Care Guidance Research Articles

Addressing Systemic Complications of Acute Stroke: A Scientific Statement From the American Heart Association.

Systemic, nonneurological complications are common after ischemic and hemorrhagic strokes, affect different organ systems, and have a major impact on patient outcomes. Despite their obvious implications, this area in stroke management remains inadequately researched, and current literature offers fragmentary guidance for care. The purpose of this scientific statement is to elucidate the major systemic complications of strokes that occur during hospitalization, to synthesize evidence from current literature and existing guidelines, to address gaps in knowledge, and to provide a coherent set of suggestions for clinical care based on interpretation of existing evidence and expert opinion. This document advocates for improved interdisciplinary collaboration, team effort, and effective implementation strategies to reduce the burden of these events in clinical practice. It also calls for further research on strategies for preventing and managing systemic complications after stroke that improve outcomes in stroke survivors.

Outcomes for women with diabetes admitted for labour care to midwifery units in the UK: a national prospective cohort study and survey of practice using the UK Midwifery Study System (UKMidSS)

ObjectivesTo describe outcomes in women admitted for labour care to midwifery units with gestational or pre-existing diabetes, compare outcomes with other women admitted to the same units and describe admission...

Making decisions about long-term foster family care as a permanence plan in England: An investigation of the implementation of the first government regulations and guidance for long-term foster care

Long-term foster family care has been included as a permanence option in policy in England since the 1980s, however it was not until 2015 that it was defined in government regulations and guidance, with a required practice framework for local authorities, including reporting placement numbers annually to the government. This was intended to give long-term foster care a more formal status as a permanence option, ensure high standards of practice and promote positive outcomes for children. This project aimed: (1) to identify the profiles and pathways of children in long-term foster care and (2) to investigate the impact of the regulations and guidance on procedure and practice in local authorities. The second aim provides the focus for the findings presented in this article. The research design included analysis of administrative data, a national survey of local authorities and interviews with 43 managers in 30 local authorities. The survey results and interview data suggested that the regulations and guidance have had a positive impact by raising the profile of long-term foster care and supporting improved procedures. But there were varying patterns of implementation and significant differences in rates of long-term foster care, which did not relate to differences in local authority populations. This article concludes, therefore, that there is a need for the provision of government support to provide greater consistency in the implementation of the regulations and guidance.

UK paediatric clinical trial protocols: A review of guidance for participant management and care in the event of premature termination.

Clinical trials provide an opportunity to identify new treatments and can offer patients access to treatments otherwise unavailable. However, approximately 10% of paediatric clinical trials discontinue before the trial has completed. If this premature termination is because the trial treatment(s) being investigated are identified to be ineffective or unsafe, it results in the abrupt discontinuation of the investigational medicinal product for participants. For some participants, there may not be other treatment options to pursue at the trial-end. Trials prematurely terminating can be a distressing experience for all involved and currently there is little published evidence about the guidance provided to healthcare professionals in the event of premature trial termination. The study protocol is the source of guidance for healthcare professionals delivering clinical research, detailing how to conduct all aspects of the trial. The aim was to quantify the proportion of clinical trial protocols that included premature trial termination and subsequently those that provided instructions related to participant management and care. In addition, to analyse the context in which premature termination was included and the detail of any instructions for participant management and care. The ClinicalTrials.gov database was searched by a single reviewer for UK interventional drug trials enrolling children with an available study protocol. Protocols were searched to assess if the risk of premature trial termination was identified, the context for premature termination being included, if information was provided to support the management and care of participants should this situation occur and the detail of those instructions. Data were summarised descriptively. Of 245 clinical trial protocols, 235 (95.9%) identified the possibility of premature trial termination, the majority within the context of the sponsor asserting their right to terminate the trial (82.7%, 115/235) and providing reasons why the trial could be stopped (65.5%, 91/235). Forty-two percent (98/235) provided guidance for participant management and care, most commonly to contact/inform the participant (45.9%, 45/98). Directions varied in the quantity and level of detail. This review of UK clinical trial protocol highlights that information surrounding premature termination is lacking, with only 42% providing guidance on the care of trial participants. While this ensures regulatory compliance, it fails to consider the challenge for healthcare professionals in managing participants on-going care or the duty of care owed to participants. Further research is required to understand if additional documents are being used in practice, and if these meet the needs of healthcare professionals in supporting research participants and families during premature trial termination.

Management of opioid use disorder: 2024 update to the national clinical practice guideline.

In an evolving landscape of practices and policies, reviewing and incorporating the latest scientific evidence is necessary to ensure optimal clinical management for people with opioid use disorder. We provide a synopsis of the 2024 update of the 2018 National Guideline for the Clinical Management of Opioid Use Disorder, from the Canadian Research Initiative in Substance Matters. For this update, we followed the United States Institute of Medicine's Standards for Developing Trustworthy Clinical Practice Guidelines and used the Appraisal of Guidelines Research and Evaluation-Recommendation Excellence tool to ensure guideline quality. We carried out a comprehensive systematic literature review, capturing the relevant literature from Jan. 1, 2017, to Sept. 14, 2023. We drafted and graded recommendations according to the Grading of Recommendations, Assessments, Development and Evaluation approach. A multidisciplinary external national committee, which included people with living or lived experience of opioid use disorder, provided input that was incorporated into the guideline. From the initial 11 recommendations in the 2018 guideline, 3 remained unchanged, and 8 were updated. Specifically, 4 recommendations were consolidated into a single revised recommendation; 1 recommendation was split into 2; another recommendation was moved to become a special consideration; and 2 recommendations were revised. Key changes have arisen from substantial evidence supporting that methadone and buprenorphine are similarly effective, particularly in reducing opioid use and adverse events, and both are now considered preferred first-line treatment options. Slow-release oral morphine is recommended as a second-line option. Psychosocial interventions can be offered as adjunctive treatment but should not be mandatory. The guideline reaffirms the importance of avoiding withdrawal management as a standalone intervention and of incorporating evidence-based harm reduction services along the continuum of care. This guideline update presents new recommendations based on the latest literature for standardized management of opioid use disorder. The aim is to establish a robust foundation upon which provincial and territorial bodies can develop guidance for optimal care.

Synopsis of the 2023 U.S. Department of VA and U.S. DoD Clinical Practice Guideline for the Management of Pregnancy.

This Clinical Practical Guideline provides recommendations based on a systematic review of the evidence to address critical decision points in the management of pregnancy. The guideline is intended to improve patient outcomes and local management of patients who are pregnant. This CPG is based on a systematic review of both clinical and epidemiological evidence and was developed by a panel of multidisciplinary experts. The Work Group provides clear and comprehensive evidence-based recommendations incorporating current information and practices targeting practitioners throughout the DoD and VA Health Care systems. The guideline is intended to improve patient outcomes and local management of patients who are pregnant. This CPG does not address every aspect of routine pregnancy care and is not intended to be a comprehensive guide to all care needed in pregnancy. It also addresses some clinically important and generally accepted standards of pregnancy care interventions that do not have sufficient high-quality evidence to support standalone recommendations. Additionally, it highlights emerging topics that have the potential to impact pregnancy care in the future and identifies gaps in the literature that warrant further research. The development of all VA/DoD guidelines is directed by the Evidence-Based Practice Guideline Work Group and adheres to the standards for trustworthy guidelines that were set by the National Academy of Medicine. A patient focus group was convened to assess important aspects of treatment for patients and to gain information about patient values and preferences. The Lewin Group, a contracted third party with expertise in CPG development, facilitated meetings and the development of key questions using the population, intervention, comparison, outcome, timing, and setting format. Consensus was achieved among the Work Group through an iterative process involving discussions on conference calls and in person during the recommendation development meeting. An independent third party, ECRI, conducted the systematic evidence review, which the guideline Work Group then used to develop recommendations using the Grading of Recommendations Assessment, Development and Evaluation system (7-9). The search methods and results are detailed in the full guideline. This CPG provides 28 clinical practice recommendations that cover selected topics that the Work Group deemed had high priority need for evidence-based standards. The recommendations are divided into 3 main categories: routine care, complicated obstetrics, and mental health. An algorithm delineating recommended interventions and appropriate timing of these interventions over the course of the pregnancy and postpartum period was also created. The CPG is not intended to define standards of care nor address all care needed in pregnancy; it does provide comprehensive guidance for routine pregnancy care. It aligns with the VA and DOD's goal of providing care that is consistent in quality and utilization of resources in efforts to reduce errors and inappropriate variations in practices. In total, the Work Group identified 71 items needing further study, including areas requiring stronger evidence to support current recommendations and newer topics that will guide future guideline development.

Application of fine nursing mode in nursing management of blood oncology department

Objective: To explore the effect of fine nursing on cancer-related fatigue (CRF), anxiety, and depression in patients with hematological tumors undergoing chemotherapy, and to provide a feasible intervention plan for clinical management of these symptoms. Methods: A quasi-experimental study was conducted on patients with hematological tumors undergoing chemotherapy, admitted to our hospital from June 2018 to November 2021. A total of 84 eligible patients were randomly divided into two groups: 44 in the experimental group and 40 in the control group. The control group received routine nursing care, including psychological support, diet guidance, catheter care, bleeding prevention, and chemotherapy guidance. The experimental group received an additional 4 weeks of intensive nursing care on top of the routine care. Results: Three patients withdrew from the study, leaving 42 in the experimental group and 40 in the control group. No significant differences were observed between the two groups in terms of demographic and clinical baseline characteristics. Before the intervention, there were no significant differences in CRF, anxiety, and depression scores between the groups. After the intervention, the experimental group showed significantly lower scores in CRF, anxiety, and depression compared to the control group and their own baseline scores. Conclusion: Fine nursing can effectively reduce cancer-related fatigue, anxiety, and depression in patients with hematological tumors undergoing chemotherapy.

How Should We Expand Access to Psychedelics While Maintaining an Environment of Peace and Safety?

Psychedelics have long been used by individuals seeking peace and a sense of wellness. This article examines widespread adoption of ketamine as a proxy for psychedelics. For ketamine, there is a need to protect vulnerable persons from exploitation that should be balanced against risks of hypermedicalization. This article suggests strategies for striking such a balance, including by carefully differentiating between persons with psychiatric illnesses, such as treatment-resistant depression, who could benefit from psychedelics, and persons using psychedelics for peace and wellness under careful guidance.

Clinical care guidance in patients with diabetes and metabolic dysfunction-associated steatotic liver disease: A joint consensus.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide, affecting >30% of the global population. Metabolic dysregulation, particularly insulin resistance and its subsequent manifestation as type 2 diabetes mellitus, serves as the fundamental pathogenesis of metabolic liver disease. Clinical evidence of the recent nomenclature evolution is accumulating. The interaction and impacts are bidirectional between MASLD and diabetes in terms of disease course, risk, and prognosis. Therefore, there is an urgent need to highlight the multifaceted links between MASLD and diabetes for both hepatologists and diabetologists. The surveillance strategy, risk stratification of management, and current therapeutic achievements of metabolic liver disease remain the major pillars in a clinical care setting. Therefore, the Taiwan Association for the Study of the Liver (TASL), Taiwanese Association of Diabetes Educators, and Diabetes Association of the Republic of China (Taiwan) collaboratively completed the first guidance in patients with diabetes and MASLD, which provides practical recommendations for patient care.

Impact of State Abortion Policies on Family Medicine Practice and Training After Dobbs v Jackson Women's Health Organization.

The Dobbs v Jackson Women's Health Organization (Dobbs) Supreme Court decision revoked the constitutional right to abortion. Now, restrictive state abortion laws may contribute to the shortage and strain already felt in primary care practice, especially related to the provision of reproductive health care. The purpose of this study is to evaluate perceived impacts of state abortion legislation on family medicine clinicians' practice and medical education regarding reproductive health care. Ten questions were added to the 2022 Council of Academic Family Medicine Educational Research Alliance general membership survey to evaluate impact on relevant themes in reproductive health care and training after the Dobbs decision. Responses were categorized by severity of restriction of state abortion policies. Of 1,196 respondents, 49.7% reported employment in states with very restrictive or restrictive abortion policies. The 991 respondents with clinical responsibilities reported significant (P <.05) changes in their counseling practices, clinical decision making, worry of legal risks, and trust in patients' self-reported reproductive medical history, compared with peers in protective states. Perceived patient trust toward clinicians remained unchanged. Almost one-half of clinical respondents reported an absence of reproductive health care guidance or recommendations. Restrictive abortion policies significantly (P <.05) reduced the desirability and confidence in resident training programs. Reported changes to clinical activities and training, coming early after the Dobbs decision, affect our current and future workforce and therefore, our patients. Future studies are needed to document continued impact of state restrictions and inform policy to support family medicine clinicians in reproductive health practice and education.

Allometry of human calvaria bones during development from birth to 8 years of age shows a nonlinear growth pattern

Pediatric skulls change rapidly in size and shape during development, especially for children up to 8 years of age. This project was developed to address the gap in understanding of the three-dimensional growth parameters of the human skull during this period and the impact these growth patterns have on fontanelle closure and suture formation. This study offers novel data on the dynamic changes in the anatomy of the skull with the intention of providing better guidance for pediatric surgical care. Craniometric landmarks defined on three-dimensional computed tomography reconstructions were used to map skull development in children aged 0 to 8 years old. A total of 364 datasets were analyzed and statistically representative 3D skulls with anatomical craniometric features such as head shape, bone size, suture and fontanelle closure time were generated for 17 age groups spanning birth to 8 years of age to provide a comprehensive neuroanatomical understanding of how the pediatric skull changes over time. This study indicates that the cranial bones follow a non-linear growth pattern, with the occipital and frontal bones driving the directionality of fontanelle closure and delivers a 3D visualization of the developmental characteristics of the skull providing a landmark resource for understanding the growth dynamics of the human skull. While clinical measurements remain valid approaches for the planning of surgical interventions, these 3D models may provide a more accurate planning paradigm.

Parents', Families', Communities' and Healthcare Professionals' Experiences of Care Following Neonatal Death in Healthcare Facilities in LMICs: A Systematic Review and Meta-Ethnography.

Ninety-eight percent of neonatal deaths worldwide occur in low- and middle-income countries (LMICs), yet there is little bereavement care guidance available for these settings. To explore parents', families' and healthcare professionals' experiences of care after neonatal death in healthcare facilities in LMICs. Four databases were searched for peer-reviewed literature, meeting the inclusion criteria of qualitative studies exploring the experiences of people who provided or received bereavement care following neonatal death in a LMIC healthcare setting. Data were collected by two independent reviewers, collated through line-by-line coding and then reciprocal and refutational translation, and analysed through Noblit and Hare's seven-step meta-ethnography approach to create first-, second- and third-order themes. Seven first-order themes extracted from the literature included emotional responses, social relationships, staff and systems, religion, connecting with the baby, coping strategies and economic concerns. From these data, three third-order themes arose: The individual, the healthcare setting and the community/context. Overarching themes in bereavement care shape grief responses and are often similar across geographical locations. Analysing these similarities allows a deeper understanding of the important elements of bereavement care and may be helpful to inform the creation of high-quality, bereavement care guidelines suitable for use in LMIC settings.

Primary Care Guidance for Providers of Care for Persons With Human Immunodeficiency Virus: 2024 Update by the HIV Medicine Association of the Infectious Diseases Society of America.

Advances in antiretroviral therapy (ART) have made it possible for persons with human immunodeficiency virus (HIV) to live a lifespan approaching that of people without HIV, without progressing to AIDS or transmitting HIV to sexual partners or infants. There is, therefore, increasing emphasis on maintaining health throughout the lifespan. To receive optimal medical care and achieve desired outcomes, persons with HIV must be consistently engaged in care and able to access uninterrupted treatment, including ART. Comprehensive evidence-based HIV primary care guidance is, therefore, more important than ever. Creating a patient-centered, stigma-free care environment is essential for care engagement. Barriers to care must be decreased at the societal, health system, clinic, and individual levels. As the population ages and noncommunicable diseases arise, providing comprehensive health care for persons with HIV becomes increasingly complex, including management of multiple comorbidities and the associated challenges of polypharmacy, while also attending to HIV-specific health concerns. Clinicians must address issues specific to preventive health, including cancer screening, providing recommended vaccinations, as well as promoting sexual health, including sexually transmitted infection diagnosis, treatment, and prevention. Clinicians also must address issues for specific populations, including persons of childbearing potential, including during preconception and pregnancy; children; adolescents; and transgender and gender-diverse individuals. This guidance from an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America updates the previous 2020 HIV Primary Care Guidance.

Differential associations between experiences of contraceptive care and subsequent contraceptive access and preferences among family planning patients by racial and ethnic identity: Evidence from Arizona, Iowa, and Wisconsin.

While many frameworks exist for building person-centered and equitable systems of contraceptive care, evidence indicates that the reality of patients' experiences of care is often not in alignment with these ideals. Historical and current contexts of racism in the healthcare system contribute to negative perceptions and experiences of care, as well as reduced care-seeking behavior, for those who identify as Black, Indigenous, and people of color (BIPOC). Our objective in this analysis is to examine whether people's past experiences of contraceptive care are a driver of subsequent barriers to contraceptive access, and whether this relationship differs across racial and ethnic identity. We draw on panel data from five waves of surveys collected between 2018-2023 among patients ages fifteen and older seeking family planning care at sites that receive public funding for these services in Arizona, Iowa, and Wisconsin. Overall and stratified by race/ethnicity, we examine cross-sectional and longitudinal associations between patients' experiences of high-quality, person-centered contraceptive care and three contraceptive access outcomes: use of preferred contraception, satisfaction with contraceptive method, and experience of no barriers to accessing preferred contraception. We find longitudinal associations between patients experiencing higher-quality, more person-centered contraceptive care and subsequent satisfaction with contraceptive methods. Among non-Hispanic white-identifying patients, we find similar associations between shifting to higher-quality contraceptive care and use of preferred contraception, but we find no statistical relationship between experiencing higher-quality care and subsequent contraceptive outcomes for patients who identify as Black, Indigenous, or Person of Color (BIPOC). Highlighting the dissonance between clinical guidance for quality contraceptive care and patient experiences of care, and especially whether similar experiences across racial and ethnic identity lead to differential outcomes, is a crucial step toward bringing contraceptive care systems into alignment with principles of sexual and reproductive health equity.

8332 Genotype/Phenotype Profile Of Pheochromocytoma/Paraganglioma Patients In A Single Tertiary Referral Center Of South Texas

Abstract Disclosure: V. Desai: None. M.A. Escobar Vasco: None. C. Estrada-Zuniga: None. B. Landry: None. H. Gonzalez-Cantu: None. D. Pruthi: None. F. Tozzi: None. J. Ferrell: None. M. Kitano: None. C. Solis-Herrera: None. J.M. Bruder: None. S. Raghunathan: None. P.L. Dahia: None. Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors. Nearly 40% of patients with PPGLs have a heritable germline mutation and around 30% carry somatic mutations in one of &amp;gt;20 known susceptibility genes. 15-20% of cases can progress to metastatic disease. Recently, ethnic differences have been suggested in PPGLs and support further evaluation of ethnically diverse cohorts which can offer guidance for surveillance and patient care. Goal: The objective of this study is to identify genetic and clinical features of patients with a diagnosis of PPGL in predominant ethnic groups located in a single tertiary referral center of South Texas that is a designated Pheo-Para Alliance Clinical and Research Center of Excellence. Methods: Medical records were utilized to obtain demographic and clinical data, including age at diagnosis, gender, ethnicity, family history, tumor location, metastasis, clinical disease vs. carrier status, and genotype from patients enrolled in an IRB-approved repository. Results: 62 index patients who were diagnosed with PPGL or had a pathogenic germline mutation with no clinical disease were enrolled between 2006 to 2023. Patients were predominantly Caucasian (n=30/59, 50.8%) and Hispanic (n=24/59, 40.6%). In the Hispanic group, twenty-one were diagnosed with PPGL and three were asymptomatic carriers. This group had an average age of 38.3 years (range, 13-77), 85.7% had pheochromocytomas (11.1% were bilateral), 14.3% were metastatic, 16.7% had a positive family history, and 65% had an identifiable germline mutation. The most commonly mutated genes in Hispanics were VHL (n=5), SDHx (n=5), and EPAS1 (n=3). In the Caucasian group, thirty patients were diagnosed with PPGL and three were asymptomatic carriers. The average age for Caucasians was 46.4 years (range, 19-80). 23% had a positive family history, 66.7% had pheochromocytoma, 22.2% had metastatic disease, and 77.3% had a germline mutation. The most common genotype in Caucasians was SDHx (n=12) followed by NF1 (n=4). Conclusion: In this PPGL cohort, Hispanic patients tended to be younger at diagnosis, have lower proportion of SDH germline mutations and higher frequency of somatic mutations compared to Caucasians. This preliminary observation should inform further investigation into PPGL genotype-phenotype associations across ethnic groups toward improving surveillance and patient care. Presentation: 6/2/2024

8305 Assessing The Relationship Between Oral Health And Bone Disease Among Post-menopausal Women

Abstract Disclosure: N. Tahir: None. S. Ahmad: None. K. Batra: None. A. Gupta: None. K.E. Izuora: Research Investigator; Self; Novo Nordisk. Background: Menopause is associated with significant bone loss and worsening oral health, especially periodontal disease (PD). The purpose of this study was to understand the relationship between oral health and bone loss and the factors that influence this relationship. This will help better understand their pathophysiology and provide guidance for more appropriate care. Methods: ​​This cross-sectional study included post-menopausal women undergoing routine bone density evaluation at a diagnostic radiology center. After participants signed informed consent, histories were collected via an investigator-administered questionnaire, the oral cavity was inspected for teeth loss and PD, and a bone density assessment, interpreted by a radiologist, was obtained. The significance level was set at 5% and data were analyzed using chi-square and logistic regression tests. Results: In a sample of 100 eligible participants, the mean age and body mass index (BMI) were 68.17 ± 8.33 years and 29.59 ± 6.13 kg/m2 respectively. Twenty-three participants (23.0%) had T2DM, 29 (29.0%) had &amp;lt; 20 natural teeth and 17 (17.0%) had normal bone mineral density. In an unadjusted simple logistic regression, age, BMI, race/ethnicity, number of natural teeth, history of PD, and history of osteoporotic fracture were associated with bone loss. However, in the binary logistic regression, the only significant predictors of bone loss included age (aOR 1.171, p&amp;lt;0.001), BMI (aOR 0.763, p&amp;lt;0.001), and the history of osteoporotic fractures (aOR 21.273, p=0.021). Conclusion: Clinical variables associated with bone loss in our study included older age, lower BMI, and history of osteoporotic fracture. These are established risk factors for bone loss. Although unadjusted results suggest a relationship between oral health measures and bone loss, these relationships were not present when other factors were included in a multivariate model. These findings suggest PD by itself may not be a risk factor for bone loss but may reflect the similarity in the risk factors for both conditions. Presentation: 6/3/2024

Emerging Evidence Supports Broader Definition of Chairside Behavior Guidance and Familial Compliance.

Behavior management as a set of clinical techniques to induce desirable clinical treatment and subsequent compliance behaviors in children and families varies internationally based on professional training, access to care, health literacy, and societal norms. This report proposes non-typical diagnostic considerations of additional inherent behavioral conditions and familial and social qualifiers that may help predict success both at the chairside and in compliance with home self-care behaviors to reduce caries susceptibility. A review of the medical and dental literature provides ample support for the consideration of changing characteristics of both the patient and the environment. The current recommendations for choice of behavior guidance in direct clinical care, as used in the USA, often fall short of efficacy for a variety of reasons including the provider limitations, the extent and difficulty of treatment, and most recently appreciated, the complexity of negative childhood experiences, subclinical behavioral disorders, and immutable negative determinants of health outside the dental setting affecting interaction with health professionals. These same factors, such as family dysfunction and societal stresses, also impact compliance with out-of-clinic preventive efforts that many oral health care providers rely upon to help mitigate treatment limitations in reaching children. There are also behavioral elements of compliance and attitudes toward health that dentists need to recognize. A broader, more inclusive concept of behavior guidance to include factors beyond those typically associated with a dental patient affecting treatment and compliance with preventive behaviors may be beneficial. Every population and patient will have differing characteristics and require individualized care.

Efficacy of Remote Health Monitoring in Reducing Hospital Readmissions Among High-Risk Postdischarge Patients: Prospective Cohort Study.

Patients with respiratory or cardiovascular diseases often experience higher rates of hospital readmission due to compromised heart-lung function and significant clinical symptoms. Effective measures such as discharge planning, case management, home telemonitoring follow-up, and patient education can significantly mitigate hospital readmissions. This study aimed to determine the efficacy of home telemonitoring follow-up in reducing hospital readmissions, emergency department (ED) visits, and total hospital days for high-risk postdischarge patients. This prospective cohort study was conducted between July and October 2021. High-risk patients were screened for eligibility and enrolled in the study. The intervention involved implementing home digital monitoring to track patient health metrics after discharge, with the aim of reducing hospital readmissions and ED visits. High-risk patients or their primary caregivers received education on using communication measurement tools and recording and uploading data. Before discharge, patients were familiarized with these tools, which they continued to use for 4 weeks after discharge. A project manager monitored the daily uploaded health data, while a weekly video appointment with the program coordinator monitored the heart and breathing sounds of the patients, tracked health status changes, and gathered relevant data. Care guidance and medical advice were provided based on symptoms and physiological signals. The primary outcomes of this study were the number of hospital readmissions and ED visits within 3 and 6 months after intervention. The secondary outcomes included the total number of hospital days and patient adherence to the home monitoring protocol. Among 41 eligible patients, 93% (n=38) were male, and 46% (n=19) were aged 41-60 years, while 46% (n=19) were aged 60 years or older. The study revealed that home digital monitoring significantly reduced hospitalizations, ED visits, and total hospital stay days at 3 and 6 months after intervention. At 3 months after intervention, average hospitalizations decreased from 0.45 (SD 0.09) to 0.19 (SD 0.09; P=.03), and average ED visits decreased from 0.48 (SD 0.09) to 0.06 (SD 0.04; P<.001). Average hospital days decreased from 6.61 (SD 2.25) to 1.94 (SD 1.15; P=.08). At 6 months after intervention, average hospitalizations decreased from 0.55 (SD 0.11) to 0.23 (SD 0.09; P=.01), and average ED visits decreased from 0.55 (SD 0.11) to 0.23 (SD 0.09; P=.02). Average hospital days decreased from 7.48 (SD 2.32) to 6.03 (SD 3.12; P=.73). By integrating home telemonitoring with regular follow-up, our research demonstrates a viable approach to reducing hospital readmissions and ED visits, ultimately improving patient outcomes and reducing health care costs. The practical application of telemonitoring in a real-world setting showcases its potential as a scalable solution for chronic disease management.

Pregnancy in women with mitochondrial disease-A literature review and suggested guidance for preconception and pregnancy care.

Mitochondrial donation to reduce the risk of primary mitochondrial disease transmission from mother to child is now permitted under Australian law as part of a clinical trial. The energy demands of pregnancy have the potential to worsen mitochondrial disease symptoms and severity in affected women. We conducted a systematic literature review on mitochondrial disease in pregnancy; five cohort studies and 19 case reports were included. For many women with mitochondrial disease, pregnancy does not have a negative effect on health status. However, serious adverse outcomes may occur. We provide suggested guidelines for preconception counselling and antenatal care.

Towards Establishing Quality Standards on Human Rights for Services in Dementia Care.

People with dementia often experience violations of fundamental human rights and impeded access to healthcare. This study aims to investigate the views of experts regarding the use of the United Nations Convention on the Rights of People with Disabilities (CRPD) principles as quality standards for human rights-based care. A single-round Delphi e-consultation with 15 dementia experts was designed to evaluate each CRPD principle and collect feedback on their views about the application of the CRPD principles in dementia care. The CRPD principles were fully endorsed as quality standards; however, several experts commented on the complexities of the use of CRPD principles in relation to information disclosure, capacity assessment, stakeholders' involvement in decision-making, respecting needs and preferences, holistic approaches in care practice, and protection against abuse, neglect and discrimination. These findings indicate the CRPD quality standards were fully applicable for people with dementia although some clarification around interpretation could assist in their use. Future research should elaborate on further points of support and guidance for dementia care providing examples of good practice from across the globe, and develop a concordant, human rights-based scheme for the implementation and evaluation of dementia services. This study suggests that the CRPD can serve as a benchmark for human rights-based practices in dementia services globally that could enhance nursing care practice. Nursing staff are encouraged to consider human rights in relation to the complexities associated with people with dementia, their caregivers, and other services involved in their care.