Acute Wards Research Articles

Association between behavioral parameters of men in psychiatric emergency department video recording and subsequent violence in the psychiatric ward.

Violence risk is a major challenge among acute psychiatric inpatients. The study aimed to predict violent behavior risk in an acute psychiatric ward using video recordings from the emergency department. 69 videos of the emergency department recording the first ten minutes following patients' arrivals were included. Psychiatrists watched the videos, completed relevant Brief Psychiatric Rating Scale items and answered intuitive questions about each patient's risk of violence. Demographic and clinical data were also collected. Motoric mannerisms as rated in the BPRS significantly differed between violent and non-violent patients (p < 0.05). Additionally, we found a significant correlation between intuitive prediction of violence and actual violence (p = 0.008). Violent behavior was predicted in 42.1% of the cases by the intuitive evaluation compared to 11.5% mistakenly evaluated patients. Logistic regression revealed that the intuitive question and the BPRS items regarding tension and motoric mannerism created a successful model for predicting violence with 88.2% sensitivity and 72.5% specificity. We sought to define the factors that most accurately predict violence in the acute psychiatric ward, based solely on behavior in the emergency department. Intuitive impressions of clinicians and motoric mannerisms should be considered when evaluating patients for potential violent behavior.

Comprehensive Symptom Prediction in Inpatients With Acute Psychiatric Disorders Using Wearable-Based Deep Learning Models: Development and Validation Study.

Assessing the complex and multifaceted symptoms of patients with acute psychiatric disorders proves to be significantly challenging for clinicians. Moreover, the staff in acute psychiatric wards face high work intensity and risk of burnout, yet research on the introduction of digital technologies in this field remains limited. The combination of continuous and objective wearable sensor data acquired from patients with deep learning techniques holds the potential to overcome the limitations of traditional psychiatric assessments and support clinical decision-making. This study aimed to develop and validate wearable-based deep learning models to comprehensively predict patient symptoms across various acute psychiatric wards in South Korea. Participants diagnosed with schizophrenia and mood disorders were recruited from 4 wards across 3 hospitals and prospectively observed using wrist-worn wearable devices during their admission period. Trained raters conducted periodic clinical assessments using the Brief Psychiatric Rating Scale, Hamilton Anxiety Rating Scale, Montgomery-Asberg Depression Rating Scale, and Young Mania Rating Scale. Wearable devices collected patients' heart rate, accelerometer, and location data. Deep learning models were developed to predict psychiatric symptoms using 2 distinct approaches: single symptoms individually (Single) and multiple symptoms simultaneously via multitask learning (Multi). These models further addressed 2 problems: within-subject relative changes (Deterioration) and between-subject absolute severity (Score). Four configurations were consequently developed for each scale: Single-Deterioration, Single-Score, Multi-Deterioration, and Multi-Score. Data of participants recruited before May 1, 2024, underwent cross-validation, and the resulting fine-tuned models were then externally validated using data from the remaining participants. Of the 244 enrolled participants, 191 (78.3%; 3954 person-days) were included in the final analysis after applying the exclusion criteria. The demographic and clinical characteristics of participants, as well as the distribution of sensor data, showed considerable variations across wards and hospitals. Data of 139 participants were used for cross-validation, while data of 52 participants were used for external validation. The Single-Deterioration and Multi-Deterioration models achieved similar overall accuracy values of 0.75 in cross-validation and 0.73 in external validation. The Single-Score and Multi-Score models attained overall R² values of 0.78 and 0.83 in cross-validation and 0.66 and 0.74 in external validation, respectively, with the Multi-Score model demonstrating superior performance. Deep learning models based on wearable sensor data effectively classified symptom deterioration and predicted symptom severity in participants in acute psychiatric wards. Despite lower computational costs, Multi models demonstrated equivalent or superior performance than Single models, suggesting that multitask learning is a promising approach for comprehensive symptom prediction. However, significant variations were observed across wards, which presents a key challenge for developing clinical decision support systems in acute psychiatric wards. Future studies may benefit from recurring local validation or federated learning to address generalizability issues.

Drug prescriptions in elderly hospitalized patients with cognitive impairment in the Italian Dementia Friendly Hospital project

ObjectiveThe aim of the study was to characterize drug prescription patterns in elderly patients hospitalized in acute wards as a function of cognitive status and staff training.MethodsWe recorded clinical parameters reflecting health status and drug prescriptions at admission, during hospital stay, and at discharge before and after a short staff training on the needs of aged cognitively impaired patients. Participants aged 65 and older had a Mini-Mental State Examination (MMSE) score ≥16. The number of prescriptions, sedative and anticholinergic load, and drug–drug interactions were evaluated. Of the 116 older patients analyzed, 59 patients were cognitively impaired, and 57 were cognitively normal with an MMSE value &amp;gt; 24. Fifty-nine patients (28 CN, 31 CI) were assisted by the hospital health staff after training.ResultsParticipants presented a widespread polypharmacy. Cognitively impaired patients received more prescriptions, more inappropriate prescriptions, had a greater sedative load, and were exposed to more interactions. Staff training had no effect on the prescription pattern.ConclusionThe results suggest that hospitalized cognitively impaired patients are overprescribed psychotropic drugs and have an excessive sedative and anticholinergic load. Interventions designed to improve dementia care practices in health staff that are not also designed to manage drug polypharmacy do not modify prescription patterns.

Suicide risk among adult subjects hospitalized in an acute psychiatric ward: 6-yearretrospective investigation.

The phenomenon of suicide risk (SR) represents a psychiatric, social and environmental emergency. The acute psychiatric ward as the Italian Service for Psychiatric Diagnosis and Care (SPDC) represents the place where SR is high due to the acute and serious conditions of people hospitalized. The objective of this study was to evaluate the characteristics of subjects admitted to a SPDC over a 6-year period for SR represented by: suicidal ideation, attempted and failed suicide. With a retrospective single-center observational design, we collected hospitalizations from 01/01/2017 to 31/12/2022 in the SPDC of AUSL-Modena for SR, analyzed the modality of SR and compared the demographic and clinical variables of subjects with SR with those hospitalized for other clinical reasons in the same period. Data were statistically analyzed. In the 6-year of study period, we collected 2,930 hospitalizations in the SPDC of AUSL- Modena and among them, 68% (n = 528) were carried out due to SR, which represented the second leading cause of hospitalization (18%), in particular among females (Pearson Chi2 = 17.41, p < 0.001). Individuals with SR were more frequently voluntary admitted (Pearson Chi2 = 215.41, p < 0.001) for a shorter period (7.36 ± 8.16 vs 11.66 ± 15.93, t = 6.03, t-test, p < 0.001) and less frequently repeated the hospitalization during the study period for the same reason (Pearson Chi2 = 6.0, p = 0.014). The most frequent psychiatric disorders associated with SR were depressive, personality and adjustment disorders, which represented the most common factor associated with SR (68%), followed by family/relationship problems (12%) and alcohol/substance abuse (8%). We highlighted three kinds of suicidal risk: suicidal ideation (40%), often associated with personality disorders and substance use disorders, drug ingestion (30%) concomitant with conflicting family relationships and use of violent means (30%) associated with depressive disorders (Pearson Chi2 = 42.83, p = 0.002). Our study provides a real-world setting evaluation of subjects hospitalized for SR and, in accordance with literature, suggests that suicidal behavior is the product of many clinical and social factors' interaction, that occurred in a crucial moment of life in vulnerable individuals. The identification of subjects at SR represents the first step of preventive multi-professional interventions.

Validation of the German version of the SarQoL® questionnaire in sarcopenic and probable sarcopenic patients.

The German version of the SarQoL®, a sarcopenia-specific quality of life (QoL) questionnaire, has not been validated hindering its widespread use. This study aimed to evaluate the psychometric properties of the German SarQoL®. Via a cross-sectional study participants were recruited in two geriatric outpatient facilities and one acute geriatric ward in Munich (Germany). Sarcopenia and probable sarcopenia were diagnosed with the European Working Group on Sarcopenia in Older People (EWGSOP2) algorithm. From 185 participants (age 79.8 ± 6.1), 77 had probable sarcopenia, and 51 had sarcopenia. Participants completed the SarQoL® and the European Quality-of-Life 5-Dimension (EQ-5D) questionnaires. The validation included examination of the discriminative power, construct validity, internal consistency, test-retest reliability, and floor/ceiling effects. Lower SarQoL®scores for sarcopenic (p = 0.002) and probable sarcopenic subjects (p < 0.001) compared to controls indicated good discriminative power. Consistent construct validity was found for sarcopenic subjects: moderate to high correlations with domains capturing similar constructs of the EQ-5D: 'Activities of daily living' (r = -0.58, p < 0.001), 'Mobility' (r = -0.72, p < 0.001) and low correlations with domains related to different constructs like 'Pain' (r = -0.32, p < 0.022). Similar correlations were found for probable sarcopenic subjects. The Cronbach's alpha was 0.8. Test-retest reliability was excellent (intraclass coefficient correlation of = 0.96; 95% CI = 0.91-0.99), and no floor/ceiling effects were observed. QoL was similarly reduced in both patient cohorts compared to controls. The German SarQoL® is a valid and reliable instrument for measuring QoL in patients > 65 years of age with sarcopenia and probable sarcopenia and can now be used in epidemiological studies and clinical trials in a German-speaking population. German Clinical Trials Register (DRKS)-ID: DRKS00020504 (March 12th, 2021) .

The reality of nursing time: how nurses spend their shifts.

Nurse staffing levels are increasingly challenged while pressures on healthcare systems are rising. There is a clear need to optimise efficiency in healthcare delivery in order to deliver safe, effective and quality health care. To understand how nurses working shifts spend their time and explore opportunities to improve efficiency in care delivery. A time-motion study was conducted on three acute care wards in a district general hospital in West Wales; 13 nurses were observed over 14 shifts, each activity undertaken was recorded in real time. In all, 109 hours were observed. Approximately half of nurses' time is spent delivering direct patient care, with medications administration taking the majority of time. A number of recommendations are made involving processes and workforce modelling with the aim of improving efficiency and safety. Further research would be required to assess the impact of their introduction.

The admission and integration model: first‑hand experiences of staff admitted to a mental health ward

Background/Aims Over a period of 6 months, four staff members were admitted on separate occasions to a male acute mental health ward for 1 day. The purpose was for participants to gain personal insight into the experiences of patients on the ward. This study aimed to explore the experiences of staff admitted onto the ward and provide a conceptual model to describe the admission process. Methods Feedback was obtained from the study participants via pre- and post-admission questionnaires and a focus group discussion. These qualitative data were thematically analysed to generate the steps in the admission and integration model. Results Admission to the mental health ward was a useful learning experience for staff members in terms of improving empathy for their patients. A model of ward admission and integration based on these experiences was also developed. The model adhered to Maslow's hierarchy of need, where participants had to re-establish deficiency needs following admission onto the ward. Conclusions The study findings have been shared with other hospital staff, and will be used by a new working group to implement improvements in patient care.

Is intestinal colonization with multidrug-resistant Enterobacterales associated with higher rates of nosocomial Enterobacterales bloodstream infections?

ObjectiveIntestinal colonization with multidrug-resistant Enterobacterales (MDRE-IC) increases the risk of MDRE bloodstream infection (MDRE-BSI). However, its impact on the overall risk of nosocomial Enterobacterales bloodstream infections (nE-BSI) remains unclear. This study aimed to determine this risk and identify associated factors in hospitalized patients. Design and methodsThis retrospective cohort study at a 3200-bed tertiary institution included patients hospitalized in 2019 who underwent MDRE rectal swab (RS) screening. Inclusion criteria were age ≥18 years, first RS in 2019, follow-up ≥7 days, and E-BSIs >48 hours post-RS. The primary outcome was the first nE-BSI during follow-up period, analysed using a Cox model. ResultsAmong 7006 patients, 817 (11.9%) had MDRE-IC. Most were male and primarily hospitalized in acute wards. nE-BSIs occurred in 433 (6.1%) patients and was more frequent in MDRE-IC patients compared to non-colonized group (aHR = 1.78, 95%CI: 1.40-2.26). Intestinal colonization with ESBL-producing and carbapenemase-resistant Enterobacterales showed similar risks for E-BSI onset: aHR = 1.73 (95%CI: 1.33-2.24) and aHR = 2.02 (95%CI: 1.27-3.22), respectively. ConclusionIn hospitalized patients, MDRE-IC is associated with a higher rate of nE-BSI compared to those without MDRE-IC, underscoring the urgent need for improved infection prevention and control measures, as well as optimized antibiotic use to mitigate this risk.

Short-term mortality and associated factors among older hospitalized patients: A narrative retrospective analysis of end-of-life care in an acute geriatric unit

ObjectivesTo explore short-term mortality and its predictors among older patients hospitalized in a acute geriatric ward (AGW) in Northwestern Italy. DesignRetrospective observational single-center cohort study. Material and methodsPatients consecutively admitted for any reason between June 2021 and May 2022 were included in the analysis. Along with sociodemographic, clinical, and functional variables, prognosis estimation (Palliative Prognostic Index; PPI) at the time of admission was registered. Short-term all-cause mortality (in-hospital and within 3 months of discharge) was the primary outcome. ResultsAbout one-third of the total sample died in the short-term (32.4 %). Along with PPI score (OR 1.115, 95 %CI 1.034–1.202), short-term mortality was independently associated with functional dependency (OR 1.278, 95 %CI 1.170–1.395). ConclusionsThe high short-term mortality in our sample should call for the inclusion of palliative prognostic tools within the in-hospital comprehensive geriatric assessment to better recognize and appropriately manage older patients at the end of life.

Exploring accessibility, user experience and engagement of digital media among older patients with depression: a pilot and observational screening study protocol of the DiGA4Aged study

IntroductionThe prevalence of mental health problems is increasing worldwide, particularly in the vulnerable group of older people. The limited availability of therapists, long wait periods and increasing shortage of healthcare...

Buildings as reflectors of societal values: what features of psychiatric wards reveal about stigma

Abstract Built Environment (BE) features bearing domestic attributes align with the concept of psychosocial re-integration. To understand the level of de-institutionalisation in relation to mental health infrastructure, a series of 29 case studies occurred in four countries from 2000 onwards. We collected data from Europe, the UK, New Zealand and more recently in the US: England (n = 15), France (n = 5), New Zealand (n = 4) and the US (n = 5). This included five acute wards in England and five in France in 2000-2004, two further acute wards in England in 2015-2017, four facilities in New Zealand in 2017-2020 (catering also for the Māori population), six further wards (older adult rehab, older adult dementia, acute, rehab, PICU, older adults) and two forensic wards in England and five wards in the US in three different hospitals (one mental health and four mental health wards in general hospital: two adult and two adolescent) in 2023-2024. An architectural checklist was developed to evaluate the traits of the exterior and interior and measure the degree of institutionalisation vs homelikeness for mental health buildings. Cross-country comparison revealed recent case studies to be closer to the institutional end with increased anti-ligature features. Most NZ and the US samples were the most institutional ones. The checklist revealed that acuity was potentially not a determinant of institutional versus domestic buildings. Data shown that very few features were universally present, questioning what is the absolute minimum in relation to the illness rather than the policies. The US sample provides further food for thought, especially in relation to the location of psychiatric wards inside general hospitals and the reasons that lead to this. Finally, by looking at the BE for mental health, we uncover issues regarding the service provision and institutional prejudices connected to stigma. This questions the adequacy of de-institutionalisation policies in certain contexts. Key messages • The study of the architecture of healthcare facilities can depict aspects related to the health service provision and raise questions about the effectiveness of rehabilitation strategies. • The architecture of psychiatric wards questions the success of some de-institutionalisation decision-making in a cross-country comparison.

Telehealth-aided outpatient management of acute heart failure in a specialist virtual ward compared to standard care

Abstract Background/Introduction Acute decompensated heart failure (ADHF) leads to hospitalisations, frequent re-hospitalisations and mortality. The safety and efficacy of telehealth-guided outpatient ADHF management (virtual ward-VW) as an alternative to hospitalisation has not been assessed previously. Aim The aim of this study was to assess the safety and outcomes of our acute heart failure virtual ward (HFVW) pathway (Figure 1) when compared to hospitalised ADHF patients. Methods This cohort study (May 2022-October 2023) assessed the outcomes of telehealth-guided outpatient ADHF management using bolus intravenous furosemide in a HF-specialist VW. We compared baseline patient characteristics, NTproBNP, ejection fraction, NYHA Class, clinical risk score (Get With the Guidelines-Heart Failure-GWTG-HF), comorbidities (Charlson Co-morbidity Index-CCI), frailty (Rockwood Clinical Frailty Score-CFS), HF therapies and measured clinical outcomes at 1, 3, 6 and 12 months (re-hospitalisations, mortality) in the HFVW cohort versus standard care (ADHF patients managed without telehealth in 2021). Results 554 HFVW ADHF patients (age 73.1±10.9 years; 46% female) were compared with 402 ADHF patients (74.2±11.8; p=0.15 and 49% female) in the standard care cohort (SC). Despite similar baseline patient characteristics, GWTG-HF score, CCI and CFS, re-hospitalisations were significantly lower in the HFVW compared to standard care (1 month - 11.6% vs. 21%, p=0.002; 3 months - 20.4% vs. 30%, p=0.001; 6 months -29.3% vs 41%, p=0.02 and 12 months-48% vs. 57%,p=0.03) whereas mortality was lower at 1 month (6% vs. 14%; p&amp;lt;0.001), 3 months (10.5% vs. 15%; p=0.02) and 6 months (15.5% vs. 21%; p=0.04) (Figure 2). Multivariate logistic regression analysis showed that an increased daily step count whilst on HFVW independently predicted reduced odds of re-hospitalisations at 1 month (OR 0.85; 95% CI 0.7-0.9; p=0.005), 3 months [OR 0.95 (0.93-0.98); p=0.003] and 1 month mortality [OR 0.85 (0.7-0.95), p=0.01]. Whereas CCI predicted adverse 12-month outcomes [OR 1.2 (1.1-1.4), p=0.03]. Higher GWTG-HF score independently predicted increased odds of re-hospitalisation [1-month OR 1.2 (1.1-1.3), p=0.01; 12-month OR 1.1, 1.05-1.2, p=0.03) as well as mortality [1-month OR 1.2 (1.1-1.4), p=0.01; 12-month OR 1.3 (1.1-1.7), p=0.02]. Similarly higher CFS also independently predicted increased odds of re-hospitalisations [1-month OR 1.5 (1.1-2.2), p=0.03; 12-month OR 1.9 (1.2-3, p=0.01] and mortality [1-month OR 2 (1.1-3.5), p=0.02; 12-month OR 2.6 (1.6-10); p=0.02] throughout the follow-up period. Conclusions A telehealth-guided specialist HFVW management strategy for ADHF may offer a safe and efficacious alternative to hospitalisation in suitable patients. Daily step count, GWTG, CCI and CFS can play a vital role in assessing suitability for VW and in predicting risk of adverse clinical outcomes.Heart Failure Virtual Ward PathwayMortality &amp; Re-hospitalisations outcomes

Ensuring that psychological interventions are delivered as intended on mental health inpatient wards.

Talk, Understand and Listen for InPatient Settings (TULIPS) was a multi-centred randomized control trial of an intervention that aimed to increase patient access to psychological therapies on acute mental health wards. This paper aims to: (i) describe a strategy for designing a psychological intervention that is implementable in inpatient mental health settings; (ii) describe methods for assessing the fidelity of interventions within these settings; (iii) report on the extent to which fidelity was achieved in the TULIPS trial. The TULIPS intervention was designed using information from a systematic review, stakeholder interviews, pilot work and a consensus workshop. We assessed fidelity to the model in terms of the delivery and dose of essential elements of the intervention, quality of intervention delivery, engagement of participants with the intervention and differentiation between the intervention and usual care. Although the TULIPS intervention targeted known barriers to the delivery of psychological interventions on mental health wards, we found issues in implementing aspects of the intervention that were dependent upon the participation of members of the multidisciplinary team. Psychologists were able to overcome barriers to delivering individual therapy to patients as this provision was not reliant on the availability of other staff. The intervention period in the study was 6 months. A greater period of time with a critical mass of psychological practitioners is needed to embed psychological interventions on inpatient wards. Our fidelity framework and assessment methods can be used by other researchers implementing and testing psychological therapies within inpatient environments.

Cardiac rehabilitation ambassadors - a new model to enhance patient participation

Abstract Introduction Participation in outpatient Cardiac Rehabilitation (CR) is considered an integral part of secondary treatment of heart disease. Despite being considered standard care, participation remains low internationally. Encouraging patients to enrol in CR during their hospital stay is linked to higher participation. [1] This study was conducted at a hospital that provides acute cardiac and rehabilitation services in Australia. Purpose As a provider of cardiac care, we identified that increasing nurses’ knowledge of the of CR would improve their capacity to promote CR during patient’s hospital stay. Methods Utilising a quality improvement methodology, the Cardiac Ambassador Initiative was developed with key stakeholders working on cardiac units in 2022. The program consisted of an immersion experience for cardiac nurses to shadow CR nurses working in a specialist rehabilitation centre providing best practice CR for patients with a variety of cardiac conditions. To evaluate the impact of the program, cross-sectional surveys and individual interviews were conducted with participants and Nurse-Unit-Managers (NUMs). Key outcomes included: ambassadors’ knowledge and confidence to promote CR participation to their patients on the wards and NUM's perceptions of the impact of the program. Results The program was run over two years. The NUMs and CR-coordinator selected a total of 13 nurses to participate. In 2022 4 participants attended a total of 5 days each. Following evaluation, the program was modified to 3 days for participants in 2023, which enabled 9 participants to attend. All participants described not fully understanding the nature of CR and its impact on patients until they attended a program. Prior to attendance, 100% of participants considered it was important or somewhat important for patients to attend CR. Following attendance 100% of participants consider it essential or important for patients to attend. They also reported feeling more confident to discuss CR with patients and colleagues and encourage patient participation following the immersion experience. Pre-attendance 100% of participants felt either not at all confident or somewhat confident to discuss CR with their patients and this improved post program with 100% feeling very confident. 100% of participants also indicated that their confidence and skill in discussing CR with patients greatly improved and recommended that others should participate in the CR Ambassador program. Nurse Unit Managers reported that the CR Ambassadors were a valuable resource for both staff and patients on the cardiac unit and that they had identified a need to review the accessibility of CR information and referral documentation available on their wards. Conclusion The immersion experience represents a feasible and sustainable approach to establishing CR ambassadors on acute cardiac wards with the skills needed to promote CR participation to colleagues and patients.

Experiences with paediatric hospital health care: a cross-sectional study among paediatric patients

Abstract Background The measurement of patient experiences is gaining importance in many healthcare systems, including the Slovenian one. The need for a national survey on patient experiences in the paediatric inpatient settings emerged recently. Methods The survey took into account various aspects of inpatient healthcare such as admission, hospital staff, safety, food and discharge from hospital. As part of the study, children/parents were able to give praise and suggestions for improvements. We used three different questionnaires adapted to the cognitive abilities of children - a child questionnaire for the age group 9-13 years in paper form, an online adolescent questionnaire for the age group 14-18 years, and an online parent questionnaire for the age group 0 (1 month)-8 years. The questionnaires were cognitively tested and piloted before national rollout. Results The national survey was conducted between September 2023 and March 2024 and included paediatric patients who spent at least one night in an acute paediatric hospital ward. The survey included 25 paediatric wards and totally 1965 questionnaires were valid for analysis. The rough response rate was 17,6 %. The first preliminary results of the qualitative analysis suggest that surveyed paediatric patients and their parents rate highly inpatient health care services received, however they point out also to areas that need improvement such as environmental factors (noise, temperature), food, infrastructure (outdated facilities &amp; equipment) and in some cases attitude of hospital staff. Conclusions National institute of public health carried out the first national survey on paediatric patient reported experience measures in acute hospitals in Slovenia. The results of this survey will be used to improve the quality of inpatient health care services in paediatric wards, as well renew focus on the requirements of European charter of children rights and United Nations Convention on the Rights of the Child. Key messages • National institute of public health carried out the first national survey on paediatric patient reported experience measures in hospitals in Slovenia. • The results of this survey will be used to drive hospital quality improvements.

Individual Resilience among Adult Children of Parents with Bipolar Disorder in Chinese Society: An Inductive and Deductive Content Analysis Approach.

Nurses can help children of parents with mental illness discover their resilience. However, previous studies have focused on their experience in Western settings and have limited understanding of a Chinese cultural context. This study aims to explore individual resilience emerging from adult children's experience of living with parents with bipolar disorder in Chinese society within the framework of character strengths and possible cultural components. A content analysis with both inductive and deductive approaches. Twenty adults participated in this study. Interviews were conducted while the participants' parents were hospitalized in an acute psychiatric hospital ward. The framework of character strengths confirmed five emergent themes of individual resilience in this study: courage, temperance, humanity, knowledge and wisdom, and transcendence. Character strengths are an adequate framework for understanding of individual resilience. Chinese adult children develop resilience by regulating their emotions, respecting their parents, engaging in self-discipline, and positively interpreting adversity.

Neuronal plasma biomarkers in acute ischemic stroke.

Early imaging-based detection of acute ischemic stroke (AIS) has improved in the era of reperfusion therapy. Despite of this, prognosis of outcome after AIS remains a challenge. Therefore, parameters that support clinical decision making are sought. Blood-based biomarkers have the potential to provide valuable information in addition to the established prognostic factors. Neuronal biomarkers of acute or degenerative neuronal injury have shown to be reliably detected in plasma. These biomarkers are well-established in neurodegenerative pathology, such as Alzheimer's disease. In this study, we explored the association between stroke diameter and plasma biomarkers for neuronal injury and tau pathophysiology (brain-derived tau [BD-tau], phosphorylated-tau-217 [p-tau21] and neurofilament light [NfL]) in patients (n = 193) admitted to the acute ward, Akershus University Hospital. All patients received a final diagnosis of AIS, transient ischemic attack or stroke mimics. Blood samples were obtained the day after admission. We find that levels of BD-tau (p = .004) and NfL (p = .011) were higher after AIS than in patients with stroke mimics. The cortical stroke diameter correlated with BD-tau (tau-b = 0.64, p < .001) and p-tau217 (tau-b = 0.36, p = .003). Linear regression confirmed BD-tau to be the strongest variable associated with stroke diameter, pointing to the potential clinical value of plasma BD-tau in outcome prediction after AIS.

Physiotherapy in acute geriatrics wards: What (de)motivates patients? A qualitative study based on self-determination theory

BackgroundWhile the benefits of physiotherapy for hospitalized older patients (HOPs) are well established, these patients are often considered demotivated by healthcare team members (HTMs), which is perceived as a hindrance to their rehabilitation. The quantitative data currently available on the lack of involvement of HOPs are mainly measures of mobility. Motivation as such has, to our knowledge, never been measured. Therefore, this study aims to quantify for the first time the motivation levels of HOPs in their participation in activities of daily living (ADLs) and physiotherapy, and to explore the motivating factors behind their participation in physiotherapy.MethodsThe motivation of 60 older patients hospitalized in an acute geriatrics ward was quantified using the Scale of Demotivation Assessment (SDA). Out of these participants, 14 were interrogated through individual semi-structured face-to-face interviews. After transcription, data were analyzed according to Self-Determination Theory, which has been proven effective in the understanding of motivational mechanisms.ResultsThe prevalence of demotivation was 47% (95% CI: [0.34;0.6]) for ADLs and 35% (95% CI: [0.23;0.48]) for physiotherapy. The main demotivating factors were the feeling of external control (lack of autonomy) and dependance experienced by HOPs, as well as the limited availability of staff during hospitalization. Conversely, feelings of competence, security, respect for limits, and commitment from the HTMs were important motivating factors.ConclusionA large number of relational factors have an impact on the motivation of HOPs regarding their participation in ADLs and in physiotherapy sessions. Appropriate time and space organizing and the provision of suitable equipment, combined with a genuine caring and respectful attitude from the HTMs, could considerably encourage the expression of intrinsic motivation and thus the involvement of HOPs in their own care program.

The potential of body mass index-adjusted calf circumference as a proxy for low muscle mass in the global leadership initiative on malnutrition criteria

Background & AimsReduced muscle mass is one of the diagnostic components for Global Leadership Initiative on Malnutrition (GLIM), with various assessment methods proposed. Calf circumference (CC), a representative anthropometric marker of skeletal muscle mass, is now recommended to adjustment based on body mass index (BMI). This study aimed to evaluate the validity and efficacy of BMI-adjusted CC in very older adults, compared with other methods of assessing muscle mass. MethodsThis prospective cohort study included 284 patients aged 65 years and older who were admitted to the Department of Geriatric Medicine at the National Center for Geriatrics and Gerontology Hospital. Health indicators, including nutritional status, were assessed upon admission. Three months after discharge, a telephone survey was conducted to assess patients’ living conditions and survival status. Skeletal muscle mass was estimated using a dual-energy X-ray absorptiometry (DXA); moreover, anthropometric measurements (unadjusted and BMI-adjusted CC) were used as markers of muscle mass. Logistic regression analysis was performed to examine the association between mortality and GLIM-based malnutrition, using each muscle mass assessment method. ResultsThe mean age of the patients was 86.2 ± 6.2 years, and 60.9% were women. The prevalence of GLIM-based malnutrition ranged from 55.3% to 58.8% across the three methods used to assess reduced muscle mass. Three months after discharge, 244 patients were followed up, of whom 29 (11.9%) died. Multivariate logistic regression analysis, adjusted for age, sex, and comorbidities, showed that all methods significantly predicted 3-month mortality, with odds ratios of 5.67, 5.44, and 4.90 for unadjusted CC, BMI-adjusted CC, and appendicular skeletal muscle mass index using DXA, respectively. The prevalence and survival-predictive ability were similar across all methods. ConclusionGLIM-based malnutrition, diagnosed using different methods for assessing muscle mass, similarly predicted 3-month mortality in patients admitted to an acute geriatric ward. These results suggest that BMI-adjusted CC are sufficient alternatives when technical measurements such as DXA are not feasible.

Psychiatric hospitalizations among adolescents during the pandemic in Italy: a retrospective study.

The COVID-19 pandemic has negatively impacted child and adolescent mental health. The study outcome was the evaluation of the pandemic impact on adolescents' hospitalizations in an acute psychiatric ward. With an observational and retrospective design,we collected selected variables among adolescents hospitalized in an acute psychiatric ward from 01/07/2017 to 30/06/2022. Data were statistically processed. Our sample consisted of 118minors with an average age of 15.7±1.2 SD, mostly represented by females (61 %) and Italians (60.2 %), who made 204 hospitalizations inthe study period. The admissions by years drastically decreased in 2020 concomitantly with the lockdown and increased in the first half of 2022. The admission rate was higher in winter and spring, except in 2020 when all admissions decreased (p=0.000). Females more frequently were hospitalized for suicidal behavior and acute anxiety (p=0.000) and were discharged with acute stress reactions, eating disorders, and mood disorder diagnoses (p=0.000). Differently, males more frequently were hospitalized for aggressive behavior (p=0.000) and discharged with ADHD diagnosis (p=0.000). At multiple linear regression, the duration of hospitalization (dependent variable) was negatively associated with "the pandemic period" (p=0.017) and "absent aggressive behavior" (p=0.003), and positively with "autism" diagnosis (p=0.000). We highlighted the more stressful impact of COVID-19 pandemic on female adolescents, who required more frequently psychiatric hospitalizations due to suicidal behavior, anxiety and mood disorders.