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Background: The healthcare professionals involved in in-hospital treatment of myocardial infarction (MI) are also responsible to patients for their education before leaving the hospital. This education aims to modify patient behaviour in order to reduce relevant risk factors and improve self-control and adherence to medications. The aim of the study was to analyse the relationship between readiness for discharge from hospital and adherence to treatment at follow-up in MI patients. Methods: An observational, single-center, MI cohort study with 6-month follow-up was conducted between May 2015 and July 2016. The Readiness for Hospital Discharge after Myocardial Infarction Scale (RHD-MIS) and the Adherence in Chronic Diseases Scale (ACDS) were applied. Results: Two hundred and thirteen patients aged 30–91 years (62.91 ± 11.26) were enrolled in the study. The RHD-MIS general score ranged from 29 to 69 points (51.16 ± 9.87). A high level of readiness was found in 66 patients (31%), intermediate in 92 (43.2%), and low in 55 (25.8%) of patients. Adherence level assessed with the ACDS 6-months after discharge from hospital ranged from 7 to 28 points (23.34 ± 4.06). An increase in objective assessment of patient knowledge according to RHD-MIS subscale resulted in significantly higher level of adherence at the follow-up visit (p = 0.0154); R Spearman = 0.16671, p = 0.015; p for trend = 0.005. During the 6-month follow-up 3 (1.41%) patients died and 17 (7.98%) were hospitalized for a subsequent acute coronary syndrome. Conclusions: This study provided preliminary evidence of a long-term association between the results of assessment of readiness for discharge from hospital and adherence to treatment in patients after MI.

We describe the case of a previously healthy 9-year-old girl hospitalised due to hypoxaemic pneumonia. Two months after discharge, she maintained low oxygen saturations and persistent dry cough without dyspnoea, haemoptysis, migraine or palpitations. Cardiac and pulmonary auscultation was normal

Zusammenfassung. Hintergrund: Herzinsuffizienz ist einer der häufigsten Gründe für eine Hospitalisation bei älteren Menschen. Rund 22,8 % der Betroffenen werden innerhalb von 30 Tagen nach einer stationären Betreuung wieder hospitalisiert. Das pflegerische Assessmentinstrument epaAC könnte Hinweise zu Risikofaktoren für eine Rehospitalisation geben. Ziel: Das Ziel war es, Gruppenunterschiede in den Items und Scores des epaAC Austrittsassessment zu identifizieren hinsichtlich des Endpunktes einer ungeplanten Rehospitalisation bis 30 Tage nach Index-Hospitalisation. Methoden: Unter Verwendung eines retrospektiven Fall-Kontroll-Designs wurden Unterschiede in den epaAC Variablen mittels deskriptiver und vergleichender Statistik untersucht. Chi-Quadrat-Test, Wilcoxon-Test und t-Test wurden mit zweiseitigem Alpha-Niveau α < 0,05 durchgeführt. Die Alphafehler-Kumulierung wurde mittels Benjamini & Hochberg-Korrektur berücksichtigt. Ergebnisse: Es wurden keine signifikanten Gruppenunterschiede in allen Items und Scores des Austritts-epaAC gefunden. Es liegt nur ein schwacher Hinweis vor, dass eine akute respiratorische Beeinträchtigung zum Zeitpunkt der Entlassung bei den Patient_innen mit Rehospitalisation häufiger vorliegt, als bei denjenigen ohne Rehospitalisation. Schlussfolgerungen: Die Items und Scores des Pflegeassessmentinstruments epaAC unterschieden sich nicht signifikant zwischen Patient_innen mit und ohne 30-tägiger Rehospitalisation. Weitere Untersuchungen zur Beurteilung des Potenzials des epaAC zur Vorhersage einer Rehospitalisation bei Herzinsuffizienz sind erforderlich.

ObjectiveTo examine factors associated with continuation of hospital-initiated benzodiazepine receptor agonists (BZRAs) among adults aged ≥65 years, specifically instructions on hospital discharge summaries.MethodsThis retrospective cohort study involved anonymised electronic record data on prescribing and hospitalisations for 38,229 patients aged ≥65 from forty-four GP practices in Ireland 2011-2016. BZRA initiations were identified among patients with no BZRA prescription in the previous 12 months. Multivariate regression examined whether instructions on discharge messages for hospital-initiated BZRA prescriptions was associated with continuation after discharge in primary care and time to discontinuation.ResultsMost BZRA initiations occurred in primary care, however the rate of hospital-initiated BZRAs was higher. Almost 60% of 418 hospital initiations had some BZRA instructions (e.g. duration) on the discharge summary. Approximately 40% (n=166) were continued in primary care. Lower age, being prescribed a Z-drug or great number of medicines were associated with higher risk of continuation. Of those continued in primary care, in 98 cases (59.6%) the BZRA was discontinued during follow-up (after a mean 184 days). Presence of instructions was associated with higher likelihood of discontinuation (hazard ratio 1.67, 95%CI 1.09-2.55).ConclusionsImproved communication to GPs after hospital discharge may be important in avoiding long-term BZRA use.

Background Due to the rising number of acutely hospitalised older people in the coming years, there is increased interest in tailoring care to the individual goals and preferences of patients in order to reach patient-centered care. Aims This study aimed to investigate the goals of older hospitalised patients and the extent to which these goals were reached during hospitalisation. Methods A single centre prospective cohort study was performed in the Netherlands between December 2017 and January 2018. Participants aged 70 years or older were included. In the first three days of hospitalisation, a semi-structured interview was conducted to assess the patient goals regarding the hospital admission. One to two weeks after discharge patients were asked to which extent the recent hospitalisation had contributed to reaching their goals. Results One-hundred-and-four patients were included and for 86 patients follow-up was completed. The main goals reported at hospital admission were "remaining alive" (72.1%), "feeling better" (71.2%) and "improving condition"(65,4%). Hospitalisation seemed to have a positive contribution to reaching the goals "remaining alive", "knowing what is wrong", "feeling better", "reducing pain" and "controlling disease". Hospitalisation seemed to contribute little to reaching the goals in the categories "enjoying life", "independency and freedom", "improving daily functioning", "hobbies and work" and "social functioning". Conclusions It is important for healthcare professionals to know the goals of their patients. The majority of these goals were not achieved at hospital discharge. It is important to be aware of this, so sufficient aftercare can be arranged, and patients can be prepared. This article is protected by copyright. All rights reserved.

Objectives: Failure to identify women at risk of preterm labor (PTL) leads to failure to implement standard measures. This study designed to evaluate the accuracy of PremaQuick test in detection of PTL in women presented with threatened preterm labor (TPTL). Material and methods: One hundred and twenty-two (122) pregnant women, singleton pregnancy, < 37 weeks, admitted with TPTL included in this study, and were compared to 122 controls. After thorough evaluation, participants were examined using sterile vaginal speculum for cervico-vaginal fluid (CVF) sampling, and PremaQuick test. The CVF sampling was followed by trans-vaginal sonographic (TVS) assessment of cervical length (CL). Participants were managed according to hospitals policy thorough their admission, and after discharge in the ante-natal clinics till delivery. After delivery, the delivery data were compared by the recorded participants` data on admission. Results: The PremaQuick test had 95.1% sensitivity, 97.5% specificity, 97.5% positive predictive value, 95.2% negative predictive value, and 96.3% accuracy in detection of PTL. The PremaQuick had significantly higher true negative rate, specificity, positive predictive value, and overall accuracy in detection of PTL compared to CL < 25 mm (p = 0.005, 0.005, 0.01, 0.002; respectively). Conclusions: The PremaQuick is an accurate bedside test in detection of PTL in women presented with TPTL. It had 95.1% sensitivity, 97.5% specificity, 97.5% positive predictive value, 95.2% negative predictive value, and 96.3% overall accuracy in detection of PTL. The PremaQuick had significantly higher true negative rate, specificity, positive predictive value, and overall accuracy in detection of PTL compared to CL < 25 mm.

Objective To assess whether a sustained optimal haemoglobin value in the 3 months after admission for heart failure (HF) decompensation reduces morbidity and mortality during the 12 months after admission for acute HF. Patients and method Retrospective study of the 1408 patients older than 65 years included in the RICA registry divided into 3 groups: no anaemia (group A), recovered anaemia (group B), and persistent anaemia (group C), according to haemoglobin levels on admission, and 3 months after discharge. Kaplan-Meier curves were constructed, comparing the groups using the log-rank test and a Cox regression model was performed to analyse survival. Results 578 (41.1%), 299 (21.2%) and 531 (37.7%) were included in groups A, B and C, respectively. We recorded a total of 768 deaths and readmissions. There were 23 (4%), 12 (4%) and 49 (9.2%), (p=.001) individuals who died due to HF and 154 (27%), 73 (24%) and 193 (36%) (P Conclusions Persistent anaemia in the months after admission for HF increases morbidity and mortality in the subsequent year.

Background/Purpose: Multimorbidity is a worldwide issue when aging is rapidly. The aim of this study was to evaluate the impact of demography, morbidity, disability and depression on short-term and long-term mortality for multimorbid inpatients. Methods: The participants’ information were assessed upon recruitment. Multimorbidity and disability were measured by modified Charlson comorbidities Index (CCI) and Barthel Index for Activity of Daily Living (ADL), respectively. Depression was screened over one-item self-reported perceptions of depressed mood rated as yes or no. The factors of in-hospital mortality and periodic mortality after discharge were examined by Cox proportional hazard regression and Kaplan–Meier survival analyses. Results: A total of 201 inpatients from a hospitalist's ward were recruited. The in-hospital mortality was 14.4%, while 24-month mortality was 57.8%. After adjustment, severe ADL dependence (

Objectives: The aim of this study was to evaluate the clinical characteristics, pulmonary diffusion function, chest computed tomography (CT), and serum lung cell damage indicators of coronavirus disease 2019 (COVID-19) survivors 6 months after discharge. Methods: Data of COVID-19 survivors discharged from hospital between January 21, 2020 and January 11, 2021 and healthy controls were collected. Serum levels of surfactant protein D (SP-D)11 ‘Surfactant D’ has been changed to ‘surfactant protein D’ throughout, and ‘SPD’ has been changed to ‘SP-D’. Are these changes correct?, the receptor for advanced glycation end products (RAGE)22 RAGE: ‘receptor for advanced glycation products’ has been changed to ‘receptor for advanced glycation end products’ throughout. Is this correct?, laminin, and von Willebrand factor (vWF) were measured in the healthy controls and COVID-19 survivors 6 months after discharge. The relationships between serum lung cell damage indicator levels and various parameters were explored. Results: Fifty-two COVID-19 survivors (31 with non-severe disease and 21 with severe disease) and 30 controls were included. Serum levels of laminin in COVID-19 survivors 6 months after discharge were significantly higher than those in the controls. The increase was more significant in elderly and female patients. Serum levels of RAGE and vWF were not statistically different from those of the controls. However, 6 months after discharge, COVID-19 survivors with abnormal chest CT and those in the severe group had higher vWF levels. Conclusions: COVID-19 patients had abnormal lung injury indicators 6 months after discharge. The recovery time after infection is currently unknown, and long-term observation is required.

Purpose Retrograde intrarenal surgery (RIRS) is a safe and effective treatment option for upper urinary tract stones smaller than 2cm. Although several studies have documented perioperative and postoperative complications related to RIRS, there exists limited data regarding the readmission and rehospitalization of patients after RIRS. The aims of the study were to document the rates of readmission and rehospitalization after RIRS and to determine the predictive factors for readmission and rehospitalization. Materials and Methods In this study, we retrospectively analyzed patients who underwent RIRS for the treatment of renal stone disease and were unexpectedly readmitted to the hospital within 30 days after discharge. The hospital admission systems were used to determine readmissions and rehospitalizations. Readmission and rehospitalization rates, causes, and treatment procedures were evaluated. Univariate and multivariate analyses of clinicodemographic properties were performed to evaluate possible predictive factors for readmission and rehospitalization after RIRS. Results A total of 1,036 patients were included in the study. Of these patients, 103 (9.9%) were readmitted to the hospital. Among these readmissions, 35 patients (33.9%) were rehospitalized and 14 (13.6%) underwent surgical intervention. The most common reasons for readmission were renal colic and fever. The presence of preoperative pyuria (odds ratio [OR] 1.86), stone volume (OR 1.54), postoperative complications (OR 3.66), and stone-free status (OR 0.46) were predictive factors for readmission, whereas hospitalization time (OR 1.32), postoperative complications (OR 9.70), and stone-free status (OR 0.06) were predictive factors for rehospitalization after RIRS. Conclusion Nearly 10% of patients who underwent RIRS were readmitted to the hospital within the first month after discharge, and some were rehospitalized. Preoperative pyuria, high stone volume, presence of postoperative complications, and low stone-free status predicted this readmission and rehospitalization. Clinicians must recognize these predictive factors and inform their patients about this possibility.

Contains fulltext : 249010.pdf (Publisher’s version ) (Open Access) BACKGROUND: After discharge, stroke survivors and their informal caregivers need support from their social networks to resume their most valued activities. Rehabilitation professionals could help them establish a strong support system. OBJECTIVE: Explore how older stroke survivors and their primary informal caregivers expect to resume their valued activities after discharge, and discover their ideas about involving, informing and educating their family members, friends and important others during inpatient rehabilitation so that, once home, they will have adequate support. METHODS: We conducted semi-structured interviews with stroke survivors from three geriatric rehabilitation centres and their primary informal caregivers, used the pictures of daily activities to elicit their perspectives, and applied a descriptive and interpretive design to data analysis. RESULTS: Many participants had no concrete idea about how to resume their activities after discharge but nevertheless were optimistic they would. They expected help to be available and saw no need for professionals to involve their network during inpatient rehabilitation. However, once they had insight into the challenges to expect after discharge, they often appreciated the idea of professionals contacting their network. To better understand the challenges after discharge, it was helpful if professionals provided concrete, honest information about the stroke's consequences for daily life. Actually doing daily activities also helped gain better insights. CONCLUSIONS: To enhance insight in the need of social support after discharge, we suggest that rehabilitation professionals are honest about what to expect and let stroke survivors explore their valued activities in a realistic context more often.

Aim Adherence to lifestyle recommendations, medical regimens and cardiac rehabilitation is poor among patients with acute coronary syndrome. The aim of this study was to examine the effect of nurse‐led counselling and education using a person‐centred care approach on short‐term cardiac self‐efficacy in patients with acute coronary syndrome. Design A parallel, two‐armed, randomized controlled trial was conducted. Methods One hundred twenty patients who were hospitalized with diagnosis of acute coronary syndrome were selected and randomly assigned into intervention (n = 60) or control (n = 60) groups. In the intervention group, in addition to routine care, the nurse‐led counselling and education programme included two face‐to‐face sessions, two telephone counselling and education sessions, using the person‐centred care approach. Participants in the control group received only routine care. Data were collected using the cardiac self‐efficacy scale before the intervention and 1 month after discharge. Results After the intervention, we found that cardiac self‐efficacy, including the perceived self‐efficacy to control symptoms and maintain function, was statistically significantly higher in the intervention group than the control group.

Background: Patients’ illness stories are valuable information that supports person-centred care across the illness trajectory. Aims: To learn how older South Asian immigrant women experience living with heart illness long after discharge from hospital. Method: We used narrative inquiry, a personal experience method that explores and interprets lived and told stories through the three dimensions of experience. Design: Four participants, over the age of sixty, living with heart illness for over ten years, were invited to engage in narrative interview and Narrative Reflective Process. Outcomes: Giving patients voice, allows caregivers insight into the human experience of illness beyond hospitalization. Considering the increased migration of people around the globe, this knowledge is significant in provision of person-centred care. Implications: Person-centred care does not end with the hospitalization and outpatient clinics. Inter-disciplinary teams need to reconsider the trajectory of chronic illnesses and the care required throughout, especially for marginalized populations.

Background: Unnecessary emergency department (ED) visits are a crucial consideration in discharge planning for acutely admitted patients. This study aimed to identify the reasons for unnecessary visits to the ED within 30 days of discharge from a medical hospitalist unit.Methods: We performed a retrospective review of patients discharged in 2018 from a medical unit of tertiary teaching hospital in Korea. The authors discussed in-depth and determined whether or not an ED visit was unnecessary, and further classified the causes of unnecessary visits into three categories.Results: The mean age of the patients was 62.9 years (range, 15–99 years), and among the 1,343 patients discharged from the unit, 720 (53.6%) were men. Overall, 215 patients (16.0%) visited the ED within 30 days after discharge; among them, 16.3% were readmitted. Of the 215 cases of ED visits within 30 days after discharge, 57 (26.5%) were considered unnecessary. Of these, 30 (52.6%) were categorized as having failed care transition, 15 (26.3%) had unestablished care plans for predictable issues, and 12 (21.1%) had insufficient patient education.Conclusion: A substantial number of short-term ED visits by discharged multimorbid or older medical patients were considered unnecessary. Discharging patients with a thorough discharge plan is essential to avoid unnecessary ED visits.

Any survivor among the millions of patients admitted to the intensive care unit (ICU) for critical illness each year is susceptible to persistent health problems that continue after discharge and may lead to post-intensive care syndrome (PICS), defined as new or worsening dysfunction from physical impairment, cognitive impairment, or emotional impairment, or a combination. Considering the increased rates of ICU survival and the growing elderly population more likely to utilize ICU resources, critical care practitioners have broadened their focus on outcomes and care of ICU survivors to include the acute post-ICU survival period as well as months and even years after ICU discharge. This review focuses on the neuropsychiatric aspects of PICS in ICU survivors including diagnostic, screening, and treatment recommendations. It also highlights the value of post-ICU clinics and the unique role of the consultation psychiatrist in the care of this patient population.

The authors sought to investigate associations between sacubitril/valsartan adherence and clinical outcomes after hospitalization for heart failure with reduced ejection fraction (HFrEF).Sacubitril/valsartan improves outcomes in HFrEF, though the extent to which medication adherence is associated with outcomes in routine care is less well characterized.The authors analyzed patients aged ≥65 years hospitalized for HFrEF within the Get With the Guidelines-Heart Failure registry linked with Medicare claims between October 2015 and September 2018 who were discharged with sacubitril/valsartan. Sacubitril/valsartan adherence was assessed using medication fills to calculate proportion of days covered (PDC) through 90 days postdischarge. Associations between postdischarge adherence (PDC or ≥80%) and risk of readmission and death within 1 year were examined by comparing cumulative incidences and adjusted event rates.Among 897 patients prescribed sacubitril/valsartan at discharge, 295 (32.9%) had PDC ≥80% and 602 (67.1%) had PDC 80%. Baseline characteristics were balanced between groups. Compared with patients with PDC 80%, patients with PDC ≥80% had a significantly lower adjusted hazard of all-cause rehospitalization (HR: 0.66 [95% CI: 0.48-0.89]) and death (HR: 0.42 [95% CI: 0.22-0.79]) at 90 days and at 1 year (HR: 0.69 [95% CI: 0.56-0.86] and HR: 0.53 [95% CI: 0.38-0.74], respectively). For every 5 percentage point increase in PDC, patients experienced a significant reduction in rehospitalization (HR: 0.98 [95% CI: 0.97-0.99]) and death (HR: 0.96 [95% CI: 0.94-0.97]) at 1 year.In patients hospitalized for HFrEF and discharged on sacubitril/valsartan, high adherence to sacubitril/valsartan within 90 days after discharge was associated with substantially lower rates of readmission and death. Additional efforts to improve adherence with sacubitril/valsartan and other guideline-directed medical therapies in HFrEF are warranted.

BackgroundPatients with limited English proficiency (LEP) experience worse outcomes following hospital discharge. Care transition programs are common, yet little is known about the disparities in quality (process and outcome measures) experienced by patients with LEP.MethodsWe conducted a retrospective cohort study to determine the association of LEP and care transition quality at an urban, US academic hospital. We examined all adults discharge home from the hospital from May 2018 through April 2019. All patients received a multilingual, automated telephone call three days after discharge to assess and address patient-reported issues. We determined care transition quality using process measures (reach rate, time to resolve reported issue) and outcome measures (discharge instructions questions, difficulty obtaining prescriptions, medication concerns, follow up care questions, new or worsening symptoms, any other clinical issues). All results were adjusted for measured confounders; we used predicted probabilities and average marginal effect (AME) to describe associations.Results13,860 patients were included in the study; 11% had LEP. The program reached most patients regardless of LEP status but was less likely to reach patients with LEP (AME 3.3%; 95% CI, 1.4% to 5.1%). After adjustment, patients with LEP reported high rates of all measured patient-reported outcomes: discharge instruction (AME 4.8%; 95% CI, 2.7% to 6.9%), obtaining prescriptions (AME 2.9%; 95% CI, 0.6% to 5.1%), medications concerns (AME 2.3%; 95% CI, 0.0% to 4.6%), follow up questions (AME 2.8%; 95% CI, 0.3% to 5.3%), new or worsening symptoms (AME 3.2%; 95% CI, 0.7% to 5.8%), and any other clinical issues (AME 3.6%; 95% CI, 1.1% to 6.1%). When issues were identified, the association between LEP and time to resolution of an issue was statistically, but not clinically, significant.Conclusion and RelevanceAmong patients with LEP, substantial disparities exist in patient-reported post-discharge outcome measures indicating a need for better discharge processes that focus on quality and health equity. Following discharge, relatively minor disparities were observed in the processes of a care transitions program that supports non-English languages.

BACKGROUND AND OBJECTIVES Follow-up on results of inpatient tests pending at discharge (TPAD) must occur to ensure patient safety and high-quality care continue after discharge. We identified a need to improve follow-up of TPAD and began a quality improvement initiative with an aim of reducing the rate of missed follow-up of TPAD to ≤20% within 12 months. METHODS The team used the Plan-Do-Study-Act method of quality improvement and implemented a process using reminder messages in the electronic health record. We collected data via retrospective chart review for the 6 months before the intervention and monthly thereafter. The primary outcome measure was the percentage of patients with missed follow-up of TPAD, defined as no documented follow-up within 72 hours of a result being available. The use of a reminder message was monitored as a process measure. RESULTS We reviewed charts of 764 discharged patients, and 216 (28%) were noted to have TPAD. At baseline, the average percentage of patients with missed follow-up was 80%. The use of reminder messages was quickly adopted. The average percentage of patients with missed follow-up of TPAD after beginning the quality improvement interventions was 35%. CONCLUSIONS We had significant improvement in follow-up after our interventions. Additional work is needed to ensure continued and sustained improvement, focused on reducing variability in performance between providers and investing in technology to allow for automation of the follow-up process.

Aim. Study the effect of a study video, which was created by researchers and devoted to the atherosclerosis development and the effect of statin therapy on atherosclerotic plaque, on adherence to long-term therapy in patients with high or very high risk of cardiovascular complications.Material and methods. 120 patients admitted to hospital with cardiovascular diseases were included in the study. Patients were randomized into 2 groups: in the main group (n=60), the information video edited by the researchers was shown to patients on the eve of discharge, in addition to a printed brochure on lifestyle and diet modification, and in the control group (n=60), patients were given only a standard brochure. The motivating video shows the damage to the cardiovascular system by the atherosclerotic process and the beneficial effect on the body of constant intake of statins. After 1 and 3 months after discharge from the hospital, telephone calls were made, after which the patients had to visit the center for an objective examination by a researcher and control of laboratory parameters. After 1 month, 110 patients visited the center, after 3 months, 98 respondents visited the center.Results. The group with the information video demonstration noted more frequent adherence to medical recommendations compared to the control: after 1 month, 52 (96%) patients continued treatment versus 48 (86%) patients, 3 months after discharge 48 (96%) patients continued treatment versus 38 (79%) patients (pConclusion. Demonstration of a motivating video about the effect of statins on the atherosclerosis course increases patient adherence to medicinal therapy, including adherence to statins.

We report a corona virus disease (COVID‐19) case with unprecedented viral complexity. In the first severe episode, two different severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) strains (superinfection) were identified within a week. Three months after discharge, the patient was readmitted and was infected in a nosocomial outbreak with a different strain, suffering a second milder COVID‐19 episode.

Objective Severely uncontrolled diabetes mellitus (DM) is associated with poor long-term outcomes and may remain unrecognized. A high frequency of uncontrolled DM has been identified in the acute-care setting, including the emergency department observation unit (EDOU). We assess the use of standardized endocrine consultation in the EDOU for hemoglobin A1C (HbA1C) levels ≥9%. Methods Standard practice in our EDOU includes universal HbA1C screening and endocrine consultation for HbA1C levels ≥9.0%. As part of a quality improvement program, EDOU patients with HbA1C levels ≥9.0% had an endocrinology consult. One-month follow-up phone calls assessed the effects of consultation after discharge. Results HbA1C tests were administered to 3688 (95.7%) of 3853 EDOU patients, of which 7.0% (n = 258) were found to have an HbA1C level ≥9% (mean ± SD, 11.7 ± 1.8%; range, 9%-16.6%). Endocrine consults were completed for 73.6% (190/258) patients with severely uncontrolled DM. Among the 190 patients, 92.1% (n = 175) had discharge DM medication adjustments. For known patients with DM (n = 142), injectable diabetes medication prescriptions increased from 47.2% (67/142) on EDOU arrival to 78.2% (111/142) upon discharge. Newly diagnosed DM injectable prescriptions increased from 0% (0/48) on arrival to 72.9% (35/48) upon discharge. A total of 72.6% (n = 138) were contacted at a 1-month follow-up and 94.9% (n = 131) reported taking DM medications, compared with 68.2% (n = 94) before consult. Conclusion HbA1C screening coupled with endocrine consultation for HbA1C levels ≥9.0% was assessed as a performance improvement study and is shown to have valuable results. Further investigation is required to determine the long-term clinical impact and cost analysis for this novel approach.

Lay abstract Acute low back pain is one of the most common reasons patients present to the emergency department (ED), and it is often difficult to treat. The erector spinae plane block (ESPB) is a nerve block used to treat thoracic, rib, spine and abdominal wall pain. There is currently limited evidence to support its use in treating low back pain in the ED. This case series looks at outcomes of six patients who presented to the ED with low back pain who were treated with an ESPB that targets the low back muscles. Visual Analog Scale pain score reduction after the procedure ranged between 71 and 100%, with an average of 81.8%. The average length of stay (LOS) prior to the nerve block was 225 min, with a range of 107–480 min. Average LOS after the block was 73.5 min, with a range of 26–180 min. Five of six patients did not have any return ED visits for back pain. All six patients required no opiates after the procedure in the ED or after discharge. These cases show the ESPB is a promising technique that gives emergency physicians a rapid, safe and opiate-sparing option for the treatment of low back pain. ESPBs can result in decreased pain, decreased LOS, decreased opiate requirements and decreased admission for refractory pain.

Aims The methodology to distinguish between the heart failure (HF) with recovered ejection fraction (HFrecEF) and those with continuously reduced ejection fraction (EF) (HFcrEF) on admission has not been established. We recently demonstrated that the ratio of plasma levels of pro‐B‐type natriuretic peptide (proBNP) to total BNP (proBNP plus mature BNP) is decreased on admission in patients with mild acute HF, but not in severe acute HF as a compensatory mechanism for activating cyclic GMP via increases of bioactive mature BNP. We aimed to test the hypothesis that the ratio of bioactive mature BNP to total BNP is associated with reverse remodelling capacity in patients with HF with reduced EF. Methods and results Plasma proBNP and total BNP were measured in patients with acute decompensated HF by using specific and sensitive enzyme immunochemiluminescent assay. Estimated percent mature BNP (%emBNP) was calculated as ([total BNP − proBNP]/total BNP) × 100. We retrospectively identified the patients with reduced EF (≤40%, on admission) who had echocardiographic data after discharge (n = 93). We defined patients with increased EF by >10% during the follow‐up term (median, 545 days) after the admission as HFrecEF group. We compared patient characteristics, %emBNP, and other biomarkers between HFrecEF and HFcrEF. Of the enrolled patients with HFrecEF (n = 32) and HFcrEF (n = 61), on admission, %emBNP was significantly higher in HFrecEF than in HFcrEF (44.1% vs. 36.9%; P

Background. Mucormycosis is a rare and invasive fungal infection, affecting almost exclusively immunocompromised individuals. Immunosuppressive effects of corticosteroids which are widely prescribed in COVID-19 patients might be a predisposing factor for opportunistic infections even though the other factors should also be considered. Case Presentation. A middle-aged man without any significant past medical history was admitted to the hospital due to a severe COVID-19 infection. He received a high dose of corticosteroids as a part of the treatment. Five days after discharge, he presents with a headache and fever. Eventually, orbital mucormycosis was diagnosed for him and he was treated with antifungal medications. Conclusion. Opportunistic infections should be considered during the current pandemic of COVID-19, during which corticosteroids are widely prescribed.

Purpose The purpose of this study was to determine whether symptoms of spasticity, pain, and fatigue are correlated in people with stroke. Design A longitudinal-correlation, mixed-method design was used. Methods Spasticity, pain, and fatigue symptoms were explored in 22 patients with stroke admitted to three different rehabilitation units certified by the Commission on Accreditation of Rehabilitation Facilities. Data were obtained upon admission, postdischarge, and 1 month after discharge. Demographics, numeric ratings, and a semistructured interview were used to determine associations over time. Results Symptoms of spasticity, pain, and fatigue were quite variable. Fatigue was more likely to impair recovery. Spasticity appears to contain pain experiences. Pain does not appear to be a major factor over time. Conclusions In this sample of patients with stroke, symptoms of spasticity, pain, and fatigue were correlated. Clinical relevance In managing poststroke spasticity, pain, and fatigue, nurses should recognize that these symptoms are correlated.

Hospital readmission refers to the situation where a patient is re-hospitalized with the same primary diagnosis within a specific time interval after discharge. Hospital readmission causes $26 billion preventable expenses to the U.S. health systems annually and often indicates suboptimal patient care. To alleviate those severe financial and health consequences, it is crucial to proactively predict patients’ readmission risk. Such prediction is challenging because the evolution of patients’ medical history is dynamic and complex. The state-of-the-art studies apply statistical models which use static predictors in a period, failing to consider patients’ heterogeneous medical history. Our approach – Trajectory-BAsed DEep Learning (TADEL) – is motivated to tackle the deficiencies of the existing approaches by capturing dynamic medical history. We evaluate TADEL on a five-year national Medicare claims dataset including 3.6 million patients per year over all hospitals in the United States, reaching an F1 score of 87.3% and an AUC of 88.4%. Our approach significantly outperforms all the state-of-the-art methods. Our findings suggest that health status factors and insurance coverage are important predictors for readmission. This study contributes to IS literature and analytical methodology by formulating the trajectory-based readmission prediction problem and developing a novel deep-learning-based readmission risk prediction framework. From a health IT perspective, this research delivers implementable methods to assess patients’ readmission risk and take early interventions to avoid potential negative consequences.

The Comprehensive Geriatric Assessment (CGA) provides essential information about older hospitalized patients but is either not systematically adopted or not adopted at all in clinical routine. As a consequence, critical factors influencing patients' trajectories, like personal resources (geriatric resources, GR), geriatric syndromes (GS), health-related quality of life (HRQoL) and multidimensional prognosis often escape routine diagnostics.To investigate the association between HRQoL and GR/GS as well as its prognostic signature.In this study 165 inpatients older than 65 years admitted to an internal medicine department of a German large metropolitan hospital were assessed by a CGA-based calculation of the multidimensional prognostic index (MPI). Ten different GR and 17 GS, as well as HRQoL were collected. After 3, 6 and 12 months the patients were followed-up by telephone.The HRQoL was associated with MPI (p 0.001), number of GS (p 0.001) and survival days after discharge (p = 0.008). Additionally, significant associations were found between HRQoL and number of GR (p 0.001). GS displaying risk for physical dependence like instability (p 0.001) and chronic pain (p = 0.007) and single GR/GS that influence patient's confidence like isolation (p 0.001), depression (p 0.001) and emotional resources (p = 0.002) were also associated with HRQoL.The HRQoL is significantly associated to specific risk and protective factor profiles of GR and GS. To improve quality of life, targeted, patient-centered diagnostics and treatment of GS as well as stabilization of GR should be encouraged in the management of older, multimorbid patients outside geriatric settings.HINTERGRUND: Das multidimensionale Assessment (Comprehensive Geriatric Assessment, CGA) liefert entscheidende Informationen über hospitalisierte ältere Patienten, wird aber in nichtgeriatrischen Versorgungsstrukturen nicht konsequent angewendet. Als Folge werden kritische Faktoren für Patientenverläufe häufig nicht adressiert, wie persönliche Ressourcen, geriatrische Syndrome (GS), Lebensqualität und die multidimensionale Prognose.Untersuchung der Assoziation zwischen gesundheitsbezogener Lebensqualität („health-related quality of life, HRQoL“), GS und Ressourcen (GR) sowie multidimensionaler Prognose.Bei 165 über 65-jährigen hospitalisierten Patienten unter Hochleistungsmedizin wurden der CGA-basierter multidimensionaler prognostischer Index (MPI), 10 GR, 17 GS sowie die HRQoL erhoben. Follow-up-Anrufe wurden 3, 6 und 12 Monate nach Entlassung durchgeführt.Die HRQoL war mit dem MPI (p 0,001), der Anzahl der GS (p 0,001) und der Überlebenszeit nach Entlassung (p = 0,008) assoziiert. Zusätzlich ergaben sich signifikante Assoziationen zur Anzahl an GR (p 0,001), zu GS, die gefährdete körperliche Selbstständigkeit anzeigen, wie Instabilität (p 0,001) und chronische Schmerzen (p = 0,008), sowie GR und GS, die Einfluss auf das Wohlbefinden der Patienten haben, wie Isolation (p 0,001), Depression (p 0,001) und emotionale Ressourcen (p = 0,002).Zum ersten Mal konnte gezeigt werden, dass Lebensqualität, gemessen mittels HRQoL, signifikant mit einem spezifischen Profil von Risiko- und protektiven Faktoren wie GS und GR assoziiert ist. Zur Verbesserung der Lebensqualität sollten eine gezielte und patientenzentrierte Diagnose und Therapie von GS sowie die Stabilisierung von GR auch in nichtgeriatrischen Versorgungsstrukturen angestrebt werden.

Summary. The aim of the study was to identify nosologically nonspecific signs of hospitalism in patients of a gerontopsychiatric hospital and to develop, on their basis, a method for screening diagnostics of hospitalism.Materials and methods. We examined 194 inpatients aged 55 to 91 years, hospitalism was detected in 102 people, 92 people made up the comparison group. The survey was carried out at the stage of preparation for discharge in the form of a semi-structured interview, supplemented by the collection of anamnestic and follow-up data.Results. The most common signs of hospitalism in this sample were the deterioration of the mental and somatic state before discharge (78% of the examined patients of the main group, a confidence interval (CI) of 68–85%), a long duration of the current hospitalization (73%, CI 64–82%), violations of compliance (73%, CI 63-81%), long duration of inpatient treatment in anamnesis (71%, CI 61-80%), deterioration soon after discharge (67%, CI 52-80%), a large number of hospitalizations during the entire period of illness (67%, CI 57-76%), lack of discharge intention (62%, CI 51-72%), tendency to increase the duration of hospitalizations (54%, CI 43-64%), high level of anxiety before discharge (50% , CI 34-66%), reduction in the intervals between hospitalizations (49%, CI 38-59%), p Conclusion. The proposed methodology is intended for screening assessment of the presence of hospitalism and identification of the circle of persons for whom an in-depth assessment of social and psychological adaptation is advisable in order to prevent the adverse effects of hospitalization.

Knowledge regarding preventable hospital readmissions is scarce. Our aim was to compare the clinical characteristics of potentially preventable readmissions (PPRs) with non-PPRs. Additionally, we aimed to identify risk factors for PPRs. Our study included readmissions within 30 days after discharge from 1 of 7 hospital departments. Preventability was assessed by multidisciplinary meetings. Characteristics of the readmissions were collected and 23 risk factors were analyzed. Of the 1120 readmissions, 125 (11%) were PPRs. PPRs occurred equally among different departments (p = 0.21). 29.6% of PPRs were readmitted by a practitioner of a different medical specialty than the initial admission (IA) specialist. The PPR group had more readmissions within 7 days (PPR 54% vs. non-PPR 44%, p = 0.03). The median LOS was 1 day longer for PPRs (p = 0.16). Factors associated with PPR were higher age (p = 0.004), higher socio-economic status (p = 0.049), fewer prior hospital admissions (p = 0.004), and no outpatient visit prior to readmission (p = 0.025). This study found that PPRs can occur at any department in the hospital. There is not a single type of patient that can easily be pinpointed to be at risk of a PPR, probably due to the multifactorial nature of PPRs.

Background: It is likely that one-third of people that experience a stroke will be dependent on others for their care after discharge from hospital. Aims: This study aims to explore the perspectives of a range of stakeholders about the challenges impacting on a smooth transition from hospital to home following a stroke. Methods: A qualitative study was conducted, which involved people living with stroke (n=3), family carers (n=3) and senior nurses (n=5) from one health trust in the UK. Face-to-face interviews, telephone interviews and open response questionnaires were used for data collection. An inductive approach informed data analysis. Findings: The three main themes that emerged from the data analysis were 1) communication and information, 2) support mechanisms, and 3) organisational issues. The findings indicate a gap between what the service is presently delivering and what patients and carers require for a smooth care transition from hospital to home. Conclusions: The author recommends timely, coordinated discharge planning that actively involves the patient and family carer, the implementation of day leave and weekend leave, and the involvement of the family carer in providing some aspects of care for their relative in the hospital environment.

Background The purpose of this research was to describe health care nurse and providers’ pain management education priorities and barriers for pediatric cardio-thoracic surgical (CTS) patients and their caregivers. Design This was a qualitative-descriptive study design using survey methodology. Methods A convenience sample of 206 (CTS) health care professionals including 172 nurses, 11 advanced practice providers, and 23 physicians were invited to participate in this study. The survey was distributed through a work e-mail within a 145-bed tertiary pediatric hospital and focused on collaborative pain management educational priorities and barriers. Results Of the 206 cardio-thoracic service health care nurses/providers surveyed, 45.6 % (N = 94) responded to the survey. The top pain management education priority for these nurses/providers included immediate postoperative pain management knowledge for the caregiver and pediatric CTS patient. The lowest priority 13.8% (N = 13) included education related to pain management needs after discharge. Of the 94 nurses/providers who responded, 31.9% (n = 30) identified the presence of timing and communication barriers in providing pain management education with caregivers and pediatric CTS patients. Aims The aim of this research was to describe health care providers pain management education priorities and barriers for cardio-thoracic surgical (CTS) pediatric patients and their caregivers. Setting 145-bed tertiary pediatric hospital. Participants/Subjects Nurses, advanced practice providers [APP's], and physicians. Conclusions Nurses and providers prioritize immediate postoperative pain management education; however, there remains a need to focus more on the outcomes of pain management education for caregivers and pediatric CTS patients after discharge.

Objective To determine the prevalence and risk factors for inappropriate discharge on proton pump inhibitor (PPI) therapy started in the intensive care unit (ICU) for stress ulcer prophylaxis. Patients and Methods This was a retrospective cohort study of adults initiated on treatment with a PPI in any of 9 affiliated ICUs from January 1, 2014, to December 31, 2018. Patients were excluded if they had an appropriate long-term PPI indication. Logistic regression modeling was used to identify characteristics associated with discharge on treatment with an inappropriate PPI. Results Of 24,751 patients admitted to an ICU, 4127 were initiated on treatment with a new PPI, with 2467 (60%) lacking a long-term PPI indication. Of these 2467, a total of 1122 (45%) were continued on PPI therapy after transfer to the floor and 668 (27%) were discharged on PPI therapy. On multivariable analysis, risk factors for inappropriate discharge on PPI therapy included having an upper endoscopy (adjusted odds ratio [aOR], 1.70; 95% CI, 1.08-2.66), admission to the surgical compared with medical ICU (aOR, 2.03; 95% CI, 1.32-3.10), and discharge to a nursing home or rehabilitation facility (aOR, 1.43; 95% CI, 1.04-1.96; and aOR, 2.29; 95% CI, 1.62-3.24, respectively). Conclusion Among patients started on treatment with a PPI in the ICU without an indication for outpatient PPI use, 27% (668 of 2467) were nonetheless discharged on PPI therapy. Medically complex and surgical ICU patients are at increased risk for receiving PPIs without appropriate documented indications, and careful review of medication lists at discharge should occur in these high-risk groups.

Background Malingering is a common and challenging clinical presentation in emergency departments (EDs). Objective This study describes characteristics and outcomes among patients diagnosed as malingering in a psychiatric emergency service. Methods Index psychiatric ED encounters were identified for all adult patients seen during a 27-month period. Mortality data were obtained for patients from the state public health authority, and repeat ED visits for self-harm were obtained from the state hospital association. Patients with a diagnosis of malingering were compared with those without a malingering diagnosis using correlative statistics and multivariable analyses. Results Of 4710 encounters analyzed, 236 (5%) had a malingering diagnosis. No patients diagnosed as malingering died of suicide within 365 days of discharge, compared with 16 (0.4%) nonmalingering patients. Self-harm outcomes were available for 2689 encounters; 129 (5%) had a malingering diagnosis. Malingering was significantly associated with a repeat ED visit for self-harm within 365 days in multivariable analyses (adjusted odds ratio 2.52; 95% confidence interval 1.35–4.70); p Conclusions No psychiatric emergency service patients diagnosed as malingering died by suicide after discharge. New clinical approaches must balance malingering patients’ apparent low suicide risk with their other substantial comorbidities and risk for self-harm.

Summary A lack of reliable, long-term patient follow-up data after discharge from short-term surgical missions to low-income and middle-income countries remains a key issue in global humanitarian work. Project Harar is a non-governmental organisation that works in close association with surgeons from the Yekatit 12 Medical College, Addis Ababa, to treat children and adults with complex facial disfigurement in Ethiopia on an annual head and neck and facial reconstructive mission. Following a successful pilot study employing charity field workers and smart phones to follow-up patients in 2018 and 2019, Project Harar now uses patients’ own smartphones to achieve follow-up remotely, without the need for field workers in the majority of cases. Using patient smartphones, triage safety questions and post-operative photographs can be relayed directly to the charity post-operatively. Using this follow-up model, the majority of patients from the 2020 complex reconstructive mission were successfully followed-up. We present data in support of our new method of remote triage and follow-up, and detail a comprehensive algorithm for remote follow-up using patients’ own smartphones after discharge from a short-term reconstructive missions in Ethiopia. We hope this work will be beneficial for similar organisations operating in resource-limited settings around the world facing challenges in reliable patient follow-up.

Objective: The objective of this study was to evaluate the effect of an Enhanced Recovery After Surgery (ERAS) protocol on patient experience after discharge from laparoscopic hysterectomy. Materia...

Shuiping Dai,1,&ast; Bennan Zhao,2,&ast; Dafeng Liu,2 Yongzhao Zhou,3 Yaling Liu,2 Lijuan Lan,2 Yalun Li,3 Wenxin Luo,3 Yilan Zeng,2 Weimin Li3 1Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Department of Comprehensive Internal Medicine, The Public and Health Clinical Center of Chengdu, Chengdu, Sichuan, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Weimin Li; Yilan Zeng Email weimin003@163.com; 2499081791@qq.comPurpose: Some studies have shown that patients with coronavirus disease 2019 (COVID-19) still have sequelae after discharge. However, little is known about the long-term physical and psychological sequelae of patients, especially factors that influenced the prognosis.Patients and Methods: Patients with COVID-19 were followed up for 6 months. The psychological status of patients was evaluated by DASS-21 questionnaire, while physical functions were determined using medical history, laboratory examination, thoracic computed tomography (CT), and echocardiography.Results: Fifty patients infected with COVID-19 were enrolled, and 11 (22%) patients still showed symptoms related to COVID-19. The mean contents (cells/ul) of CD3+ cells, CD4+ and CD8+ T, B lymphocytes and NK cells of the survivors elevated significantly after 6-month discharge (P < 0.001). The frequency of ground-glass opacities and consolidations decreased from 90% to 42% (P < 0.001), and 54% to 20%, (P = 0.001), respectively, while the changes of reticulation and bronchiectasis were insignificant (P > 0.05). The frequency of left ventricular diastolic dysfunction decreased from 40% to 15% (P = 0.002). Depression was observed in 5 (12.5%) participants, stress in 3 (7.5%), anxiety in 6 (15%), and among them 1 (2.5%) showed extremely severe anxiety. Covariation analysis elucidated age might be a risk factor (OR: 1.09, 95% CI: 1.01– 1.18, P = 0.038), while NK cell was a good prognostic factor for pulmonary recovery. The comorbidities were significantly positive correlated with persist pulmonary damage (r = 0.33, P = 0.020). Compared with patients with antiviral therapy, patients without antiviral therapy had higher anxiety score (3 vs 0, P = 0.033).Conclusion: After 6-month discharge, the persisting cardiopulmonary damage was observed in recovery patients, and psychological implications should not be ignored. Age, comorbidities, NK cell and antiviral therapy might be associated with the prognosis of COVID-19.Keywords: COVID-19, follow-up, cardiopulmonary, psychology, influence factors

We still have little understanding of short-term predictors of suicidal thoughts and behaviors (STBs). Prior research links increased negative affect to STBs, but the vast majority of earlier work is limited by measuring negative affect at one time point and aiming to predict STBs months or years in the future. Recently, intensive longitudinal studies have shown that negative affect is associated with suicidal thoughts over relatively short, clinically useful time periods; however, the specific patterns and types of negative affect that predict STBs remain unclear. Using ecological momentary assessment (EMA) data from psychiatric inpatients hospitalized for suicide risk (n = 83), this study sought to test whether the patterns (means and variability) of two types of negative affect (anxiety/agitation and shame/self-hatred, which were derived from a larger EMA battery) during hospitalization predict STBs in the 4 weeks after discharge: an extremely high-risk time for suicidal behavior. The mean—but not the variability—of both anxiety/agitation and shame/self-hatred during hospitalization predicted the number of days with suicidal thoughts after discharge. The mean and the variability of shame/self-hatred—but not anxiety/agitation—predicted post-discharge suicide attempt. We discuss implications for assessment and treatment of suicidal individuals and propose key directions for future research. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s42761-021-00058-6.

To observe the effect of continuous nursing intervention on exercise tolerance and rehospitalization rate in patients with chronic heart failure. Methods 134 patients with chronic heart failure admitted to our hospital were divided into two groups, routine nursing intervention group (control group) and continuous nursing intervention group (observation group), with 67 cases in each group. The resting and peak heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the two groups were recorded. The change of 6min walking distance, modified European Heart Failure Self-Care Behavior Scale (EHFSCB-9) and quality of life (SF-36) of the two groups were compared before and after intervention, and moreover, rehospitalization rate of heart failure of two groups 6 months after discharge was compared between the two groups. Results : Before intervention, there was no significant difference between the two groups (P>0.05). After intervention, there was no significant difference in resting and peak HR, SBP and DBP between the two groups and those before intervention (P>0.05). Further comparison between the two groups showed that there was no significant difference in resting and peak HR, SBP and DBP between the observation group and the control group (P>0.05). After intervention, 6min walking distance and SF-36 scale scores (role physical, physiological function, physical pain, energy, health status, social function, mental health and emotional function) were increased in the two groups (P

Introduction: Post-COVID syndrome is a common finding during the first year after SARS-CoV-2 infection affecting the daily living of many patients. The aim of this study was to assess the functioning of patients with post-COVID syndrome. Material and methods: A self-reported questionnaire — the Functioning in Chronic Illness Scale (FCIS) — was applied in 79 (30 women, 49 men) patients (mean age of 62.7 ± 13.6 years), suffering from post- COVID syndrome 5.8 ± 2.3 months after discharge from hospital. Results: The mean FCIS score was 86.2 ± 12.8 points, corresponding to medium functioning level. The mean score in the first, second and third subscale was 27.0 ± 6.4; 27.5 ± 3.7; and 31.7 ± 4.3 points respectively. Better functioning was observed in men vs women: the FCIS score 88.59 ± 10.95 vs 82.20 ± 14.71; p = 0.02 and in the youngest patients: first ( 67 years): FCIS score 92.76 ± 14.84 vs 83.15 ± 11.64 vs 83.07 ± 9.68; p = 0.01). The amount of time from COVID-19-related hospitalisation did not affect the FCIS score. Conclusion: Symptoms of post-COVID syndrome influencing patients’ functioning persist within the first year regardless of the time elapsing from the disease. Men and younger patients demonstrate better functioning abilities.

BACKGROUND AND OBJECTIVE: Monitoring recovery process of coronavirus disease 2019 (COVID-19) patients released from hospital is crucial for exploring residual effects of COVID-19 and beneficial for clinical care. In this study, a comprehensive analysis was carried out to clarify residual effects of COVID-19 on hospital discharged patients. METHODS: Two hundred sixty-eight cases with laboratory measured data at hospital discharge record and five follow-up visits were retrospectively collected to carry out statistical data analysis comprehensively, which includes multiple statistical methods (e.g., chi-square, T-test and regression) used in this study. RESULTS: Study found that 13 of 21 hematologic parameters in laboratory measured dataset and volume ratio of right lung lesions on CT images highly associated with COVID-19. Moderate patients had statistically significant lower neutrophils than mild and severe patients after hospital discharge, which is probably caused by more efforts on severe patients and slightly neglection of moderate patients. COVID-19 has residual effects on neutrophil-to-lymphocyte ratio (NLR) of patients who have hypertension or chronic obstructive pulmonary disease (COPD). After released from hospital, female showed better performance in T lymphocytes subset cells, especially T helper lymphocyte% (16% higher than male). According to this sex-based differentiation of COVID-19, male should be recommended to take clinical test more frequently to monitor recovery of immune system. Patients over 60 years old showed unstable recovery process of immune cells (e.g., CD45 + lymphocyte) within 75 days after discharge requiring longer clinical care. Additionally, right lung was vulnerable to COVID-19 and required more time to recover than left lung. CONCLUSIONS: Criterion of hospital discharge and strategy of clinical care should be flexible in different cases due to residual effects of COVID-19, which depend on several impact factors. Revealing remaining effects of COVID-19 is an effective way to eliminate disorder of mental health caused by COVID-19 infection.

espanolDebido al alto porcentaje de recaidas posteriores al tratamiento por consumo de drogas, se presenta un esquema de intervencion, con un enfoque cognitivo conductual orientado al desarrollo de habilidades y estrategias de afrontamiento de las situaciones riesgosas y estresantes. Objetivo. Conocer en los adictos rehabilitados el nivel de autoeficacia para mantener la abstinencia. Metodo. A traves de un curso-taller de 10 sesiones dirigido a los residentes de una Comunidad Terapeutica, se promovio el desarrollo de habilidades de control acerca de los pensamientos relacionados a las sustancias y a su consumo. Resultados. Se realizo un seguimiento a los participantes a los dos y cuatro meses posteriores a su egreso, de estos, 67% continuaban en abstinencia y 33% habia recaido; las situaciones de mayor riesgo de recaida fueron: momentos y emociones agradables con otros, seguidas por la necesidad fisica creada por la droga acostumbrada. Discusion y Conclusiones. Las ideas nucleares permisivas del consumo se pueden modificar con tecnicas cognitivo conductuales y los cambios logrados pueden perdurar y asi disminuir la intensidad del craving. Este tipo de intervencion logra mayor autoconocimiento de la conducta de consumo y aumenta la autoeficacia para sostener la abstinencia. EnglishDue to the high percentage of relapses after treatment for drug use (between 40 and 60%), a scheme of intervention in their prevention is presented, with a cognitive behavioral approach oriented to the development of skills and coping strategies for risky situations of drug use or stress conditions, whose Objective was to analyze the situations of consumption in relation to self-efficacy to maintain abstinence. Method. Through a ten session workshop-course aimed to 10 residents of a Therapeutic Community, control skills were developed about thoughts related to substances and their consumption. Results. Participants were followed up two and four months after discharge, of these, 67% continued abstinence and 33% had relapsed; the situations with the highest risk of relapse were: pleasant moments and emotions with others, followed by the physical need created by the customary drug. Discussion and Conclusions. The permissive nuclear ideas of consumption can be modified with cognitive behavioral techniques and the changes achieved can last and thus decrease the intensity of craving. This type of intervention achieves greater self-awareness of consumer behavior and increases self-efficacy to sustain abstinence.

Objective Interpersonal negative life events (NLEs) have been linked to risk for suicidal thoughts and behaviors. However, little is known about how this risk is conferred over the short term and the mechanisms linking interpersonal NLEs to suicide risk, particularly in adolescents. This study used an intensive longitudinal design to examine thwarted belongingness with family and friends as potential mechanisms linking interpersonal NLEs to suicidal thoughts. Method Forty-eight adolescents (Mage = 14.96 years; 64.6% female, 77.1% White), who recently received acute psychiatric care for suicide risk, were followed intensely for 28 days after discharge. Smartphone-based ecological momentary assessment was used to measure presence of interpersonal NLEs at the day level, fluctuations in thwarted belongingness with family and friends (separately) within day, and fluctuations in suicidal thoughts within day. A multi-level structural equation model was utilized to examine family thwarted belongingness and friend thwarted belongingness as parallel mediators in the relationship between interpersonal NLEs and next-day suicidal thoughts. Results Significant direct effects were observed between interpersonal NLEs and family thwarted belongingness, family thwarted belongingness and suicidal thoughts, and friend thwarted belongingness and suicidal thoughts. In addition, family, but not friend, thwarted belongingness significantly mediated the association between interpersonal NLEs and next-day suicidal thoughts. Conclusions Interpersonal NLEs predicted greater suicidal thoughts over the short term (next day) in high-risk adolescents. Findings suggest how interpersonal NLEs may confer risk for suicidal thoughts - by reducing feelings of family belongingness. Future research is needed to examine how modifying belongingness may reduce suicide risk in adolescents.