries undergoing joint replacement in US hospitals (N = 146,074) linked with data from Medicare's BPCI program and Nursing Home Compare. METHODS: We ran fixed effect regression models regressing BPCI participation on hospital-SNF referral patterns (number of SNF discharges, number of SNF partners, and SNF referral concentration) and SNF quality (facility inspection survey rating, patient outcome rating, staffing rating, and registered nurse staffing rating). RESULTS: We found that BPCI participation was associated with a decrease in the number of SNF referrals and no significant change in the number of SNF partners or concentration of SNF partners. BPCI participation was associated with discharge to SNFs with a higher patient outcome rating by 0.04 stars (95% CI, 0.04-0.26). BPCI participation was not associated with improvements in discharge to SNFs with a higher facility survey rating (95% CI, -0.03 to 0.11), staffing rating (95% CI, -0.07 to 0.04), or registered nurse staffing rating (95% CI, -0.09 to 0.02). CONCLUSIONS: BPCI participation was associated with lower volume of SNF referrals and small increases in the quality of SNFs to which patients were discharged, without narrowing hospital-SNF referral networks. [ABSTRACT FROM AUTHOR]

BACKGROUND: The return to activities and sports after the anterior cruciate ligament (ACL) reconstruction is a critical decision. OBJECTIVE: To verify the most used elements during the isokinetic evaluation for discharge after ACL reconstruction. METHODS: Systematic review (PROSPERO CRD42021224433). Research in the literature: PubMed, Medline, SciELO, Lilacs, CENTRAL, PEDro, Web of Science and Embase, in February 2022. Studies that performed isokinetic evaluation during the discharge period in male patients aged 18 to 59 years after ACL reconstruction. Descriptive synthesis on the most used parameters during isokinetic evaluation as a discharge criteria after ACL reconstruction. RESULT: Twenty-three studies involving 1,792 participants were included. Medium and high quality evidence identified that most isokinetic evaluations targeted only muscle strength after rehabilitation of the ACL (peak moment). CONCLUSION: The most used elements during the isokinetic evaluation were: angular velocity of 60∘/s, 1 set of 5 repetitions, concentric mode and peak moment. [ABSTRACT FROM AUTHOR]

Background: Ingested foreign bodies pose a unique challenge in medical practice, especially when lodged in the oesophagus. While endoscopic retrieval is the standard treatment, certain cases require more innovative approaches. Methods: This paper reports the case of a patient who intentionally ingested a butter knife that lodged in the thoracic oesophagus. After multiple endoscopic attempts, a lateral neck oesophagotomy, aided using a Hopkins rod camera and an improvised trochar as a protective port, was performed. Results: The foreign body was successfully extracted without causing oesophageal perforation. The patient was made nil by mouth, with nasogastric feeding only until a swallow assessment after one week. The patient was discharged and recovered well. Conclusion: This case illustrates a successful, innovative approach to removing a foreign body in a high-risk patient, highlighting the significance of adaptability in surgical practice. It emphasises the need for individualised approaches based on the patient's history, the nature and location of the foreign body, and associated risks. [ABSTRACT FROM AUTHOR]

To examine whether extended compared to standard level of physiotherapy is feasible and has beneficial effects on physical function in ICU survivors. This prospective pilot study with a before and after design included patients discharged from ICU to a surgical ward. The comparison group were recruited between January and April 2019 and received standard level of physiotherapy. The intervention group were recruited between May and December 2019 and received extended physiotherapy, corresponding to 50% additional physiotherapist, working 4 hours per weekday. The intervention participants received an individual rehabilitation plan developed in collaboration with a ward-based physiotherapist, and an extended number of sessions provided by the extra resource included practicing individualized exercises, for example walking and stair climbing. Physical function was measured with the Chelsea Critical Care Physical Assessment tool (CPAx) at ICU discharge, during hospital stay and discharge. Group differences were analyzed using the Mann–Whitney U-test and Chi2 test. Out of 46 eligible patients, 39 (85%) fulfilled the study (comparison n = 12, intervention n = 27) and were included in the final analyses. No adverse events occurred, and the attendance rate was high (98.5%). There were no statistically significant differences between the groups regarding physical function, hospital stay, and readmissions, but there were tendencies to better outcomes in all these parameters in favor of the intervention group. Additionally, patients in the intervention group had statistically significantly higher scores in the CPAx items "transferring from bed to chair" (median 5 vs 4, p =.039) and "stepping" (median 5 vs 4, p =.005) at hospital discharge. This pilot study indicates that extended physiotherapy after ICU discharge is feasible and does not entail patient safety risks. However, determining the potential beneficial effects for the patients remains to be evaluated in a larger trial. [ABSTRACT FROM AUTHOR]

Objective Safety and efficacy data on controlled hypothermia (CH) for neonates with moderate to severe hypoxic ischemic encephalopathy has been extrapolated to a subgroup of these patients who also require extracorporeal membrane oxygenation for refractory persistent pulmonary hypertension of the newborn (PPHN). However, safety data on the concomitant use of CH and extracorporeal membrane oxygenation (ECMO) are lacking. Methods This is a single-center retrospective study of neonates ≥35 weeks' gestation with refractory PPHN who required ECMO between January 2010 and December 2020. Study groups were divided into those receiving CH/ECMO versus ECMO only. Baseline characteristics, short-term outcomes, and brain magnetic resonance imaging (MRI) data were compared. Results A total of 36 neonates who received ECMO for refractory PPHN were included. Of these, 44.4% (n = 16) received CH/ECMO and 55.6% (n = 20) received ECMO only. Bleeding complications were more common in CH/ECMO group 50% (n = 8) versus ECMO only 15% (n = 3, p = 0.023). T1 brain MRI severity scores were higher in CH/ECMO group versus ECMO only group, however, there were no statistical difference in T2 and diffusion-weighted image scores. Functional status and survival to discharge were comparable between groups. Conclusion In our cohort, neonates who received CH/ECMO had higher bleeding complications than ECMO only group with comparable functional status and survival at discharge. Key Points Safety data on the concomitant use of CH and ECMO are lacking in neonates. In our cohort, neonates who received CH/ECMO had higher bleeding complications than ECMO only group. Functional status and survival to discharge were no differences between the two groups. [ABSTRACT FROM AUTHOR]

The article offers information on the critical recovery period following major pediatric surgery, focusing on the first weeks at home. Topics include pain experience post-discharge, emphasizing the need for a better understanding of pain during this period to identify factors associated with adverse outcomes and intervention opportunities.

The purpose of this study was to evaluate the handoff guidance (HG) self-management intervention for multimorbid chronic obstructive pulmonary disease (COPD) patients following hospitalization for acute exacerbation of COPD (AECOPD) using HG self-management intervention compared to a control group on COPD self-management outcomes (self-care, self-efficacy, health engagement) and assess feasibility, acceptability, and healthcare utilization. A randomized pilot study used a 2-group with repeated measures design. Adults with COPD who had been hospitalized for AECOPD were recruited. After discharge, the HG self-management intervention employed health coaching delivered at: 1--3, 10--12, and 20--22 days after hospital discharge. Follow-up data collected was collected at 1--3, 10--12, 20--22, 30, 60, and 90 days after hospital discharge. A total of 29 subjects participated, with a mean age of 66 (+8.7) years old, the majority were females (n = 18). Intervention participants reported the acceptability of the HG self-management intervention. Participants in both groups continued to report COPD symptoms after discharge, which decreased over time, although not significantly different by group. The use of COPD maintenance, monitoring, and management behaviors was higher in the treatment group, although not significantly different. [ABSTRACT FROM AUTHOR]

BACKGROUND: With increasing implementation of Enhanced Recovery After Surgery protocols and rising demand for inpatient hospital beds accentuated by COVID-19, there has been interest in same-day discharge (SDD) for bariatric surgery. The aim of this study was to determine the national trends, safety profile, and risk factors for complications of SDD for minimally invasive bariatric surgery. STUDY DESIGN: We analyzed the MBSAQIP database from 2016 to 2021 to characterize trends in SDD for minimally invasive bariatric operation. Multivariate logistic regression was performed on preoperative patient characteristics predictive of increased complications associated with SDD. A comparative analysis of postoperative outcomes within 30 days was performed for SDD and admission after 1:1 nearest neighbor propensity score matching for patient demographics and preoperative comorbidities. RESULTS: SDD increased from 2.4% in 2016 to 7.4% in 2021. Major preoperative factors associated with increased complications for SDD included Black race, history of MI, renal insufficiency, deep vein thrombosis, and smoking. SDD for Roux-en-Y gastric bypass had 72% increased risk of postoperative complications compared with sleeve gastrectomy. The overall major complications were lower in SDD cohort vs admission cohort (odds ratio [OR] 0.62, p < 0.01). However, there was a significant increase in deaths within 30 days (OR 2.11, p = 0.01), cardiac arrest (OR 2.73; p < 0.01), and dehydration requiring treatment (OR 1.33; p < 0.01) in SDD cohort compared with admission cohort. CONCLUSIONS: Nationally, there has been a rise in SDD for bariatric operation from 2016 to 2021. Matched analysis demonstrates that SDD is associated with a significantly higher mortality rate. Additionally, the risk of complications with SDD is higher for RYGB compared with sleeve gastrectomy. Therefore, further studies are required to appropriately select patients for whom bariatric surgery can be safely performed as an outpatient. [ABSTRACT FROM AUTHOR]

BACKGROUND: Many institutions have developed operation-specific guidelines for opioid prescribing. These guidelines rarely incorporate in-hospital opioid consumption, which is highly correlated with consumption. We compare outcomes of several patient-centered approaches to prescribing that are derived from in-hospital consumption, including several experimental, rule-based prescribing guidelines and our current institutional guideline. STUDY DESIGN: We performed a retrospective, cohort study of all adults undergoing surgery at a singleacademic medical center. Several rule-based guidelines, derived from in-hospital consumption (quantity of opioids consumed within 24 hours of discharge), were used to specify the theoretical quantity of opioid prescribed on discharge. The efficacy of the experimental guidelines was compared with 3 references: an approximation of our institution's tailored prescribing guideline; prescribing all patients the typical quantity of opioids consumed for patients undergoing the same operation; and a representative rule-based, tiered framework. For each scenario, we calculated the penalized residual sum of squares (reflecting the composite deviation from actual patient consumption, with 15% penalty for overprescribing) and the proportion of opioids consumed relative to prescribed. RESULTS: A total of 1,048 patients met inclusion criteria. Mean (SD) and median (interquartile range [IQR]) quantity of opioids consumed within 24 hours of discharge were 11.2 (26.9) morphine milligram equivalents and 0 (0 to 15) morphine milligram equivalents. Median (IQR) postdischarge consumption was 16 (0 to 150) morphine milligram equivalents. Our institutional guideline and the previously validated rule-based guideline outperform alternate approaches, with median (IQR) differences in prescribed vs consumed opioids of 0 (-60 to 27.25) and 37.5 (-37.5 to 37.5), respectively, corresponding to penalized residual sum of squares of 39,817,602 and 38,336,895, respectively. CONCLUSIONS: Rather than relying on fixed quantities for defined operations, rule-based guidelines offer a simple yet effective method for tailoring opioid prescribing to in-hospital consumption. [ABSTRACT FROM AUTHOR]

Aims: To elicit experiences of patients, family caregivers, and healthcare professionals in intermediate care units (IMCUs) in an academic medical centre in Baltimore, MD related to the challenges and intricacies of multimorbidity management to inform development of a multimorbidity symptom management toolkit. Design: Experience‐based co‐design. Methods: Between July and October 2021, patients aged 55 years and older with multimorbidity admitted to IMCUs at an academic medical centre in Baltimore, Maryland, USA were recruited and interviewed in person. Interdisciplinary healthcare professionals working in the IMCU were interviewed virtually. Participants were asked questions about their role in recognizing and treating symptoms, factors affecting the quality of life, symptom burden and trajectory over time, and strategies that have and have not worked for managing symptoms. An inductive thematic analysis approach was used for analysis. Results: Twenty‐three interviews were conducted: 9 patients, 2 family caregivers, and 12 healthcare professionals. Patients' mean age was 67.5 (±6.5) years, over half (n = 5) were Black or Hispanic, and the average number of comorbidities was 3.67. Five major themes that affect symptom management emerged: (1) the patient–provider relationship; (2) open and honest communication; (3) accessibility of resources during hospitalization and at discharge; (4) caregiver support, training, and education; and (5) care coordination and follow‐up care. Conclusion: Patients, caregivers, and healthcare professionals often have similar goals but different priorities for multimorbidity management. It is imperative to identify shared priorities and target holistic interventions that consider patient and caregiver experiences to improve outcomes. Implications for the Profession and/or Patient Care and Impact: This paper addresses the paucity of research related to the shared experience of disease trajectory and symptom management for people living with multimorbidity. We found that patients, caregivers, and healthcare professionals often have similar goals but different care and communication priorities. Understanding differing priorities will help better design interventions to support symptom management so people with multimorbidity can have the best possible quality of life. Reporting Method: We have adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines in our reporting. Patient or Public Contribution: This study has been designed and implemented with patient and public involvement throughout the process, including community advisory board engagement in the project proposal phase and interview guide development, and member checking in the data collection and analysis phases. The method we chose, experience‐based co‐design, emphasizes the importance of engaging members of a community to act as experts in their own life challenges. In the coming phases of the study, the public will be involved in developing and testing a new intervention, informed by these qualitative interviews and co‐design events, to support symptom management for people with multimorbidity. [ABSTRACT FROM AUTHOR]

Aims: The aims of the study were to gain insight in the transfer process from hospital to homecare or rehabilitation centre from a patient's perspectives and to describe the experienced involvement, information provision and information needs patients. Design: A multiple case study with a phenomenological approach. Methods: Observations and interviews were employed, between May 2019 and August 2019, to capture the patient's perspectives and experiences on involvement, information provision and needs. Observations were executed during the discharge process from hospital to homecare (n = 6) or revalidation centre (n = 1) and during admission interviews with community nurses (n = 6). Interviews were conducted at the patient's home and the revalidation centre. Results: Eight themes were identified within three phases of the transfer process. The Sign‐up phase contained two themes: 'organizing follow‐up care' and 'planning the moment of discharge from the hospital'. The two themes in the Transfer phase were, 'verbal information provision' and 'written information provision'. Four themes were identified in the End phase: 'nursing supplies', 'medication', 'the electronic patient portal' and 'continuation of (para)medical care'. Conclusions: Patient participation in the transition process from the hospital to follow‐up care can be improved. This study indicates that unsafe situations could be prevented by patient involvement and clear perceptions of the role and responsibilities of patients, family and healthcare professionals. Implications to Patient Care: Patient and family involvement has the potential to improve transition of care and techniques for shared decision‐making can be applied to a greater extent. Impact: This paper highlights that patients and families should be acknowledged as key figures in the transfer process and gives direction to healthcare professionals on how to increase involvement in the transfer process by actively inviting patients to participate in the transfer process. Reporting Method: COREQ guidelines for qualitative reporting. No patient or public contribution. Contribution to Global Clinical Community: This paper gives insights in patients' and families' perspectives on transition of nursing care and their involvement during the whole transfer process.This paper gives direction how to improve patient participation during the discharge process from hospital to follow‐up care. [ABSTRACT FROM AUTHOR]

Objectives: Internationally, hip or knee arthroplasty (TJA) with a 1-day hospital length of stay (LOS) is common and demonstrates improved patient and health service outcomes. This study aimed to develop and pilot an enhanced recovery program (ERP) for patients undergoing TJA to achieve a next-day discharge in an Australian public hospital setting. Methods: A project lead and six perioperative clinical craft group leads developed an ERP protocol based on enhanced recovery after surgery (ERAS) principles. Strict patient eligibility criteria were developed. Quality improvement methodology was used to implement the ERP. A patient navigator was put in place as a single contact point for patients. Results: A total of 825 patients were screened for the ERP and 47 patients completed the protocol. The mean ± standard deviation (s.d.) of the LOS was 34.7 (± 7.2) h with 41 patients (87%) achieving next-day discharge, the remaining six (13%) discharged on Day 2. Compliance with ERAS was high (96%) with mobilisation within 12 h occurring on 87% of occasions. There were no adverse events. Patient experience was positive. Conclusion: Next-day discharge was achieved with a selected cohort of patients with no adverse events and positive patient experience, using a multidisciplinary approach and an improvement framework. Broadening inclusion criteria will make ERP available to more patients. What is known about the topic? Next-day discharge following hip or knee arthroplasty in Australian public hospital settings is uncommon and little has been published reflecting enhanced recovery principles in this local context. What does this paper add? This paper describes the development and piloting of an enhanced recovery program using a novel approach to achieve next-day discharge following hip and knee replacement. What are the implications for practitioners? Other health services may leverage this approach to design and implement an enhanced recovery program to reduce hospital length of stay and improve patient and health service outcomes. [ABSTRACT FROM AUTHOR]

Background: In health policy, much attention has been paid to collaboration between the primary and secondary health care sectors, especially in relation to hospitalisation and discharge. Despite ideal plans for collaboration, the research literature shows that inadequate communication is a well‐known problem that can be a barrier to a safe trajectory for the citizen. Based on the assumption that better knowledge of each other's work will lead to better collaboration, a cross‐sectoral exchange program with nurses was initiated. Aim: The aim was to investigate which barriers to good patient trajectories the involved nurses attributed to cross‐sectoral collaboration and what impact the exchange to the opposite sector had for them. Methods: Twenty‐eight nurses were exchanged: 14 from a cardiology department and 14 from municipal home care. The nurses shadowed a colleague from the opposite sector in their daily work. Subsequently, six focus group interviews were conducted. The transcribed material was analysed based on Ricoeur's interpretation theory. Results: Two main themes, including sub‐themes emerged: (1) Challenging communicative conditions: (a) Inadequate digital communication, (b) Inadequate care plans and discharge reports, (c) Conversation promotes understanding, and (d) Challenging collaboration and communication with the discharge coordinators. (2) Perceived importance of the exchange: (a) Cross‐sectoral relationship, prejudice and gaining respect for each other and (b) Working in two different worlds. Conclusion: Electronic communication is inadequate, and the IT systems do not support sufficient cross‐sectoral communication. The organisational model in the municipal care sector is inflexible in terms of allocations for the current needs of citizens, and professionals feel that their professional judgements are not recognised. The nurses gained insight into each other's work and working conditions and respect for each other's professionalism. The exchange has the potential to both improve the relationship and communication between the sectors for the benefit of a better and more coherent patient course. [ABSTRACT FROM AUTHOR]

Background: Socially marginalised patients face many challenges related to their health condition and often have several contacts with healthcare and social service workers. The Danish social nursing initiative, whose nurses have experience and knowledge about marginalisation, aims to support socially marginalised patients during hospital admission and through hospital transitions. However, there is limited knowledge about the hospital transitions of patients being supported by a social nurse. Objectives: The objectives of this study were to explore (1) the perspectives of socially marginalised patients on the transition from hospital to home and (2) how these patients experience the importance of social nursing on patient trajectories after hospital discharge. Methods: A qualitative study with a phenomenological and hermeneutic approach was performed at a large hospital in southern Denmark. Adult patients who had contact with a social nurse during hospital admission were purposely sampled. Data were collected between January 2023 and March 2023. Initial patient interviews were conducted during hospital admission with a second interview 7–22 days after discharge. Systematic text condensation was used for the analysis, and Nvivo 12 supported data storage and coding. Ethical Approval: The study is registered with the Danish Data Protection Agency (22/47509). Informed consent was given by the participants. Results: Sixteen patients participated in the study. The participants experienced major challenges in their transitions from the hospital, which were generally related to their interactions with many different social and healthcare services. While the social nurses supported the patients and helped facilitate care during hospital admission and after discharge, the participants identified transitional care gaps related to multidisciplinary cooperation and standardised care options. Conclusions: This study identifies challenges related to the hospital transition of socially marginalised patients, which indicates a gap in healthcare services. Future research should focus on improving interprofessional collaboration with socially marginalised patients across healthcare services. [ABSTRACT FROM AUTHOR]

BACKGROUND: Moderately preterm infants (MPTI) comprise a large proportion of NICU admissions and are an understudied population. The unique experience of families with MPTIs has yet to be examined in the literature. Describing MPTI parent needs and preferences may inform interventions to improve care and outcomes for this population. METHODS: Semistructured qualitative interviews were performed with English-speaking birth parents of infants born between 32 and 34 weeks gestation to describe their NICU experience and identify areas for improvement specifically surrounding care team inclusion, education, discharge, and communication. Interviews were recorded, transcribed, and analyzed using directed content analysis. Enrollment ceased when the data reached thematic saturation. RESULTS: Sixteen birth parents participated. Four themes emerged around parent-medical team connectedness, parental confusion, discharge readiness, and the desire for a use of a mix of in-person and electronic communication methods (e-mail, texting, apps, etc) for communication. MPTI parents valued a strong connection with the medical team; owever, they described a lack of knowledge regarding the reasons for admission and ongoing management. Near discharge, parents desired more information regarding feeding, reflux, and breathing patterns. Parents preferred in-person discussions but described a role for electronic methods to improve their understanding of their infant and discharge readiness. CONCLUSIONS: From the MPTI parent perspective, clinicians can focus improvement efforts on communication, specifically around reasons for admission, discharge planning, and anticipatory guidance. These results may serve as a foundation for initiatives to improve the MPTI parent experience and potentially parent and MPTI outcomes. [ABSTRACT FROM AUTHOR]

Tetanus is a life-threatening, vaccine-preventable disease caused by an endotoxin produced by Clostridium tetani. We report a case of severe tetanus in an adult male with a history of intravenous drug use. The patient presented with a 1-day history of inability to open his jaw and a right lower extremity necrotic wound. Initial management consisted of tetanus toxoid, human tetanus immunoglobulin, antimicrobials and intermittent lorazepam. Due to progressive symptoms, wound debridement and placement of an advanced airway in the operating room ensued. Episodes of tetany were associated with fever, autonomic instability, acute desaturations and preemptive ventilator triggering despite maximum doses of continuous propofol and midazolam. Neuromuscular blockade with cisatracurium was added, resulting in control of tetany. Despite initial control, NMB could not be weaned due to recurrent spasms. Intravenous dantrolene was therefore sought as an alternative antispasmodic. Following an initial load, patient was successfully liberated from cisatracurium. Dantrolene was therefore converted to enteral to facilitate gradual down-titration of intravenous sedatives with subsequent conversion to oral benzodiazepines. After a prolonged hospital course, the patient was able to be discharged home. Dantrolene was thus effectively utilized as an adjunctive antispasmodic agent to facilitate liberation from cisatracurium and continuous sedation. [ABSTRACT FROM AUTHOR]

Objectives: To examine the relationship between medications prescribed during the first 6-months post-stroke and functional outcome. Materials and Methods: A retrospective analysis of ischemic stroke survivors enrolled in an observational stroke recovery study from June-2017 to July-2019 was performed. Survivors with favorable outcomes (modified rankin scale (mRS) score 0-2) were compared to those with unfavorable outcomes (mRS ≥3) 6-months after stroke on the following: discharge medication classes prescribed, achievement of recommended targets for blood pressure control, glycemic control, and LDL ≤70 mg/dL, medication changes, medication interactions, and medication list discrepancies. Results: Unfavorable 6-month outcomes occurred in 36/78 (46.2%) of survivors. Survivors with unfavorable outcomes were more likely to be prescribed a central nervous system-acting agent (97.2% vs 71.4%; P =.0022) and/or an anti-hyperglycemic agent (25.0% vs 9.5%; P =.009) at discharge. After adjustment of baseline covariates, total number of medications prescribed was associated with unfavorable 6-month outcomes (OR 1.13, 95% CI 1.0-1.28). Secondary stroke prevention measures were not achieved in a high proportion of survivors. Medication changes during 6-month follow up were common and survivors with unfavorable outcomes were more likely to have clinically significant drug-drug interactions. Discussion: At 6-months, survivors with unfavorable outcomes were found to be prescribed more medications, particularly central nervous system-acting and anti-hyperglycemic agents. There were also more drug-drug interactions in the medications prescribed compared to those with favorable outcomes. Together, these data suggest the need for enhanced screening of high-risk stroke survivors focused on close monitoring of polypharmacy, drug-drug interactions, and adverse events with pharmacotherapy. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to analyse the risk factors for unplanned readmissions within 1 month after hospital discharge to develop a seamless support system from discharge to home care. Background: With shorter hospital stay lengths, understanding the characteristics of patients with multiple risk factors is important to prevent rehospitalization. Design: This is a single‐centre retrospective descriptive study. Methods: Logistic regression and decision tree analyses were performed using eight items from the records of 3117 patients discharged from a university hospital between April–September 2017 as risk factors. Results: Unplanned readmission risk was significantly associated with emergency hospitalization (odds ratio [OR]: 3.12, 95% confidence interval [CI]: 2.04–4.77), malignancy (OR: 2.16, 95% CI: 1.44–3.24), non‐surgical admission (OR: 1.76, 95% CI: 1.07–2.88), hospital stay of ≥ 15 days (OR: 1.66, 95% CI: 1.14–2.43) and decline in activities of daily living owing to hospitalization (OR: 1.68, 95% CI: 1.06–2.64). The highest risk combinations for rehospitalization were as follows: emergency hospitalization and malignancy; emergency admission, non‐malignancy and a hospital stay of ≥15 days; and scheduled hospitalization, no surgery and a hospital stay of ≥15 days. Conclusions: Patients with multiple risks for unplanned readmission should be accurately screened and provided with optimal home care. Summary statement: What is already known about this topic? Although the characteristics of patients at high risk of rehospitalization include malignancy, heart failure, conditions such as chronic obstructive pulmonary disease and other diseases prone to recurrence, old age, reduced activities of daily living and emergency hospitalization, few studies have reported on cases with multiple risks. What this paper adds? The most frequent risk types for unplanned readmissions within a month were emergency admissions for malignant tumours, emergency admissions for non‐malignant tumours with a hospital stay of 2 weeks or more and scheduled admissions for non‐surgical purposes with a length of stay of 2 weeks or more. The implications of this paper: The risk of unplanned readmission within 1 month of discharge increased due to a combination of multiple risks.This study helps us identify patients who are at high risk for readmission early in the hospitalization process and in providing nursing support for transition to their homes. [ABSTRACT FROM AUTHOR]

Aims: This work aims to investigate the association between obesity and risk of delayed discharge and unplanned readmission in day surgery patients. Background: Day surgeries are well received and developing rapidly. Associations between obesity and delayed discharge and unplanned readmission, which are clinically relevant outcomes in day surgeries, are complex. Design: A systematic review and meta‐analysis was conducted. Data Sources: The PubMed, Web of Science, EMBASE, Cochrane Library, CNKI, VIP, and Wan Fang databases were comprehensively searched from inception until January 2021. Review Methods: Two independent reviewers assessed the studies and extracted data. Pooled estimates were obtained using a random‐effects model. Results: Eleven articles published between 2007 and 2020 were finally included. Obesity appeared not to increase the risk of delayed discharge. However, morbid obesity seemed to be associated with a higher risk of delayed discharge. The meta‐analysis revealed no relationship between higher body mass index (BMI) and unplanned readmission for day surgery patients. Conclusions: Obesity appeared not to increase the risk of delayed discharge except in patients with morbid obesity. Additionally, a higher BMI was not associated with increased risk of unplanned readmission after day surgery. Future studies are required to address this issue further in different types of surgery and areas. Summary statement: What is already known about this topic? The complexity and flexibility of day surgeries have gradually broadened, but selecting the most suitable patients for day surgery is important for safety.Controversies exist on the association between obesity and risk of delayed discharge and unplanned readmission in day surgery patients. What this paper adds? This systematic review and meta‐analysis suggests that obesity did not significantly increase the risk of delayed discharge except in patients with morbid obesity.A higher BMI was not associated with increased risk of unplanned readmission after day surgery. The implications of this paper: Obesity should not be regarded as a contraindication to day surgery although patients with morbid obesity should be scheduled with caution and evaluated on a case‐by‐case basis. Future studies are required to address this issue further in more types of surgery and in different areas. [ABSTRACT FROM AUTHOR]

Background: Hemiarthroplasty (HA) is a common form of treatment for displaced neck of femur fractures. There is ongoing debate as to whether cemented or uncemented HA is a more superior treatment modality. The aim of this study was to compare the outcomes between patients that underwent cemented HA to uncemented HA. Secondarily, we analysed the costs associated of each treatment option. Methods: This was a retrospective study conducted at a busy district general hospital. The study included 335 patients that were treated with either a cemented or uncemented HA for a displaced neck of femur fracture between January 2017 and December 2018. Data collected included age, sex, American Society of Anesthesiologist (ASA) score, treatment modality, length of stay (LOS) and general costs. Results: 197 (58.8%) of the cohort underwent cemented HA and 138 (41.2%) underwent uncemented HA. Mean age for the cemented cohort was 84.7 years and 85.9 years in the uncemented group (p = 0.31). There was no significant differences between the groups with regard to mean LOS and discharge disposition (p = 0.44). There were no significant difference in 30-day and 1-year mortality between the two groups (p = 0.2). We did find a statistically significant difference in the costings between the two procedures, with cemented HAs costing £66 more than uncemented HAs (p < 0.001). Conclusion: We found that both cemented and uncemented HAs produced comparable results. We found a statistically significant reduction in operative time and costs associated with uncemented HA. Uncemented HA implants may be considered where a shorter operation duration is essential. [ABSTRACT FROM AUTHOR]

Objective: Shoalhaven District Memorial Hospital is a rural (MM3) secondary hospital which is over an hour travel time from the nearest tertiary centre. The objective of the present study was to pilot the implementation of the BEFAST (Balance, Eyes, Face, Arms, Speech and Time) stroke screening tool at the ED, and determine whether its usage improved timely stroke detection. Methods: During initial implementation and training (October–December 2019), triage nurses consulted with senior medical officers before activating stroke calls. Data were collected for the subsequent 24 months (January 2020–2022), and retrospective records for confirmed strokes during a 24‐month period prior to BEFAST implementation (October 2017–2019) were also collected. The main outcome measures were triage category, CT scan result time, discharge destination, length of stay (LOS) and Modified Rankin Score (MRS). Results: After BEFAST implementation, patients (n = 268) were three times more likely to be triaged at category 1 or 2, and door‐to‐CT scan time was reduced by 20.7 min on average. More patients were discharged to their usual residence and more quickly (LOS 7.9 vs 11.1 days). MRS 90 days after stroke was less, and patients were nearly twice as likely to experience an improvement in neurological symptoms. Conclusions: Patient outcomes were improved after implementation of the BEFAST stroke triage tool. More stroke patients were identified upon presentation to the ED, and in a timely fashion. For those with a stroke diagnosis, time‐critical interventions can take place earlier, allowing patients to return home sooner, and with less disability. [ABSTRACT FROM AUTHOR]

Objective: Low acuity presentations (LAPs) contribute to large numbers of ED presentations and carry numerous consequences. The present study sought to improve the understanding of regional infant LAPs by analysing temporal patterns of presentation, discharge diagnoses and potential predictive factors. Methods: This retrospective observational study examined ED presentations among children less than 12 months old (infants) to the Royal Prince Alfred Hospital between 2017 and 2019. Descriptive statistics were used to identify temporal patterns of presentation and common discharge diagnoses among LAPs. Multivariable logistic regression was used to determine the association between early life, demographic and perinatal factors and low acuity presenters. Results: Of 6881 infant ED presentations, 19.8% were LAPs, occurring disproportionately on weekdays (82.2%) and during hours of 08.00–17.00 (69.9%). Respiratory tract infections and gastrointestinal complaints were most common overall, though non‐allergic rash, feeding difficulties, eczema and developmental concerns contributed substantially among LAPs. Socio‐economic status (SES) (odds ratio [OR] 1.71), overseas maternal nationality (OR 1.25) and Medicare ineligible maternal financial class (OR 0.49) were associated with low acuity presenters. Low appearance, pulse, grimace, activity and respiration score (OR 3.53), low SES (OR 3.26), complicated delivery (OR 1.64), maternal multiparity (OR 0.50), maternal partner presence (OR 0.40) and obstetric complications (OR 0.37) were associated with repeat, multi‐low acuity presenters (multi‐LAPs). Conclusion: A substantial minority of infant ED presentations are LAPs. Targeted interventions may benefit from focusing on families with a background of socioeconomic disadvantage, social isolation, cultural and linguistic diversity and perinatal complications, with a view to strengthening engagement with community‐based services among these groups. [ABSTRACT FROM AUTHOR]

Objective: The Interpersonal Theory of Suicide (ITS) could help identify differences in groups of suicidal adolescents and inform treatment. Method: Latent Profile Analysis (LPA) using thwarted belongingness (TB), perceived burdensomeness (PB), hopelessness, and capability was conducted on data from an at‐risk clinical sample (N = 500). The ITS prediction that changes in TB and PB are associated with changes in suicidal ideation was tested using admission and discharge data. Results: Latent Profile Analysis identified three profiles with increasing complexity and severity on ITS factors. The profiles were labelled low‐severity (7.6% of participants), moderate‐severity (45.2%), and high‐severity (47.2%). ITS predictions were partially supported for the full sample and only for the high‐severity and moderate‐severity subgroups, whereby changes in TB were significantly associated with changes in suicidal ideation over the course of treatment. However, changes in PB were only significant in the moderate‐severity subgroup, and none of the ITS predictions were supported in the low‐severity subgroup. Additionally, effect sizes for changes in TB and PB were modest in all analyses. Conclusions: Our findings highlight the importance reducing low belongingness in youth, which is a component of all supported interventions of youth suicide prevention. However, given the modest association of changes in ITS variables had with changes in suicidal ideation, it may be fruitful to elaborate on the relative importance on types of low belongingness or include other non‐ITS variables. [ABSTRACT FROM AUTHOR]

Background: There are few reports on drug use in patients while hospitalised and none regarding management or clinical outcomes. Aims: To describe cases of drug use by inpatients requiring an urgent clinical response. Methods: We retrospectively reviewed cases at a teaching hospital in Sydney, Australia, from February 2019 to March 2021. Results: Thirty cases were identified, with no deaths. Two patient groups were identified: (i) substance use disorders, using illicit drugs and (ii) self‐harm history, using prescribed or over‐the‐counter drugs. Management involved cardiac monitoring (40%), intensive care (30%), charcoal (20%), antidotes (20%) and intubation (13%). Discharge was planned in 22 of 30 patients, against medical advice in four and directed by medical staff in four. Conclusions: Inpatient drug use requiring an urgent clinical response was infrequently recognised but presents a risk of harm to patients and staff and increases service utilisation and costs. Both harm reduction and systematic approaches guided by institutional policy are recommended. Using these events as reachable moments to address driving factors may modify patients' risk from future events. [ABSTRACT FROM AUTHOR]

Background: There are numerous publications on inpatient medication errors. However, little focus is given to medication errors that occur at home. Aims: To describe and analyse the types of medication errors among community-dwelling patients following their discharge from an acute care hospital in Singapore. Method: This is a retrospective review of a 'good catch' reporting system from December 2018 to March 2022. Medication-related errors were extracted and analysed. Findings: A total of 73 reported medication-related error incidents were reviewed. The mean age of the patients was 78 years old (SD=9). Most patients managed their medications independently at home (45.2%, n=33). The majority of medications involved were cardiovascular medications (51.5%, n=50). Incorrect dosing (41.1%, n=39) was the most common medication error reported. Poor understanding of medication usage (35.6%, n=26) and lack of awareness of medication changes after discharge (24.7%, n=18) were the primary causes of the errors. Conclusion: This study's findings provide valuable insights into reducing medication errors at home. More attention must be given to post-discharge care, especially to preventable medication errors. Medication administration and management education can be emphasised using teach-back methods. [ABSTRACT FROM AUTHOR]

Simple Summary: Most cancer patients are older and have concomitant diseases because the incidence of most cancer types increases with age. This leads to patients taking a variety of medications that can cause drug-related problems (DRPs). DRPs can cause harm, including increased illness, avoidable hospital stays, and even death. Common DRPs are drug–drug interactions, not taking medication as prescribed, and adverse drug reactions. In our study, we aimed to assess these medication risks in hospitalized cancer patients and to identify factors that influence their health-related quality of life (HRQOL) as a patient-relevant outcome. The results of the pharmacist-led medication reviews show that DRPs are common in hospitalized cancer patients. Therefore, patient questionnaires about therapy-related symptoms could improve the detection of DRPs. While drug-related factors had no effect on HRQOL during the hospital stay, our analysis revealed other influencing factors, such as relapse status of the cancer disease and length of hospital stay. Background: We aimed to assess medication risks and determine factors influencing the health-related quality of life (HRQOL) in cancer inpatients. Methods: A retrospective analysis was conducted to identify drug-related problems (DRPs) based on medication reviews, including patient-reported outcomes (PROs). Multiple linear regression analyses were performed to identify sociodemographic, disease-related, and drug therapy-related factors influencing changes from hospital admission to discharge in the scales of the EORTC QLQ-C30 questionnaire. Results: A total of 162 inpatients with various hematological and solid cancer diseases was analyzed. Patients received a mean of 11.6 drugs and 92.6% of patients exhibited polymedication resulting in a mean of 4.0 DRPs per patient. Based on PRO data, 21.5% of DRPs were identified. Multiple linear regression models described the variance of the changes in global HRQOL and physical function in a weak-to-moderate way. While drug therapy-related factors had no influence, relapse status and duration of hospital stay were identified as significant covariates for global HRQOL and physical function, respectively. Conclusion: This analysis describes underlying DRPs in a German cancer inpatient population. PROs provided valuable information for performing medication reviews. The multiple linear regression models for global HRQOL and physical function provided explanations for changes during hospital stay. [ABSTRACT FROM AUTHOR]

To verify the effectiveness of experimental occupational therapy plus intensive standard rehabilitation compared to intensive standard rehabilitation alone on the reintegration to social activities of complex patients three months after hospital discharge. Patients with a score ≥ 9 on the Rehabilitation Complexity Scale at admission to an intensive rehabilitation ward were randomized to the control or experimental group. Both groups received intensive multidisciplinary rehabilitation aimed at recovering independence in the basic activities of daily life (ADL). The experimental group also received experimental occupational therapy services to address goals identified through the administration of the Canadian Occupational Performance Measure (COPM). Experimental occupational therapy began during the in-hospital phase and continued in the home-based setting. It consisted of teaching strategies, recommending aids, and providing personalized information regarding available community support. Ninety-two individuals with a mean age of 65 years (female 44.6%) were enrolled. The experimental group significantly improved participation measured by the Reintegration to Normal Living Index (mean changes 8.61, 95% CI: 1–16.23, p = 0.027). The performance and satisfaction scores of the COPM, both during hospitalization and after discharge, and independence in ADL also improved. No differences in mood disturbances were found. Early post-discharge occupational therapy integrated with multidisciplinary rehabilitation improves the social participation of complex patients. Future research should investigate the concrete feasibility of implementing this complex intervention cost-effectively and in different contexts. ClinicalTrials.gov Identifier NCT03668938 (first posted date 13/09/2018) Early post-discharge rehabilitation assists patients' transition from hospital to home by improving the management of problems they encounter. In complex patients, occupational therapy initiated during hospitalization and extended to the early post-discharge phase improves social participation, independence in basic and instrumental daily activities, and performance and satisfaction when carrying out relevant occupational activities. The strong partnership between the Occupational Therapist and the patient improves compliance to treatment, enhancing the chances of success of rehabilitation interventions. [ABSTRACT FROM AUTHOR]