Volatile anesthetics have been suggested to exert neuroprotective effects in patients with subarachnoid hemorrhage caused by a ruptured cerebral aneurysm. However, their effects on functional outcomes remain unverified. We assessed the association between volatile anesthetics and functional outcomes in patients with subarachnoid hemorrhage. Using data from the Japanese Diagnosis Procedure Combination inpatient database, patients with subarachnoid hemorrhage, aged = 18years, and undergoing any procedures for aneurysm treatment were selected. Patients were categorized into those who received volatile anesthetics and those who did not. The primary outcome was a composite of in-hospital death or impaired functional outcome at discharge. The secondary outcomes included in-hospital mortality, postoperative cerebral infarction, postoperative acute hydrocephalus, tracheostomy, hospital stay, and total healthcare costs. After 1:1 propensity-score matching, a generalized linear model or linear model was applied for each outcome, with cluster-robust standard error adjustment. Interaction analysis was also conducted for the primary outcome and in-hospital mortality. Overall, 35,097 matched pairs were generated. No significant difference was noted in the primary outcome between the two groups (total intravenous anesthetics: 44.5%; volatile anesthetics: 44.1%; odds ratio 0.99, 95% confidence interval [CI] 0.93-1.06, p = 0.84). However, in-hospital mortality differed significantly between the groups (total intravenous anesthetics: 9.3%; volatile anesthetics: 8.7%; odds ratio 0.89, 95% CI 0.82-0.97, p < 0.01). Other secondary outcomes showed no significant group differences. Interaction analysis indicated that volatile anesthetics worsened outcomes among patients with impaired consciousness at admission. Volatile anesthetic use was not associated with improved functional outcomes in patients with subarachnoid hemorrhage. In patients presenting with impaired consciousness, volatile anesthetics were associated with poorer outcomes, although this finding should be interpreted with caution, given the observational nature of the study.

Diabetes and Technology - an Update for the General Physician.

Government of Himachal Pradesh imposed smoke ban in 2009 with convincing decline in smoking prevalence among young adults. Thereafter, government wanted to assess the impact of smoke ban considering its effective implementation. The objectives of this study were to assess reduction in acute myocardial infraction (AMI) and stroke hospital admissions in two districts (Shimla and Kangra) of Himachal Pradesh after smoke ban on July 1, 2009. A secondary data-based retrospective study using Poisson regression-based interrupted time series (ITS) modeling was carried out from January 2007 to December 2011. Monthly AMI and stroke hospital admission data were collected from January 2007 to December 2011 from two tertiary care hospitals. In district Kangra, admission data for study period 2007 (January to November) were not available, so ITS analysis was done from 2008 to 2011 for the said district. Risk ratio was calculated as exp (regression estimate) with a 95.0% confidence interval (CI) to assess effect. In both districts, smoke ban showed no effect (Shimla: 1.03; 95% CI: 0.85-1.25, Kangra: 0.97; 95% CI: 0.74-1.28) in terms of AMI admissions, even across gender and age groups. In Kangra district, smoke ban showed a protective effect on stroke admissions but with wide confidence intervals (0.21; 95% CI: 0.07-0.59). However, in Shimla district, it showed significant positive effect on an increase in stroke admissions (1.06; 95.0% CI: 1.03-1.75). Smoke ban showed no impact on AMI and stroke monthly hospital admissions in both districts, except in Kangra for stroke.

To assess the interrater reliability, concurrent validity, and responsiveness of the Children's Eating and Drinking Activity Scale (CEDAS). Interrater reliability was assessed using an online questionnaire completed by speech and language therapists working in hospital and community settings. Participants (n=39) applied CEDAS to 12 vignettes. Interrater reliability was calculated using Krippendorff's alpha (α). Additionally, CEDAS was applied retrospectively to consecutive speech and language therapy referrals at a single hospital (n=85, median age 11 years 2 months, range 1 week-17 years 1 month). Responsiveness was assessed by comparing median CEDAS scores at referral, after initial speech and language therapy assessment, and at discharge. The Functional Status Scale (FSS) feeding domain was used to evaluate concurrent validity. Interrater reliability was excellent (Krippendorff's α=0.927). CEDAS was responsive to change, with expected score increases seen between referral and discharge (Z=-4.37, p < 0.001), and initial assessment and discharge (Z=-3.23, p < 0.001). Strong concurrent validity was established with the FSS (rs=-0.77 to -0.99, p < 0.003). CEDAS demonstrates excellent interrater reliability across clinical settings. It is a responsive tool with established construct validity when used in an acute hospital setting.

BackgroundPatients with multimorbidity have complex health care needs and are at high risk for adverse health outcomes. Primary care teams need tools to effectively and proactively plan care for these patients. We developed VET-PATHS (Veteran Panel Management Tool for High-Risk Subgroups), a novel care planning informatics tool for complex primary care patients. VET-PATHS groups patients by chronic condition via latent class analysis of electronic health record data, then jump-starts care planning by suggesting “care steps” based on data-driven high-priority care for the group.ObjectiveThe study aimed to iteratively adapt VET-PATHS with user input, then test feasibility and acceptability by frontline primary care teams for empaneled patients at high risk.MethodsThree rounds of user-centered design sessions with 17 primary care providers and registered nurses at 5 sites from 2019 to 2021 were conducted to obtain feedback on the VET-PATHS layout, content, and user interface. Feedback was summarized into 4 user experience domains (useful, desirable, credible, and usable), leading to progressively updated prototypes. After the national tool release, we conducted a pilot intervention study in 2023‐2024 with 6 primary care teams at 4 sites using VET-PATHS during asynchronous regular meetings. Tool use and resulting care plans were assessed by templated observation during meetings, postpilot chart review, and administrative data. Individual qualitative interviews were analyzed by rapid template analysis for feasibility, acceptability, and utility.ResultsUser-centered feedback led to updated tool content, context (eg, use in proactive panel management), targeted users (eg, focusing on primary care providers), and display layout. Pilot teams used VET-PATHS over 4 to 8 weekly meetings (mean length 24, range 16‐49 min), actively reviewing 80% (280/351) of empaneled patients at high risk visible in the tool. Tool use prompted 127 new actions for 91 unique patients (33% of patients reviewed) and documentation of >1 new care plan for 19% of patients reviewed. Common actions included requests to return to the clinic (n=34, 27%), referrals (n=25, 20%), or vaccinations (n=24, 19%). Of the 127 actions planned, 53 (42%) were received by patients. Difference-in-difference trends for acute hospitalizations declined post pilot, while outpatient utilization was stable or increased for pilot team patients compared to all patients at high risk at pilot sites (per-patient counts: acute hospitalizations −0.15; primary care visits 0.00; mental health visits 0.99). Four generalist teams (n=11 interviews) described higher acceptability. Two “focused” teams with more homogenous panels, for example, substance use disorder (n=3 interviews), found care steps less useful. Teams described how VET-PATHS improved efficiency of care planning through automated patient grouping and identification of care gaps and increased multidisciplinary involvement.ConclusionsUser-centered improvements to VET-PATHS were designed to help clinicians process and use complex information about patient multimorbidity to efficiently create new care plans. Subsequently, VET-PATHS was acceptable and feasible to frontline primary care teams, particularly with more general patient panels, and led to concrete changes to clinical care delivery.

Objectives. To evaluate the completeness and utility of influenza hospital data reported to the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) from September 2021 to April 2024. Methods. Acute care and critical access hospitals in the United States reported daily numbers of new hospital admissions of patients with laboratory-confirmed influenza to NHSN during voluntary and mandatory reporting periods. To evaluate the completeness of data reported to NHSN, we compared the number of influenza hospital admissions reported to NHSN with data reported to the Influenza Hospitalization Surveillance Network (FluSurv-NET) among 13 states and overlapping counties reporting to both systems from September 2021 to April 2024. Results. During voluntary reporting, about 77% of US hospitals reported daily influenza hospital admission counts to NHSN; during mandatory reporting, this increased to a mean of 94%. These data were highly correlated (r = 0.978; 95% confidence interval = 0.968, 0.985; P < .001) with numbers from FluSurv-NET and in most states (r range = 0.861-0.988) within overlapping surveillance areas. Conclusions. Influenza hospital admissions reported to NHSN demonstrate high levels of complete reporting; overall counts are highly correlated with a high-quality, long-standing influenza hospitalization surveillance system. (Am J Public Health. Published online ahead of print December 4, 2025:e1-e5. https://doi.org/10.2105/AJPH.2025.308282).

BackgroundAll hospital trusts are required to have stewardship programmes to promote the judicious use of antimicrobials. These programmes have historically focused on antibiotics, although attention to antifungals has increased. However, few studies in the literature focused on antiviral stewardship (AVS). A shortage of parenteral aciclovir (ACV) arose in May 2024. During the contingency planning phase, we read of the success of virology stewardship reviews at University Hospitals Birmingham1 and decided to introduce this locally.ObjectivesTo introduce virology stewardship reviews at Salford Royal Hospital.; to reduce unnecessary usage of parenteral aciclovir ;and to promote good antiviral stewardship practice.MethodsVirtual AVS reviews were performed by consultant virologist(s) and an antimicrobial pharmacist. Patients prescribed ACV IV were identified via the electronic prescribing system. Reviews were conducted biweekly initially then weekly for the last 2 weeks. Data was collected over 12 weeks between 9/5 and 31/7/24.ResultsA total of 41 reviews were performed for 19 patients The average time taken was 20 min per session. AVS recommendations were: continue (29), stop (6), dose modification (5) and oral switch (1). During the intervention period, mean monthly consumption of ACV IV in defined daily doses (DDDs) fell to 35.5 compared to 61.7 over the same period the previous year. Total expenditure on ACV IV over May–July 2024 was £950, a saving of £1299 compared to May–July 2023. Other additional findings were as follows. (i) ACV continued whilst awaiting cerebrospinal fluid (CSF) viral PCR results from an external laboratory with turnaround times of >48 h. In some cases, ACV could have been stopped in the context of clinical review, timing of CSF collection and brain imaging. The average time taken for PCR result to be received and actioned during the study was 8.3 days, which is a significant delay that is being addressed. (ii) ACV was prescribed unnecessarily for suspected viral meningitis in immunocompetent patients in some cases. There are no proven benefits of continuing ACV IV in most causes of viral meningitis.2 With regular reinforcement we found that this practice reduced over the timeframe of the intervention. (iii) Dosing weights for ACV were inconsistent between actual, ideal and adjusted body weight. British National Formulary recommends ideal body weight whereas other references3 recommend adjusted body weight. This was taken to the Trust antibiotic steering group for discussion.ConclusionsAntiviral stewardship reviews reduced consumption of IV aciclovir. Regular reviews and feedback to clinicians helped optimize treatment plans. Overall, AVS reviews successfully promoted judicious use of ACV and preserved supplies for the highest risk patients.

Youths experiencing a behavioral health crisis often have a long length of stay (LOS) in emergency departments (EDs) and on inpatient psychiatric units, with myriad negative consequences. This scoping review aimed to identify interventions that decrease LOS in these acute care settings and to characterize helpful practices. MEDLINE, Embase, PsycInfo, and Web of Science were systematically searched. Peer-reviewed empirical articles that described interventions to decrease LOS in acute care hospitals for youths (up to age 18) with behavioral health concerns were included. Two screeners from a group of four independently reviewed each study, determined study eligibility, and extracted data. Twenty-eight articles met inclusion criteria. Studies were primarily evaluated through same-setting pre-post designs and conducted in the United States. Interventions to address LOS in EDs and on inpatient psychiatric units included assessment protocols, adjustments to the continuum of care available to youths, disorder-specific clinical pathways, personnel restructuring, structural changes, technology implementation, evidence-informed treatments, and multiple strategies. Although no singular model for helpful intervention emerged, several categories of interventions had encouraging results. Reducing LOS in acute care settings is a burgeoning area of research and is critically important given the ongoing youth behavioral health crisis. Continued research should prioritize rigorous study design, consistent reporting, the inclusion of representative samples, and intervention scalability.

Survivors of hemorrhagic stroke exhibit a high burden of cerebrovascular risk factors, including hyperlipidemia and diabetes, which can impact future risk of recurrence and major adverse cardiovascular events. Systematic evaluation and management of these comorbidities during hospitalization remains suboptimal, despite the availability of effective treatment strategies. This study aimed to determine whether an electronic health record-based intervention improves assessment and management of hyperlipidemia and diabetes after hemorrhagic stroke. We conducted a prospective cohort study comparing a historical cohort of 314 consecutive patients with primary intracerebral hemorrhage (2016-2019) with a prospective intervention cohort of 296 patients with hemorrhagic stroke (2023-2024) at a single tertiary care center. The intervention was composed of an electronic health record-deployed best practice alert to prompt providers to order low-density lipoprotein cholesterol (LDL-C) and glycated hemoglobin (HbA1c) levels. We compared the cumulative incidence of LDL-C and HbA1c evaluation before and after intervention through Gray's test and assessed the effectiveness of the intervention using a multivariable Fine and Gray model, adjusted for relevant confounders. Finally, we evaluated changes in the treatment intensification of suboptimal LDL-C and HbA1c levels between the 2 periods using χ2 and Fisher exact tests. Following the intervention, the cumulative incidence of HbA1c and LDL-C evaluations increased significantly, with HbA1c measurements rising from 57.9% to 75.8% (P<0.001) and LDL-C from 55.3% to 72.4% (P<0.001). The Fine and Gray model demonstrated a 61% increase in the subdistribution hazard for both evaluations during the intervention period (LDL-C: hazard ratio [HR], 1.61 [95% CI, 1.34-1.94]; P<0.001; HbA1c: HR, 1.61 [95% CI, 1.35-1.93]; P<0.001). Despite improvements in comorbidity assessments, no significant changes were observed in treatment intensification for abnormal HbA1c/LDL-C values. Our electronic health record-based intervention significantly improved the proportion of patients with hemorrhagic stroke evaluated for key comorbidities during acute hospitalization. However, future studies are needed to assess whether increased evaluations improve long-term management and outcomes. URL: Clinicaltrials.gov; Unique Identifier: NCT05643001.

Background: Large bowel obstruction (LBO) is a critical surgical emergency characterized by the cessation of normal colonic transit, leading to rapid physiological decompensation. It is a common initial presentation of advanced colorectal cancer and can also arise from benign causes like volvulus, diverticulitis, or pseudo-obstruction. Aim: This comprehensive review aims to detail the etiology, pathophysiology, clinical evaluation, and contemporary management strategies for LBO, emphasizing the integration of emergency care, diagnostic imaging, and multidisciplinary treatment. Methods: A narrative synthesis of current literature was conducted, analyzing diagnostic approaches (including CT imaging and endoscopy) and evidence-based interventions. The review evaluates guidelines and recent clinical trials comparing endoscopic, radiologic, and surgical management. Results: Initial management prioritizes aggressive fluid resuscitation and electrolyte correction. CT imaging is the diagnostic cornerstone. For malignant LBO, self-expanding metal stenting has emerged as an effective bridge-to-surgery, reducing stoma rates and enabling elective single-stage resection with similar long-term oncologic outcomes to emergency surgery. Surgery remains definitive for many cases, with approach (single vs. multi-stage) tailored to patient physiology and disease characteristics. Specific etiologies like sigmoid volvulus require endoscopic decompression, while acute colonic pseudo-obstruction is managed with neostigmine. Conclusion: Successful LBO management requires timely diagnosis, hemodynamic stabilization, and an etiology-driven intervention strategy. A coordinated, interprofessional approach optimizes outcomes by integrating endoscopic, radiologic, and surgical expertise to reduce morbidity and mortality.

Food insecurity screeners focus on identifying a financial barrier to accessing food. Other social and medical factors influence an individual's nutritional status and the need for food provision support. Yet, there are no existing tools that elicit the various life factors that influence food and nutrition needs and further identify relevant resources to address those needs. To develop the Nutrition Health Related Social Need Assessment and Referral Tool (N-HART) to facilitate individualized referrals to food and nutrition resources, based on both medical and social factors. Resources include food provision, nutrition and cookingeducation, and benefits assistance. We used a multi-phase approach to develop and refine the N-HART from March 2023 to March 2024. An initial draft of the N-HART was developed based on a literature review and field scan. Cognitive interviews with patients were used to iteratively refine the tool. The tool was developed for use across a health system, applicable to both inpatient and ambulatory settings. We conducted cognitive interviews with 15 patients at an acute care hospital in Philadelphia, PA to inform the refinement of the N-HART. The N-HART is a 13-item dual-function tool that screens for food and nutrition needs and recommends a best fit food resource type (e.g., medically tailored meals, non-tailored prepared meals, food pantry) based on an individual's needs. Cognitive interviews informed changes in N-HART framing and period of focus, and led to the elimination of some items to be as efficient and actionable as possible. With health systems focusing on HRSN, the N-HART may provide a strategy for informing more individualized nutrition referrals using a structured approach.

Asthma exacerbations are a leading cause of pediatric hospitalization, and systemic corticosteroids are a mainstay of inpatient treatment. This study describes hospital-level variability and trends in systemic corticosteroid prescribing during acute asthma exacerbation hospitalizations and examines hospital-level associations between prescribed corticosteroid and hospitalization outcomes. This retrospective cross-sectional study used the Pediatric Health Information System database to examine encounters of patients aged 2 to 18years who were hospitalized with an acute asthma exacerbation between January 1, 2016, and December 31, 2023 and were administered dexamethasone, prednisone, prednisolone, or methylprednisolone. We analyzed trends and hospital-level variation in systemic corticosteroid prescribing. We used generalized estimating equations to analyze the association of annual hospital-level dexamethasone use with hospitalization outcomes-length of stay, ED revisit, and readmission rates, with models adjusted for relevant clinical and demographic factors. We identified 122 856 asthma hospitalizations across 38 children's hospitals. From 2016 to 2023, the proportion of hospital-level dexamethasone use increased from 42% to 77%. The proportion of hospitals prescribing dexamethasone for over 80% of hospital encounters rose from 18% in 2016 to 66% in 2023. There was no difference in hospitalization outcomes based on annual hospital-level dexamethasone use, including a subanalysis also based on annual hospital-level dexamethasone use focusing on exclusive dexamethasone or exclusive prednisone/prednisolone use (P > .05). Dexamethasone use during asthma hospitalizations increased during the study period, without differences in hospitalization outcomes between hospitals that used a higher proportion of dexamethasone vs those that used less.

Mobility During an Acute Medical Hospitalization: A Prospective Cohort Study.

Phase angle as a predictor of complications in acute stroke: A cohort study.

Beyond paychecks: Unravelling the nexus of nurse and physician wages and mortality in acute care settings - A cross-sectional study using routine data.

Hypercapnic Chronic Obstructive Pulmonary Disease and Overlap Syndrome.

Mortality from tibial shaft fractures in the elderly (MTFE)-a multicentre study of management outcomes.

Nurses' attitudes toward nutritional care in medical and surgical units: A multicenter cross-sectional analysis.

Impact of the EAGLEcareACT Telehealth Program on Emergency Department Outcomes Among Nursing Home Residents: A Retrospective Cohort Study.

Flap reconstruction for pressure ulcers remains a surgical challenge, requiring careful selection of suitable patients to optimise outcomes. Postoperative care, especially pressure offloading, is critical for the prevention of complications, which include failure of the skin flap and wound recurrence. While the rates and risks of postoperative complications have been acknowledged, the challenges of postoperative care have been largely unaddressed. A 10-year retrospective review of all patients undergoing flap reconstruction for pressure ulcers at the College of Medicine (University of Florida, Florida, US) was conducted to elucidate factors that affected delays to discharge, post-discharge disposition (where the patient is discharged to), postoperative care and associated complications. Among patients who underwent multiple separate reconstructions, disposition to home versus a skilled nursing facility (SNF) or long-term acute care hospital (LTACH) had a significant association with a higher risk of complications. In these high-risk patients, a multidisciplinary approach that would ideally be put in place preoperatively should be used to optimise postoperative care and prevent unnecessary prolonged hospitalisation.