Conventional Hospital Research Articles

L'angioplastie du Tronc commun gauche en ambulatoire : Comment s'y prendre ?

The steady development of same-day discharge (SDD) PCIs in recent years means that, by 2024, we will be able to tackle increasingly complex lesions, including those of the left main artery. This strategy is supported by the literature, but requires an appropriate patient selection (based on medical and social criteria) and precise assessment of the anatomical complexity of the lesion and the foreseeable risks of the PCI. Strict adherence to pre-established service protocols for patient preparation and follow-up, as well as the establishment of clinical and paraclinical criteria for discharge to a conventional hospital unit, are essential to the success of an SDD PCI program.

Impact of a dedicated radial lounge on same-day discharge percutaneous coronary intervention.

The same-day discharge (SDD) program after elective percutaneous coronary intervention (PCI) is a safe strategy that allows for the optimization of hospital resources. However, the lack of adequate infrastructure and a specially targeted care model may limit its implementation. Our center developed an outpatient care model based on an area designed for percutaneous procedures called radial lounge (RL). Evaluate the efficacy and safety of the RL care model: (1)SDD rate,(2) patient experience,(3) major adverse cardiac events (MACEs) (in-hospital, 30-day, and 1-year mortality andintervention),and (4) vascular access complication. Impact of RL SDD rate on total elective SDD-PCI volume. We conducted a retrospective observational cohort study at a cardiovascular hospital, including consecutive patients undergoing elective PCI between 2015 and 2022 who were admitted to the conventional hospitalization area (CHA) or the RL about the stated objectives. Patient experience was assessed using the Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. A total of 5466 elective PCI procedures were included: 2102 in the RL and 3364 in the CHA. The SDD rate was 85.2% in the RL group and 54% in the CHA. After the implementation of RL, a significant increase in the volume of elective SDD-PCI was observed and patient satisfaction improved significantly (p < 0.005) with CHA. Finally, a greater amount of MACEs were not observed in the RL. The PCI program in RL proved to be safe and effective. It showed a higher rate of SDD and a significant improvement in patient experience was observed without affecting safety.

Cost-Utility Analysis of Teledermatology Units in Primary Care Centers Versus Face-to-Face Dermatology Consultations in the Hospital.

To perform an economic evaluation to determine whether or not teledermatology (TD) units in primary care (PC) centers offer an alternative in terms of cost-utility and cost per quality-adjusted life years (QALYs) to conventional dermatology consultations (face-to-face dermatology [F-F/D]) at the hospital from the perspective of the Public Health System (PHS) and the patients. This is a randomized, controlled, nonblinded, and multicenter study. During 6 months, data from 450 patients (TD: 225 vs. F-F/D: 225) were collected. From both perspectives, costs, quality of life, and costs per QALYs were analyzed. The QALY scores were estimated from the EuroQol-5D-5L (EQ5D-5L) questionnaire responses. From the perspective of the PHS, the cost per patient was 53.04% lower in the TD group (p < 0.001). Hospital visits decreased by 72.43% in the TD group (p < 0.001). From the patients' perspective, TD reduced costs per patient by 77.59% (p < 0.001). The cost per QALY was 63.34% higher in the F-F/D group (p < 0.001). The TD group's total costs were 56.34% lower (p < 0.001). Furthermore, patients in the TD group gained 0.05 QALYs more than those in the F-F/D group (p = 0.004). This study shows that TD units in PC represent a significant cost-effective alternative to conventional hospital follow-up. To enhance TD in PC, it is important to introduce remote consultation platforms incorporating artificial intelligence for prediagnosis. This will enable general practitioners and nurses to make more accurate initial assessments. It is also crucial to provide thorough training to healthcare personnel using these technologies to ensure more efficient and personalized care. Public health nurses will benefit from gaining new skills in managing digital tools, which will help in the early identification of dermatological diseases and reduce unnecessary referrals to specialists. This will optimize resources and improve response times for patients.

A step further: Antibiotic stewardship programme in home hospital.

To evaluate the adequacy of empirical antibiotic prescription and the duration of antibiotic therapy for infected patients admitted for conventional hospitalization (CH) and Hospitalization at Home (HaH) after implementation of an antibiotic stewardship programs (ASP) in HaH. Retrospective cohort study. Patients admitted for infection to Emergency Department between October and December 2023. "CH-ASP cohort" was admitted to CH with ASP intervention, "CH cohort" was admitted to CH without ASP intervention, "HaH cohort" was admitted to HaH (integrated daily ASP intervention). Ninety-one patients were analyzed in CH-ASP, 60 in CH, and 101 in HaH. The ASP made recommendations on empirical antibiotic therapy for 175 patients (92 %) with a 98 % acceptance rate. For 111 patients (44 %) the ASP made recommendations on antibiotic duration (24 % CH-ASP vs 89 % HaH, p < 0.001), with a 73 % acceptance rate (41 % CH-ASP vs 81 % HaH, p < 0.001). Empirical antibiotic adequacy was 94 % (93 % CH-ASP vs 87 % CH vs 100 % HaH, p = 0.006). Median duration of antibiotic therapy was nine days in CH-ASP and CH vs seven in HaH (p < 0.001). There were no differences in mortality and readmissions. In the multivariate analysis, patients in CH-ASP and CH had total duration of antibiotic therapy of 2.2 (95 % CI: 0.2-4.2) and 3 days more (95 % CI: 0.8-5.3) respectively as compared to HaH. ASP improves empirical antibiotic adequacy in patients admitted for infection. ASP in HaH, because of high acceptance of intervention regarding antibiotic duration, achieves shorter treatment durations without increased mortality or readmission.

Assessment of non-inferiority in terms of six-month morbidity and mortality of a hospital-at-home care pathway for patients with acute heart failure: FIL-EAS-ic study protocol

BackgroundHeart failure (HF) is a common cause of hospitalization and is associated with high mortality rates, long hospital stays and high economic costs worldwide. Novel care pathways are increasingly considered to address these burdens. In France, a mixed conventional hospitalization and hospital-at-home (HaH) care pathway (named FIL-EAS-ic) has been designed to reduce hospital length of stay without impairing HF outcomes. This protocol describes the study design evaluating the non-inferiority of the FIL-EAS-ic pathway compared to conventional hospitalization in terms of six-month all-cause mortality and/or unscheduled HF-related hospitalization. Methods and ResultsA randomized, prospective, multicenter trial (NCT04878263) will be conducted involving two groups of patients in a 1:2 ratio: i) a control group following the conventional hospitalization pathway, and ii) the experimental group following the FIL-EAS-ic pathway. We aim to include 454 patients from the Centre Hospitalier Intercommunal de Toulon La Seyne sur Mer and the Hôpital d'Instruction des Armées Sainte-Anne in France from June 2021 to June 2023. The non-inferiority of the FIL-EAS-ic pathway compared to conventional hospitalization, in terms of six-month all-cause mortality and/or unscheduled HF-related hospitalization will be tested by the Farrington-Manning method. Impact on treatment adherence, HF rehospitalizations and cumulative time spent in the hospital will also be compared between the two groups. ConclusionsThis clinical trial will provide evidence on a novel HF care pathway in France as well as its potential to improve follow-up care, quality of life and patient satisfaction as well as its potential to reduce costs.

Meta-Analysis of eVisit Technology on Psychological Anxiety and Factors Influencing the Parents of NICU Newborns.

Due to the geographical distance, work obligations, and parenting responsibilities, it is often difficult for parents to visit the neonatal intensive care unit (NICU). Limited parent presence might also constrain updates about infant status thus increasing anxiety, which potentially leads to a stronger necessity for visitation. Examine the evidence for use of electronic visit (eVisit) technology for parents of newborns in NICU, for example, do eVisits decrease anxiety and are there other factors that demonstrate effectiveness. Seven databases were used to search for evidence from 1 January 2000 to 13 November 2023. Studies were included with terms related to eHealth, NICU, infant, parent and 41 eligible studies were assessed. Data were extracted by 2 reviewers with a systematic-staged review approach. Eight studies with a total of 1450 cases were included. Results of meta-analysis showed that eVisit technology improved anxiety compared with conventional visitation (MD=-5.04, 95% CI [-5.92,-4.17], P <.01) and hospitalization satisfaction (RR=1.09, 95% CI [1.05, 1.13], P <.01), but the effect was not significant with regard to reduction in infant length of stay (MD=-1.07, 95% CI [-5.39, 3.25], P =.63). A large sample, high-quality, multi-centered randomized controlled study needs to be conducted to validate the effect of eVisit technology on the psychological state of parents, implications for nursing practice as well as potential newborn affects to improve future ease of use. Available for more insights from the authors. This video shows the concept, current status, significance, and implications for practice and research of eVisit technology.

Non-traumatic spinal cord injury - etiological profile and associated factors: single rheumatological center experience.

Non-traumatic spinal cord injury (NTSCI) represents a medical-surgical emergency. In Burkina Faso, limited data exist on the etiological profiles of this syndrome in rheumatology. This study aimed to describe the etiological profile of NTSCI in the Rheumatology Department of the University Hospital Center of Bogodogo (CHU-B). This was a cross-sectional, retrospective study with descriptive and analytical aims, conducted from March 1, 2017, to December 31, 2023, in the Rheumatology Department of CHU-B. Patients diagnosed with non-traumatic spinal cord compression syndrome during hospitalization were included. The frequency in the Rheumatology Department of NTSCI was 2.94%, accounting for 104 patients. There were 68 men (65.38%), with a sex ratio of 1.88. The average age of the population was 57.91 years. All patients experienced back pain, with a lumbar location in 77 patients (74.04%). The average duration of the motor deficit was 2.97 months. A total of 3,532 patients were admitted to the conventional hospitalization unit of the Rheumatology Department at the CHU-B from March 1, 2017, to December 31, 2023. Among these, 104 patients had NTSCI, yielding a frequency of 2.94%. Spinal MRI was performed in 58 patients (55.77%), and the compression was extradural in 76.92% of cases (n = 80). The etiologies identified were Pott's disease in 32 patients (30.77%), followed by spinal metastases in 22 patients (21.15%). Twenty-nine patients (27.89%) experienced complications related to prolonged bed rest. No factor was significantly associated with the recovery of the motor deficit. Non-traumatic spinal cord injury is relatively rare in rheumatological practice in Ouagadougou. The etiology is predominantly Pott's disease, which confirms the geographical distribution of NTSCI causes.

Application of a specialist nurse–led wireless smart monitoring system in elderly patients with persistent atrial fibrillation

Background: With the increase in the elderly population, the prevalence of persistent atrial fibrillation (AF) among older adults has significantly risen, becoming one of the crucial cardiovascular diseases affecting the health and quality of life of the elderly. Patients with persistent AF require continuous cardiac function monitoring to prevent possible complications such as stroke and heart failure. Traditional monitoring methods often necessitate frequent hospital visits, increasing the economic burden and psychological stress on patients. With advancements in medical technology, wireless smart monitoring systems have emerged as a new remote health care technology, offering a more convenient and effective monitoring option for patients with persistent AF. Specialist nurses play a pivotal role in monitoring and managing patients using these systems. Their professional knowledge and skills are vital for improving monitoring efficiency and patient compliance. Therefore, this study aims to explore the application of wireless smart monitoring systems led by specialist nurses in elderly patients with persistent AF, in hopes of providing a scientific basis for improving the monitoring and management of this patient group. Methods: A total of 88 elderly patients with persistent atrial fibrillation admitted to the Cardiology Ward of a tertiary hospital in Weifang City from October 2021 to April 2023 were selected as research subjects. They were divided into an intervention group and a control group with conventional care, with 44 cases in each group, according to the order of admission. The control group received conventional hospitalization guidance, while the intervention group utilized a wireless smart monitoring system led by specialist nurses. The effects before and after the intervention in both groups were compared. Results: The intervention group patients had better scores in terms of mental stress, sleep quality, and comfort compared with the control group, and the nursing shift change time during hospitalization for the intervention group was shorter than that of the control group (P&lt;0.05). Conclusions: The wireless smart monitoring system led by specialist nurses can improve the mental stress and sleep conditions of elderly patients with persistent atrial fibrillation, increase comfort, and enhance the efficiency of nursing shift changes.

Effectiveness of Treatment Approaches in COVID-19 Pneumonia: A Comparative Evaluation between a Specialized Center and Conventional Hospitals.

The early stages of the COVID-19 pandemic overwhelmed general hospitals in Spain. In response, a dedicated hospital for COVID-19 care, the Hospital de Emergencias Enfermera Isabel Zendal (HEEIZ), was established. This study aimed to compare clinical outcomes of COVID-19 patients treated at the specialized HEEIZ with those at conventional general hospitals (CGHs) in Madrid, Spain. The study was a prospective, observational cohort study including COVID-19 patients admitted to the HEEIZ and 14 CGHs (December 2020 to August 2021). Patients were assigned based on hospital preference. Clinical data were collected and analyzed using multivariate regression to assess primary and secondary outcomes, including hospital mortality, need of invasive mechanical ventilation (IMV), and pharmacological treatments. The HEEIZ cohort (n = 2997) was younger and had lower Charlson comorbidity scores than the CGH cohort (n = 1526). Adjusted HEEIZ hospital mortality was not significantly higher compared with CGHs (OR: 1.274; 95% CI: 0.781-2.079; p = 0.332). During the study period, patients admitted to the HEEIZ showed no significant differences in clinical outcomes, compared with patients admitted at CGHs. These results might support the use of specialized centers in managing pandemic surges, allowing CGHs to handle other needs.

Multitask Neural Networks to Predict Antimicrobial Susceptibility Results of Escherichia coli Clinical Isolates

Background: Machine-learning (ML) models, such as neural networks (NNs), have been proposed to predict antimicrobial susceptibility at the patient level while incorporating patient-level information from electronic medical record (EMR) systems. However, NNs often do not perform well in predicting rare outcomes, such as carbapenem resistance. We aimed to apply a novel multitask NN to create personalized antibiograms for individual patients with Escherichia coli clinical isolates to predict antimicrobial resistance (AMR) for four major antimicrobial classes simultaneously with improved accuracy for carbapenem resistance by using shared hidden layers (Figure 1). Methods: We analyzed all E. coli clinical isolates from the US Veterans Health Administration’s network from January 1, 2017, to December 31, 2019, focusing on AMR profiles of aminopenicillins, narrow-spectrum (NS) cephalosporins, extended-spectrum (ES) cephalosporins, and carbapenems. Patient-level clinical data (demographics, antimicrobial exposure history, previous isolates (if any), comorbidities, and recent procedures) were extracted from EMR. Antibiograms for all hospitals were generated using standard methods for the preceding calendar years. We employed logistic regression to evaluate the efficacy of conventional antibiograms in predicting AMR profiles. We adopted the ML approach using conventional NNs and novel multitask NNs on all extracted clinical data and hospital antibiograms. The models were trained with data from 2017 and 2018 and then tested on 2019 data, assessing their performance using the area under the receiver-operating curve (AUC). Results: The study included 257,968 E. coli isolates, split into 171,391 for training and 86,577 for validation. The prevalence of AMR in the test data from 2019 was 49.8% for aminopenicillins, 28.4% for NS cephalosporins, 10.7% for ES cephalosporins, and 0.2% for carbapenems, respectively. Conventional hospital antibiograms showed low prediction accuracy with AUC scores of 0.56 for aminopenicillins, 0.67 for NS cephalosporins, 0.61 for ES cephalosporin, and 0.67 for carbapenem. AUC scores from preliminary models for conventional and multitask NNs were 0.78/0.78 for aminopenicillins, 0.83/0.82 for NS cephalosporins, 0.84/0.85 for ES cephalosporins, 0.68/0.75 for carbapenems. While producing improved accuracy for carbapenem and comparable accuracies for three other classes, multitask NNs took approximately 66% less time for model training than conventional NNs. Conclusions: Integrating EMR data with NNs improved their predictive accuracy, potentially leading to a decision-support tool for better empirical antimicrobial therapy guidance in the window between species identification and confirmed susceptibilities. Multitask NNs can potentially improve the prediction accuracy of uncommon AMRs while maintaining comparable prediction accuracies for common AMRs and optimizing the efficiency of model training.Disclosure: Michi Goto: Contracted Research - Merck

Holmium laser enucleation of the prostate (HoLEP) in short-circuit outpatient care: Is prostatic volume a limiting factor?

Our goals were to study prostatic volume as a limiting factor after HoLEP surgery with short-circuit outpatient care (4 h) and to define other factors that affect the success of the proposed circuit. An observational analysis and review was performed using a prospective database. Preoperative, intraoperative, and postoperative variables were included for patients who were scheduled for short-circuit outpatient care (SCOC) and who underwent HoLEP between 2020 and 2023. We defined SCOC as a postoperative hospital stay of 4 h. Subjects who required more than 4 h in hospital were categorized as conventional hospital admission (CHA). A descriptive populational study was conducted, expressing the mean using a 95% confidence interval and percentages for the continuous variables. In order to analyze them, we used the Student's t-test for the continuous variables and the chi-squared test for the categorical variables. Sixty-eight patients were included, 54 of which completed SCOC, which represented a success ratio of 79.5%. The mean age and prostatic volume of the whole cohort were 68.9 (±6.8) years and 79.5 (±29.1) mL, respectively. We found no significant differences in age, prostatic volume, antiplatelet drug use, indwelling bladder catheter, or applied energy among the subjects who completed SCOC and those who required CHA. No patient was presented with a complication of Grade 3 (or higher) in the modified Clavien-Dindo classification. At the six-month follow-up, no differences were observed in the uroflowmetry or International Prostate Symptoms Score variables. Prostatic volume does not seem to be a limiting factor after undergoing HoLEP with short-circuit outpatient care.

Comparison of Length of Stay and Discharge Disposition after Short-Segment Lumbar Fusion Surgery at Tertiary Care and Non-Tertiary Care Hospitals: A Propensity Score Matched Analysis.

A retrospective study. To compare the perioperative and postoperative outcomes among lumbar fusion patients treated at an orthopaedic specialty hospital (OSH), a hybrid community hospital (HCH), and a conventional community hospital in comparison to a tertiary care hospital (TCH). In spine surgery, strategies to reduce length of stay (LOS) include a myriad of pre-, intra-, and postoperative strategies that require a multidisciplinary infrastructure. The sum of these efforts has led to the creation of orthopedic specialty hospitals and protocols that have been adopted by community hospitals as well. There is a notable lack of information regarding the results of these efforts across different healthcare institution models. This was a retrospective study of patients undergoing elective one or two-level lumbar fusion between 2017 and 2022 at a large urban TCH, an OSH, a HCH, and a conventional CH. Data was collected on patient characteristics, demographics, comorbidities, BMI, smoking status, surgical type, surgical levels, surgery duration, hospital length of stay, readmissions, reoperations, and discharge status within a year. Patients across the four surgical settings were matched based on age, BMI, CCI, type of procedure, and number of levels fused. A total of 1435 patients met the inclusion criteria. Length of hospital stay was significantly longer at TCH compared to OSH, HCH, and CH by an average of 1-2 days (P<0.001). 90-day readmissions were higher at TCH compared to OSH (P=0.001). TCH patients also were less likely to be discharged home than OSH and HCH patients (P=0.001 and P=0.016, respectively). No significant differences were noted in 1-year reoperation rates across all hospital models. Shorter lengths of stays and more home discharges at the orthopaedic specialty hospital and community hospital settings did not compromise surgical quality or postoperative outcomes.

Optimization of a home hospitalization program for hematopoietic stem cell transplantation with ehealth integration and clinical pharmacist involvement.

Home hospitalization represents an alternative to traditional hospitalization, providing comparable clinical safety for hematological patients. At-home therapies can range from the delivery of intravenous antibiotics to more complex scenarios, such as the care during the early period after hematopoietic stem cell transplantation and chimeric antigen receptor T-cell therapy. Early discharge from conventional hospitalization is feasible and helps reduce hospital resources and waiting lists. The coordinated efforts of multidisciplinary teams, including hematologists, nurses, and pharmacists, ensure patient safety and continuity of care. The traditional model of home hospitalization relies on home visits and telephone consultations with physicians and nurses. However, the use of eHealth technologies, such as MY-Medula, can enhance communication and monitoring, and thereby improve patient outcomes with no additional costs. The active involvement of a clinical pharmacist in home hospitalization programs is essential, not only for the proper logistical management of the medication but also to ensure its appropriateness, optimize treatment, address queries from the team and patients, and promote adherence. In conclusion, the implementation of hematopoietic stem cell transplantation and chimeric antigen receptor T-cell therapy home hospitalization programs that use both an eHealth tool and a multidisciplinary care model can optimize patient care and improve quality of life without increasing healthcare costs.

Assessment of the Impact of Home-Based Hospitalization on Health Outcomes: An Observational Study.

In Portugal, evidence of clinical outcomes within home-based hospitalization programs remains limited. Despite the adoption of homebased hospitalization services, it is still unclear whether these services represent an effective way to manage patients compared with inpatient hospital care. Therefore, the aim of this study was to evaluate the outcomes of home-based hospitalization compared with conventional hospitalization in a group of patients with a primary diagnosis of infectious, cardiovascular, oncological, or 'other' diseases. An observational retrospective study using anonymized administrative data to investigate the outcomes of home-based hospitalization (n = 209) and conventional hospitalization (n = 192) for 401 Portuguese patients admitted to CUF hospitals (Tejo, Cascais, Sintra, Descobertas, and the Unidade de Hospitalização Domiciliária CUF Lisboa). Data on demographics and clinical outcomes, including Barthel index, Braden scale, Morse scale, mortality, and length of hospital stay, were collected. The statistical analysis included comparison tests and logistic regression. The study found no statistically significant differences between patients' admission and discharge for the Barthel index, Braden scale, and Morse scale scores, for both conventional and home-based hospitalizations. In addition, no statistically significant differences were found in the length of stay between conventional and home-based hospitalization, although patients diagnosed with infectious diseases had a longer stay than patients with other conditions. Although the mortality rate was higher in home-based hospitalization compared to conventional hospitalization, the mortality risk index (higher in home-based hospitalization) assessed at admission was a more important predictor of death than the type of hospitalization. The study found that there were no significant differences in outcomes between conventional and home-based hospitalization. Home-based hospitalization was found to be a valuable aspect of patient- and family-centered care. However, it is noteworthy that patients with infectious diseases experienced longer hospital stays.

Impact du mode de suivi des ruptures prématurées des membranes avant 36 SA sur la durée de latence

IntroductionPreterm premature rupture of membranes (PPROM) is the main cause of premature delivery, complicating 1–3% of all pregnancies. Conventional hospitalization (CH) is the most frequent mode of follow-up, but homecare (HC) seems to be an alternative. ObjectivesStudy of the impact of the monitoring mode on the duration of the latency period and on the latency ratio after PPROM, and analysis of the risk factors modifying this ratio. MethodsThis was a bicentric retrospective cohort study here-abouts including patients who presented a PPROM between 24 and 36weeks of gestation from 2016 to 2018. Patients had a follow-up in HC at Lille University Hospital center (UHC) and in CH at Nantes UHC according to two different follow-up protocols. The latency ratio corresponded to the real latency period divided by the latency period to theoretical term. ResultsWe included 154 patients: 102 in HC and 52 in CH. The mean latency period was significantly higher in HC: 36.9±21.8 days, corresponding to an 85.5±23.7% latency ratio versus 20.2±12 days, corresponding to an 66.9±29.8% latency ratio in CH (P<0.001). The latency ratio in CH was correlated with term at PPROM (P=0.001). ConclusionsThe duration of the latency period seems prolonged for PPROM followed by HC management versus CH in selected populations. This study suggests a benefit to HC in stable patients.

The value of admission avoidance: cost-consequence analysis of one-year activity in a consolidated service.

Many advantages of hospital at home (HaH), as a modality of acute care, have been highlighted, but controversies exist regarding the cost-benefit trade-offs. The objective is to assess health outcomes and analytical costs of hospital avoidance (HaH-HA) in a consolidated service with over ten years of delivery of HaH in Barcelona (Spain). A retrospective cost-consequence analysis of all first episodes of HaH-HA, directly admitted from the emergency room (ER) in 2017-2018, was carried out with a health system perspective. HaH-HA was compared with a propensity-score-matched group of contemporary patients admitted to conventional hospitalization (Controls). Mortality, re-admissions, ER visits, and direct healthcare costs were evaluated. HaH-HA and Controls (n = 441 each) were comparable in terms of age (73 [SD16] vs. 74 [SD16]), gender (male, 57% vs. 59%), multimorbidity, healthcare expenditure during the previous year, case mix index of the acute episode, and main diagnosis at discharge. HaH-HA presented lower mortality during the episode (0 vs. 19 (4.3%); p < 0.001). At 30 days post-discharge, HaH-HA and Controls showed similar re-admission rates; however, ER visits were lower in HaH-HA than in Controls (28 (6.3%) vs. 34 (8.1%); p = 0.044). Average costs per patient during the episode were lower in the HaH-HA group (€ 1,078) than in Controls (€ 2,171). Likewise, healthcare costs within the 30 days post-discharge were also lower in HaH-Ha than in Controls (p < 0.001). The study showed higher performance and cost reductions of HaH-HA in a real-world setting. The identification of sources of savings facilitates scaling of hospital avoidance. ClinicalTrials.gov (26/04/2017; NCT03130283).

Job satisfaction of health workers at a Vietnamese University Hospital and its predicted factors: A cross-sectional study.

Job satisfaction of healthcare workers from conventional and university hospitals (or teaching hospitals) might be different due to several factors, for example medical staff required to carry out multiple clinical and teaching tasks simultaneously. Our study aimed to determine how the job satisfaction among healthcare workers in university hospitals is different from those in conventional hospitals. A cross-sectional study was conducted by using the validated and contextualized job satisfaction tool for the Vietnamese context to survey 216 healthcare workers at a university hospital in Vietnam from January to March 2020 with online Google forms. The results indicated low overall job satisfaction (43.1%) in our study university hospital with the score cutoff of 80%. However, healthcare workers still reported high job satisfaction rates in certain aspects, such as personal empathy (70.8%), discipline, and reward (67.6%), co-worker collaboration (65.3%), training and promotion (63%), workplace environment (57.4%), and salary and allowance (44.9%). Subgroup analysis revealed statistically significant differences in job satisfaction (p < 0.01) related to age (31 to 40-year-old), and job position with ORs 3.9, and 8.6 respectively. University hospitals need to improve the healthcare workers' job satisfaction. It is recommended that special human resource strategies should be developed focusing on keeping satisfying older healthcare staff by recognizing their contributions and providing appropriate benefits based on their positions in the hospital.

Persistence and emergence of new neuropsychological deficits following SARS-CoV-2 infection: A follow-up assessment of the Geneva COVID-COG cohort.

Despite numerous observations of neuropsychological deficits immediately following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, little is known about what happens to these deficits over time and whether they are affected by changes in fatigue and any psychiatric symptoms. We aimed to assess the prevalence of neuropsychological deficits at 6-9 months and again at 12-15 months after coronavirus disease 2019 (COVID-19) and to explore whether it was associated with changes in fatigue and psychiatric symptoms. We administered a series of neuropsychological tests and psychiatric questionnaires to 95 patients (mean age = 57.12 years, standard deviation (SD) = 10.68; 35.79% women) 222 (time point 1 (T1)) and 441 (time point 2 (T2)) days on average after infection. Patients were categorised according to the severity of their respiratory COVID-19 symptoms in the acute phase: mild (no hospitalisation), moderate (conventional hospitalisation), and severe (hospitalisation in intensive care unit (ICU) plus mechanical ventilation). We ran Monte-Carlo simulation methods at each time point to generate a simulated population and then compared the cumulative percentages of cognitive disorders displayed by the three patient subgroups with the estimated normative data. We calculated generalised estimating equations for the whole sample to assess the longitudinal associations between cumulative neuropsychological deficits, fatigue, and psychiatric data (anxiety, depressive symptoms, posttraumatic stress disorder, and apathy). Most participants (>50%) exhibited a decrease in their neuropsychological impairments, while approximately 25% showed an escalation in these cognitive deficits. At T2, patients in the mild subgroup remained free of accumulated neuropsychological impairments. Patients with moderate severity of symptoms displayed a decrease in the magnitude of cumulative deficits in perceptual and attentional functions, a persistence of executive, memory and logical reasoning deficits, and the emergence of language deficits. In patients with severe symptoms, perceptual deficits emerged and executive deficits increased, while attentional and memory deficits remained unchanged. Changes in executive functions were significantly associated with changes in depressive symptoms, but the generalised estimating equations failed to reveal any other significant effect. While most cumulative neuropsychological deficits observed at T1 persisted and even worsened over time in the subgroups of patients with moderate and severe symptoms, a significant proportion of patients, mainly in the mild subgroup, exhibited improved performances. However, we identified heterogeneous neuropsychological profiles both cross-sectionally and over time, suggesting that there may be distinct patient phenotypes. Predictors of these detrimental dynamics have yet to be identified.

Five years of Hospital at Home adoption in Catalonia: impact, challenges, and proposals for quality assurance

BackgroundHospital at home (HaH) was increasingly implemented in Catalonia (7.7 M citizens, Spain) achieving regional adoption within the 2011-2015 Health Plan. This study aimed to assess population-wide HaH outcomes over five years (2015-2019) in a consolidated regional program and provide context-independent recommendations for continuous quality improvement of the service.MethodsA mixed-methods approach was adopted, combining population-based retrospective analyses of registry information with qualitative research. HaH (admission avoidance modality) was compared with a conventional hospitalization group using propensity score matching techniques. We evaluated the 12-month period before the admission, the hospitalization, and use of healthcare resources at 30 days after discharge. A panel of experts discussed the results and provided recommendations for monitoring HaH services.ResultsThe adoption of HaH steadily increased from 5,185 episodes/year in 2015 to 8,086 episodes/year in 2019 (total episodes 31,901; mean age 73 (SD 17) years; 79% high-risk patients. Mortality rates were similar between HaH and conventional hospitalization within the episode [76 (0.31%) vs. 112 (0.45%)] and at 30-days after discharge [973(3.94%) vs. 1112(3.24%)]. Likewise, the rates of hospital re-admissions at 30 days after discharge were also similar between groups: 2,00 (8.08%) vs. 1,63 (6.58%)] or ER visits [4,11 (16.62%) vs. 3,97 (16.03%). The 27 hospitals assessed showed high variability in patients’ age, multimorbidity, severity of episodes, recurrences, and length of stay of HaH episodes. Recommendations aiming at enhancing service delivery were produced.ConclusionsBesides confirming safety and value generation of HaH for selected patients, we found that this service is delivered in a case-mix of different scenarios, encouraging hospital-profiled monitoring of the service.

Change in the Proportion of Death at Home during the COVID-19 Pandemic and Its Associated Factors in the Municipality Level: A Nationwide Study in Japan.

The coronavirus disease 2019 (COVID-19) pandemic may have led to an increase in home deaths due to hospital bed shortage and hospital visitation restrictions. This study aimed to examine changes in the proportion of home deaths before and after the COVID-19 pandemic and identify associated factors. We used publicly available nationwide data to describe the proportion of home deaths among total deaths from 2015 to 2021. Furthermore, we used municipal-level data to examine the factors associated with the increase in the proportion of home deaths from 2019 to 2021. The dependent variable was the absolute change in the proportion of home deaths from 2019 to 2021. The independent variables included each municipality's 2019 home death percentage, medical and long-term care (LTC) resources divided by the population of older people, population density, and cumulative number of COVID-19 cases. A multivariable linear regression analysis was conducted after the standardization of each variable. The proportions of home deaths in 2015, 2019, and 2021 were 12.7%, 13.6%, and 17.2%, respectively, indicating a sharp increase in home death rate after the COVID-19 pandemic. In the multivariable linear regression analysis that included 1,696 municipalities, conventional home care support clinics and hospitals (HCSCs) (coefficient [95% confidence intervals (CIs)], 0.19 [0.01-0.37]), enhanced HCSCs (0.53 [0.34-0.71]), home-visiting nurses (0.26 [0.06-0.46]), population density (0.44 [0.21-0.67]), and cumulative COVID-19 cases (0.49 [0.27-0.70]) were positively associated with the increase in home deaths, whereas beds of LTC welfare facilities (-0.55 [-0.74--0.37]) and the proportion of home deaths in 2019 (-1.24 [-1.44--1.05]) were negatively associated with the increase. During the COVID-19 pandemic, home deaths significantly increased, particularly in densely populated areas with high cumulative COVID-19 cases. HCSCs, especially enhanced HCSCs, are crucial for meeting the demand for home-based end-of-life care.