Day Hospital Research Articles

Advances in the Neuro-Rehabilitation of Parkinson’s Disease: Insights from a Personalized Multidisciplinary Innovative Pathway

Background/Objectives: Parkinson’s disease (PD) is a progressive neurodegenerative disorder that requires comprehensive and personalized rehabilitation. This retrospective study focused primarily on the usability and patient acceptability of the innovative pathway. In addition, the secondary objective was to evaluate the effectiveness of a personalized and multidisciplinary rehabilitation pathway on cognitive function, especially executive functions. Methods: We conducted a retrospective study on 80 patients with PD (Hoehn and Yahr scores 1–3). Patients were divided into an experimental group (EG), which received the innovative pathway, and a control group (CG), which received traditional therapy. The rehabilitation program included three phases: initial outpatient assessment, a two-month inpatient program, and a telerehabilitation phase in a day hospital (DH) or home environment. Interventions combined traditional therapies with treatments based on robotic and virtual reality. Cognitive assessments (Mini Mental State Examination—MMSE—and frontal assessment battery—FAB), mood (Hamilton Rating Scale—Depression—HRS-D), anxiety (HRS-Anxiety—HRS-A), and goals achievement (GAS) were the primary outcome measures. Results: At baseline, there were no significant differences between the groups in terms of age, gender, education, or test scores. After rehabilitation, EG showed significant improvements in all measures (p < 0.001), particularly in cognitive tests and goal achievement. CG improved in GAS (p < 0.001) and mood (HRS-D, p = 0.0012), but less than EG. No significant changes were observed in the MMSE of CG (p = 0.23) or FAB (p = 0.003). Conclusions: This study highlights the high usability and acceptability of VR and robotics in PD rehabilitation, contributing to improved adherence and patient engagement. The experimental group showed greater cognitive benefits, particularly in executive functions. These results are in line with the existing literature on personalized technology-based rehabilitation strategies for PD.

Combined Korean Medicine Treatment of a Patient Diagnosed with Posterior Limb of Internal Capsule Infarction Presenting with Hiccups as the Chief Complaint - A Case Report

Objective: Hiccup is a sudden, involuntary contraction of the diaphragm and intercostal muscles, followed by laryngeal closure. Persistent hiccups can occur in the central nervous system following a cerebral infarction. While medications, for example chlorpromazine, are commonly used for treatment, they often fail to fully resolve the hiccups, showing little to no improvement in symptoms. The aim of this study was to present the treatment response of a patient diagnosed with posterior limb of internal capsule (PLIC) infarction, who was experiencing hiccups and was treated with combined Korean medicine after taking chlorpromazine.Case Presentation: A 71-year-old male diagnosed with left PLIC infarction was experiencing problems in daily life due to hiccups and dysarthria. During the 10-day hospitalization, he received treatment that included herbal medicine (modified Hyeolbuchugeo-tang, Xiěfǔzhúyūtāng), acupuncture (GV20, LI11, ST36, LI4, LR3, and submandibular area acupoint), moxibustion, cupping, and physical therapy. After 10 days of hospitalization, the patient’s hiccups disappeared, and he did not have to take any chlorpromazine. The score on the Numerical Rating Scale fell from 7-8 to 1-2. The 5-level EQ-5D version (EQ-5D-5L) fell from 11 to 7, and the EQ Visual Analogue Scale (EQ-VAS) rose from 20 to 80. The frequency (times per minute) of hiccups decreased and almost disappeared. During outpatient treatment, the patient stated that he did not experience hiccups for 7 months, and no significant side effects were observed.Conclusion: This study suggests that a patient with hiccups as a chief complaint can be effectively treated with combined Korean medicine. However, more studies with control groups are needed to confirm these findings.

Olanzapine-Induced Hypothermia: A Case Report in an Elderly Black Male Patient Diagnosed with Bipolar 1 Type Disorder

There are few reports that describe incidence of hypothermia in patients treated with olanzapine. We report a case of an elderly 83-year-old black male, readmitted to the state psychiatric hospital December 2023 due to psychiatric exacerbation after 6 months of successful discharge to community, who experienced a fall and profound hypothermia with bradycardia that resulted in a 10-day acute hospitalization in January 2024. Medical workup was unrevealing except for multivessel disease found on CT stroke study of the brain. When patient returned to inpatient psychiatric hospital, his psychiatric medications, including both quetiapine and olanzapine, were restarted at half the dose. The next morning, the patient was again hypotensive, bradycardic and hypothermic. For this patient, only the olanzapine was new upon the most recent admission, and thus this case report supports the other few reports already published, implicating olanzapine in the pharmacologic adverse effect of drug induced hypothermia.

Can direct bilirubin-to-lymphocyte ratio predict surgery for pediatric adhesive small bowel obstruction?

Estimating which patients might require surgical intervention is crucial. Patients with complete bowel obstructions exhibit disrupted enterohepatic cycles of bile and bacteremia due to bacterial translocation. The goal of this study was to develop a prediction index using laboratory inflammatory data to identify patients who may need surgery. The patients were divided into two groups based on their management strategy: Non-operative management (Group 1) and surgical management (Group 2). The indirect bilirubin, direct bilirubin, and total bilirubin were significantly higher in Group 2 than in Group 1 (p = 0.001, p < 0.001, and p < 0.001, respectively). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-NLR (PNLR), and direct bilirubin-to-lymphocyte ratio (DBR) were significantly higher in Group 2 compared to Group 1 (p = 0.041, p = 0.020, and p < 0.001, respectively). In group 2, 78% have viable bowels. Resection was performed in 40% of cases, with 12% mortality and a 10-day average hospital stay. DLR performs the best overall accuracy (72%), demonstrating a well-balanced sensitivity (62%) and specificity (81%). This study suggested that DBR is a more accurate predictive index for surgical intervention in pediatric adhesive small bowel obstruction patients compared to NLR and PNLR, providing valuable guidance for treatment strategies.

A recovery-oriented day hospital in psychiatry: A springboard for reintegration

Psychiatric disorders are common and can cause psychological disabilities. While the creation of day hospitals (DHs) was intended to direct psychiatric care towards community settings, they may have paradoxically contributed to a form of chronicity. Furthermore, the heterogeneity and lack of evaluation of care within DHs prevent the availability needed to collect objective data on users outcomes. In this article, we aim to describe and measure the effects of a transformation of practice within a sector-based DH initially focused on traditional institutional psychiatry towards a rehabilitation model of care which offers different therapeutic tools, structured in three stages, and whose main objective is professional integration. This retrospective mirror study compares, before and after the transformation of this DH, several indicators including the rate of professional integration and its maintenance after two years. We found that this psychosocial rehabilitation model for care allowed a very clear increase in the professional integration rate and its maintenance at two years while reducing the length of stay to around 18 months. These promising results therefore highlight the pivotal role of DHs as "stepping stones" in addressing psychological disabilities towards recovery.

Epidemiology of a psychiatric day hospital service in rome: descriptive analysis of a two-year period of hospitalizations

IntroductionPsychiatric Day Hospital (DH) constitutes an area of semiresidential care for short- and medium-term diagnostic and therapeutic-rehabilitative services. Through a descriptive analysis, we analyzed the clinical rationale and expected goals leading to an admission to the psychiatric day hospital service at St. Andrew’s Hospital in Rome, over a two-year period (2021-2022).ObjectivesWe aim, through the evaluation of the epidemiological data of patients, particularly the causes of admission and sending institutions, to be able to have at our disposal important comparison data to understand the characteristics of the patient population received in psychiatric day hospital services.MethodsMedical records of 218 patients admitted from 01.01.2021 to 31.12.2022 at the Psychiatry Day Hospital of Sant’Andrea Hospital in Rome were analyzed. The main sociodemographic and clinical characteristics and finally the type of psychiatric service from which the admission came were collected and analyzed, in addition to the reason for referral and therapeutic goal. Statistical analyses were conducted using Excel spreadsheets.Results64% of admissions aimed to modify or start new medication regimens with monitoring (e.g., Clozapine, Carbolithium, Esketamine). 19% were for medical evaluations, mainly neurological, cardiological, endocrinological, or internal medicine. 9% were for diagnostics. 2% were for infusion therapy, and an additional 2% for Esketamine treatment. The main findings highlight that Day Hospital use primarily focused on comprehensive patient assessments and therapy adjustments, often involving closely monitored drugs. Notably, 19% were for medical evaluations, with 28% of them being neurological assessments. This suggests challenges in conducting detailed medical assessments outside a context with prioritized access to such services.ConclusionsLimited data in the literature make it challenging to conduct comparative analyses regarding patients in psychiatric day hospital services. However, our data can spark a discussion about admissions with objectives that could potentially be addressed through alternative services. We should also explore why this isn’t happening. It could be interesting to conduct a descriptive analysis comparing epidemiological data from the two years before and after the period under investigation. Conducting retrospective statistical analysis on the collected data can yield more comprehensive results.Disclosure of InterestNone Declared

Long-Term Trends in Psychiatric Day Hospitalization: A Retrospective Study in Algarve, Portugal

IntroductionCurrent healthcare policies encourage the investment in transition units between hospitalization and outpatient care. Psychiatry day hospitals (DH) serve as partial hospitalization structures that facilitate this transition. The DH at the Faro Unit of the Centro Hospitalar Universitário do Algarve (CHUA), began its activity in 2008, is situated in southern Portugal and provides support to the entire eastern Algarve region (approximately 300,000 people). Its focus is on rehabilitating individuals with severe mental illnesses necessitating multidisciplinary care, with personalized therapeutic plans.ObjectivesWe aimed to categorize patients based on diagnoses (primary psychotic disorder, depressive disorder, and others) according to the International Classification of Diseases (ICD-11) and to characterize and compare sociodemographic and clinical data among these three groups.MethodsA retrospective study spanning from May 2008 to June 2023 was conducted. We assessed sociodemographic, clinical, and epidemiological data of patients undergoing treatment at CHUA Faro Unit’s DH.ResultsOver this period, 541 treatment cycles were carried out to 433 distinct patients, between 18 and 78 years old. Of the total treatments, 38% were for Primary Psychotic Disorder (PPD), 24% for Depressive Disorder (DD) and among the others (39%) the diagnosis of Bipolar Affective Disorder and Personality Disorder predominated . Statistically significant differences were identified among these three groups. The PPD group exhibited a male predominance, whereas DD and others were largely female. Patients in the PPD group were significantly younger (average age of 36 in PPD, 40 in others, and 48 in DD), more likely to be single, and a majority were unemployed (with several patients retired due to disability). No significant differences were noted regarding dropouts, expulsions, or the duration of DH treatment. These results are preliminary, and additional relevant data are being collected and processed.ConclusionsThe diagnostic group’s consideration revealed differences in the social, demographic, and clinical characteristics of patients. These findings offer insights into patient details, enabling the future adaptation of intervention strategies in a more personalized manner.Disclosure of InterestNone Declared

Epidemiology and management of transient ischemic attack in Trieste district, how day hospital assessment improves outcomes: a five-year retrospective study.

Transient ischemic attack (TIA) is defined as a transient episode of neurologic dysfunction, without acute infarction or tissue injury lasting less than 24h. Previous data suggest TIA precedes 15% of ischemic strokes, with a higher risk in the first week. Current practice guidelines advise evaluation through rapid neurological visit or admission to hospital. We provide data on TIA incidence in Trieste, and we compare three different types of assessment: day hospital (DH), stroke unit (SU), and emergency department/outpatients (ED). This is a 5-year retrospective study of transient cerebrovascular events admitted in the University Hospital of Trieste (230.623 inhabitants), between 2016 and 2020. We calculated TIA prevalence in Trieste district's general population. Our primary endpoint is ischemic recurrences within 90days, and we evaluate the possible association between different types of management. TIA incidence rate was 0.54/1000 inhabitants. In the multivariate analysis remained significantly associated with primary endpoint: ABCD2 (OR 1.625, CI 95% 1.114-2.369, p = 0.012) and DH evaluation (OR 0.260, CI 95% 0.082-0.819, p = 0.021). Incidence of TIA in Trieste district is in line with previous data. We demonstrate the crucial role of DH evaluation over the outpatient/ED in reducing overall mortality and recurrence rate. Prompt recognition of patients at high risk for cerebrovascular events and specialist follow-up may reduce the incidence of major vascular events and death.

P311 Prevalence and impact of sarcopenia in patients with inflammatory bowel diseases: a prospective cohort study

Abstract Background Sarcopenia is associated with increased morbidity and mortality in IBD. The main objective of this study was to prospectively evaluate sarcopenia by combining morphological and functional criteria in an outpatient IBD population. Methods In a prospective cohort study, we included all IBD patients admitted to the Day Hospital (DH) of our department between March 1st and 31st, 2023. Patients with short bowel syndrome were not included. Muscle mass was assessed using a Bodystat®1500MDD dual-frequency impedance meter, and muscle function was assessed by measuring handgrip strength, Carym® digital dynamometer. Pre-sarcopenia was defined by a handgrip measurement &amp;lt; 16 to 26, and myopenia was defined by an appendicular muscle mass index (AMMI) &amp;lt; 5.5 to 7 kg/m2 or a fat-free mass index (FFMI) &amp;lt; 15 to 17 in women or men. Sarcopenia was defined by the association of pre-sarcopenia and myopenia. Patients were followed-up at 6 months to measure a composite criterion of disease activity combining one of the factors: FC &amp;gt; 250µg/g, endoscopic activity, therapeutic change, hospitalization, or IBD-related surgery. Results In total, 60 patients were included, median age 37 years (IQR 28-54), 55% women, with CD (52%) or UC (48%) diagnosed 9 years (4-17) ago, mostly in remission (67%, n=40). Patients with CD had ileocolic (48%), ileal (35%), or colonic (16%) involvement. Patients with UC had E1 (7%), E2 (41%), or E3 (52%) involvement. A history of digestive surgery linked to IBD was noted in 30% of cases. The biologics administered were infliximab (61%), vedolizumab (25%), or ustekinumab (14%). The BMI was 24 (21-27) and serum albumin was 41g/l (39-44). The prevalence of sarcopenia, pre-sarcopenia and myopenia was 10%, 11% and 20%, respectively. Sarcopenic patients were significantly older (59 vs. 36 years, p=0.01), with older disease (20 vs. 8 years, p=0.003), and associated joint damage (40% vs. 2%, p=0.002) and tended to involve CD more frequently (80 vs. 49%, p=0.36). There was no significant difference between biologics, BMI or albuminemia in sarcopenic patients, but vitamin D levels tended to be lower (15 vs. 43, p=0.27). Myopenia was significantly associated with a history of surgery (67 vs. 21%, p=0.004), a lower BMI (21 vs. 24, p=0.001) and a more active disease at M6 according to the composite criterion (50 vs. 21%, p=0.04 after adjustment for age, sex, and disease activity at baseline). Myopenia indices were strongly correlated with handgrip values (r=0.7, p&amp;lt;0.001). Conclusion In a prospective study of Day Hospital IBD patients, sarcopenia was identified by impedancemetry in 11% and myopenia in 20% of cases, and associated with an increase in morbidity.

Community diagnostic services @ proximity care units: The experience of a Portuguese hospital

Background Summary: This co-design approach project was implemented focusing on the elder and vulnerable population of Cantanhede region. On a weekly basis, a team from Hospital Arcebispo João Crisóstomo (HAJC) provides Diagnostic Services (DS) to patients at primary health care units and third sector organizations (TSO), located on the outskirts of the region.&#x0D; We pursued a strategy of integration between levels of care and articulation with the municipality and TSO. This person-centred project adapts the public response in an area with an ageing population, fragile socio-economic background, and scarce public transport. &#x0D; Goals: &#x0D; - Rapid diagnose - capacitate GP´s to refer patients for the appropriate diagnostic test, diverting patients from hospital (reducing waiting times or allowing sooner referral of patients.&#x0D; - Proximity - Moving diagnostic services into the community makes access for patients easier, reducing travel, improved parking options and physical access.&#x0D; Methodology: A team of the hospital´s professionals (radiologist, radiographers, lab, and EEG technicians) to perform DS (echographs, blood tests, electrocardiograms, etc), in a variety of community settings, and referral of patients for an ambulatory response.&#x0D; Results: This collaboration runs in most of the primary care units and 11 nursing homes, allowing to improve access to health care to particularly vulnerable population (elder and people with mobility limitations).&#x0D; A Day Hospital (DH) was created because of the need of an outpatient articulated treatment to chronic disease complications (e.g., patients over 65 y/o (60%) shown a higher percentage of co-morbidities, including hypertension (80%), dyslipidaemia (71%) or obesity (38%)).&#x0D; We facilitated an agile communication between professionals of the various setting of care.&#x0D; Efficiency improvement by increasing the number of exams performed - a total of 300 patients/year (efficiency gains to 53% increase in external exams, representing 35% of production in this area vs 26%, in 2020).&#x0D; &#x0D; &#x0D; Conclusion: To reduce health inequalities, it is crucial to provide tailor-made solutions.&#x0D; The satisfaction level of the patients’ experience was high: classification of “Good” or “Very Good” by 97,7% of respondents.&#x0D; We believe that we deliver a better diagnostic service and more personalised experience by providing multiple point of access to the citizens.&#x0D; We increased productivity and were able to track several pathologies, separating acute diagnostic activity in hospital settings from outpatient requests by primary care clinicians and streamlining access in both settings by removing the need for diagnostic departments to triage requests and re-arrange appointments.&#x0D; Future: HAJC intends to replicate this good practice as a community centred integrated model. There for, the hospital is planning to expand the diagnostic capacity to other settings in the region.&#x0D; The hospital is working on engaging other relevant stakeholders as patient and caregivers’ associations.&#x0D; We intend to prove the impact on the streamlining of the local diagnostic pathways because of the greater access to diagnostic testing for GPs to speed up diagnoses and reduce the need for some outpatient appointments, or even extend the diagnostic interval for some patients, if they need a specialist referral.

Experiences with Working: A Letter from Older Adults with Sickle Cell Disease

Introduction With medical advancements over the past decades, the life expectancy for people with sickle cell disease (SCD) is longer than ever before. As they age, people with SCD acquire both SCD-complications and age-related comorbidities that lead to premature functional impairment, requiring individuals to make complex decisions that affect their work and career ambitions. There is a gap in the literature on work experiences in older adults with SCD. The purpose of this study is to describe the work experiences of older adults with SCD. Methods We enrolled 19 older adults with SCD (age ≥ 50) from a comprehensive sickle cell center. We conducted semi-structured interviews by phone and in-person. Participants were asked open-ended questions about their experiences living with SCD and their single biggest problem faced with having SCD. Participants described obstacles faced when working and strategies to continue working as older adults living with SCD. Audio-recorded interviews were transcribed verbatim. Conventional content analysis was used to analyze the transcripts. Results The mean age of participants was 58 years (range 50-71) and 47% were women. Nearly half were externally employed (47%), 5% unemployed, 11% retired, 32% disabled, and 5% self-employed. Only 21% had a high school education or less, 37% completed some college, associates, or technical school, 26% had a bachelor's degree, and 16% had an advanced degree. For household income, 37% earned ≤ $30,000, 16% earned $30,001-$50,000, and 42% earned &amp;gt; $50,001. The majority were the head of their household (53%) and 21% reported living alone. Within the last 6 months, 32% were hospitalized and 26% missed at least a day of work due to a pain crisis. Most participants (53%) had HbSS genotype, 37% had HbSC, and 11% had HbSβ+-thalassemia. There were two major work-related themes that emerged from the interviews (Figure 1). Theme 1 was “ Obstacles faced when working ”, which centered around interferences with work. Participants discussed the physical limitations, SCD-related complications, lack of energy to perform job tasks, and pain crises that would interfere with their work schedule and sometimes keep them out of work for years. Participants described concerns about being forced to retire early or give up their business due to health-related issues. Many described challenges with work as the single-biggest problem they faced as an older adult with SCD. Participants also described obstacles related to a lack of understanding from their employers. They described getting sick and staying in the hospital for days at a time, then being expected to return to work immediately after discharge. One participant described sharing their disease diagnosis with an employer and being discriminated against working that kind of job. Theme 2 was “Strategies to continue working”, which centered around participants knowing their limits and modifying the type of work they did. Participants described learning to listen to their body when it has reached its limit, knowing when to back away and come back to job responsibilities, and knowing when to take breaks. Participants also described the importance of finding accommodating employers who were understanding of when they had to miss work. Some participants described how they had to learn new skills to do alternative, more flexible jobs that were not as physically taxing on their body, such as working from home, starting a business, or becoming a real estate agent. They especially emphasized the importance of being aware of how far they could go with certain jobs to avoid triggering pain crises. Participants also described going through periods of temporary disability or retirement, then getting a new job and slowly working their way up from part-time to full-time. Conclusion Older adults with SCD provided insight into the unique obstacles they faced while working and described work-related challenges as the single biggest problem they faced. Moreover, many described the strategies they developed over time and accommodations that allowed them to continue working or re-enter the workforce. Data provided from these experiences convey the dire need for policymakers and employers to support accommodations needed by adults with SCD to continue working. This information will help guide younger adults with SCD to better navigate the working world and achieve their ambitions as they advance in age.

Benefit-risk preferences for treatments for newly-diagnosed multiple myeloma.

320 Background: Clinical studies are generating evidence on benefits and risks of emerging, novel treatments, including bispecifics and CAR-T, for newly diagnosed patients with multiple myeloma (MM) who are not candidates for stem-cell transplant (SCT). This study quantified the extent to which patients would accept short-term risks following MM therapy for the potential benefit of a longer, treatment-free interval. Methods: Adult patients with MM from the Duke Cancer Institute Tumor Registry were invited to complete an online discrete-choice experiment (DCE) survey in which they were to suppose they had a friend (same age and gender) recently diagnosed with MM who is not a candidate for SCT. Respondents chose the better post-induction therapy treatment for their friend from pairs of experimentally designed hypothetical treatments. In each question, treatments varied in terms of time until relapse (3, 5, or 10 years), impact of treatment-related side effects on daily activities (no, minor, or moderate limits), treatment-related mortality (0% to 10% in the first 3 months), and risk of reversible, short-term side effects (described as neurotoxicity or cytokine release syndrome) resulting in a 10-day hospitalization (0% to 20% risk in the first 3 months). DCE data were analyzed with a random-parameters logit model to estimate preference weights (PW) which were used to estimate the maximum level of short-term mortality risk acceptable to patients for longer time to relapse and less impact on daily activities. Results: The survey was completed by 176 patients (mean age; 66 yrs; 51% female, 22% Black) of whom 80% had a transplant and 31% had at least one relapse. Responses to the DCE were logically ordered (patients preferred lower levels of risks and better levels of benefit). For the levels specified, avoiding treatment-related mortality was most important (PW: 3.69), followed by gaining relapse-free years (PW: 3.32), and reducing impact on daily activities (PW: 2.04). Risk of reversible, short-term side effects was relatively least important (PW: 0.58). All else equal, patients would accept 5.7% mortality (95% CI: 3.8-7.2) for a 2-year gain in time to relapse (from 3 to 5 yrs) or 6.0% mortality risk (95% CI: 4.5-7.3) to avoid side effects that moderately limit their daily activities. Conclusions: Patients considering initial treatment following induction therapy for MM assigned least importance to reversible, short-term side effects that may be associated with CAR-T. Specified levels of treatment mortality were acceptable in exchange for longer relapse free intervals and fewer impacts on daily activities.[Table: see text]

Incendiary Dramas: Black Theatre Classics and Afrofuturism

How do Afrofuturism and Black Theatre fit together? A provocative question worthy of deep thought! Loosely construed, Afrofuturism provides a critical descriptive lens to explore black culture that questions the commingling of race, science, and technology, with a dash of the supernatural thrown into the mix from a largely African American context which impacts how we perceive literature, music, and film. From a theatrical standpoint, live performance provides a place to see Afrofuturism at work. The live performance element, the bringing of an imagined reality to real-life, in a sense, with real people, playing the parts in front of other real people, generates amazing stories of black experience. The dynamism of Black Theatre certainly lends itself to Afrofuturist speculation and critical thought. Theatre amplifies the stuff of life--joy, sadness, oppression, violence, laughter, love, emotions that cannot otherwise be described. The beauty is in the sparked thoughts firing in resistance to being made to feel lesser.Replete with Afrofuturism, Black Theatre provokes many future visions. Douglas Turner Ward's Day of Absence: A Satirical Fantasy (1965), Lorraine Hansberry's A Raisin in the Sun (1959), Amiri Baraka's Dutchman (1964), August Wilson's The Janitor (1985), and Lynn Nottage's Poof! (1993) represent five such disparate visions ranging from a sudden mass disappearance to changing neighborhoods, to a subway ride, to a speech, to spousal abuse. Each play represents the creative force of Afrofuturism and the desire to make better futures by exploring possibilities. Afrofuturism offers both emancipatory visions and cultural alarums--lightness and dark.

First clinical case of tick-borne encephalitis (TBE) in a dog in Greece

Tick-borne encephalitis virus (TBEV) causes tick-borne encephalitis (TBE), affecting human health in Europe and Asia. Reports on canine clinical cases of TBE are rare, although dogs are used as sentinels for assessing human health risks. The first canine clinical TBE case in Greece is reported in this case report. The dog had a history of tick infestation and displayed neurological symptoms, particularly tetraparesis, neck hyperalgesia, and a sudden behavior change. Serum samples were obtained and examined in a commercial ELISA to detect anti-TBEV specific IgG and IgM antibodies. The dog tested seropositive for both IgG and IgM, and based on its history and compatible clinical signs, the diagnosis of TBE infection was reached. The prognosis was initially poor, and treatment included the administration of fluids, corticosteroids, and antibiotics, followed by physical therapy. After a 10-day hospitalization, the dog had a much better prognosis. This case highlights that TBEV does emerge in new locations, increasing human and animal infection risk. Veterinarians should include TBE in their differential diagnosis of canine patients with a history of tick infestations, progressive neurological symptoms, and abnormal behavior.

Timing of Transport of Patients with COVID-19.

The objective of this study was to evaluate the risk of mortality or ECMO cannulation for patients with confirmed or suspected COVID-19 transferred from sending hospitals to receiving tertiary care centers as a function of the duration of time at the sending hospital. To determine outcomes of critically ill patients with COVID-19 who were transferred to tertiary or quarternary care medical centers. Retrospective cohort study of critical care transports of patients to one of seven consortium tertiary care centers from March 1, 2020, through September 4, 2020. Age 14 years and older with confirmed or suspected COVID-19 transported from a sending hospital to a receiving tertiary care center by the critical care transport organization. Patients transported with confirmed or suspected COVID-19 to tertiary care centers had a mortality rate of 38.0%. Neither the number of days admitted, nor the number of days intubated at the sending hospital correlated with mortality (correlation coefficient 0.051 and -0.007, respectively). Similarly, neither the number of days admitted, nor number of days intubated at the sending hospital correlated with ECMO cannulation (correlation coefficient 0.008 and -0.036, respectively). It may be reasonable to transfer a critically ill COVID-19 patient to a tertiary care center even if they have been admitted at the sending hospital for several days.

Bone Marrow Transplantation: Pre and after care

Worldwide, Hematopoietic stem cell transplantation is one of the curative options of treatment for hematological malignancies and other hematological diseases. In few recent years, in Bangladesh, Hematopoietic stem cell transplantation (HSCT) has started and improved significantly, especially in patients with hematological malignancies &amp; nonmalignant hematological diseases. As one of the leading BMT Center, CMH Dhaka has started BMT 8 years ago with the successful case of Allogeneic Bone Marrow Transplantation (Allo-HSCT) which was first time in Bangladesh. It was a historic event and landmark achievements in the history of Medical Science of Bangladesh as Allo-HSCT Bone Marrow Transplantation comparatively have a higher risk of life-threatening complications than Auto-HSCT. Till date, Dhaka CMH BMT Center has successfully completed 65 Bone Marrow Transplantation (48 Auto- HSCT &amp; 17 Allo-HSCT). It is an amazing milestone and advancement in medicine of Bangladesh. A series of tests (Like-Hematological profile, Extensive infection screening, Heart function test, Lung function test, Bone Marrow Study, Bone density scan, PET-scan, CT-scan, Chest X-ray, HLA Typing etc.) and procedures can assess general health and the status of patient‘s condition. The tests and procedures also ensure that patient is physically prepared for the transplant. The evaluation may take several days or more. In the days and weeks after bone marrow transplant, BMT specialists do blood tests and other tests to monitor patient‘s condition. They may need medicine to manage complications, such as nausea and diarrhea. After bone marrow transplant, the patient remains under close medical care. If a patient experiencing infections or other complications, he/ she may need to stay in the hospital for several days or longer for close monitoring. Patients may need periodic transfusions of red blood cells and platelets until bone marrow begins producing enough of those cells on its own. Patient needs follow up and Transplant Physician supervision till death. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 191

Overview of premedication prescription and intake in an oncology day hospital: What do we need to change to improve patient management?

Premedication of cancer therapy against nausea and vomiting (NV) and hypersensitivity reaction (HS) is essential for good patient management. However, this prescription is not always optimal. Today, as a large part of cancer therapies are administered in day hospitals (DH), premedication taken on the day of the cancer treatment is injected as a 30-min infusion. To assess compliance with recommendations for premedication prescription and intake; to analyse patient attitude about switching to exclusively oral forms taken at home. The study is conducted in the medical oncology DH of a French Hospital from 17 January to 25 February 2022. The data collection is carried out as an individual interview, associated with the distribution of two questionnaires. Data are coupled with the premedication set up on our software and the last medical report. Intakes are considered optimal when recommendations, tolerance, background, and adherence of the patient are taken into account. Seventy patients were included for interviews. Regarding software prescriptions, our configuration was consistent with recommendations in 100% of cases for HS and 37% for NV. Intakes were compliant in 51.4% of cases, non-compliant in 17.1% and debatable in 31.5%. Disparities between the practices of different physicians were identified. Regarding the feasibility of oral substitution, it could concern 63.5% of patients. This work makes it possible to improve the management of all patients and to make the operation of the care unit more fluid.

Comparative efficacy of a day-stay hospital and telerehabilitation treatment: A retrospective study in 180 patients with COVID-19

BACKGROUND: Growing evidence indicates that coronavirus disease 2019 (COVID-19) is associated with long-term virus transmission by patients during the convalescence period. This fact required changes in the existing procedures of rehabilitation treatment while maintaining its staging. Particularly, the transformation of in-person rehabilitation to telerehabilitation is recommended. The previous experience allowed us to organize telerehabilitation for patients with COVID-19 in the early days of the pandemic. We have summarized the findings of our study in this article.&#x0D; AIM: to compare the effectiveness of two technologies for the rehabilitation treatment of patients with post-COVID: an in-person treatment (a day-stay hospital) and telerehabilitation&#x0D; MATERIALS AND METHODS: This retrospective single blind study included patients with post-COVID, who received day hospital or telerehabilitation treatment between May 2020 and February 2021. The efficacy was estimated by the intensity level of physical activity measured according to the Borg scale and by the generic quality of life by EQ-5 (European Quality of Life 5-Dimension Questionnaire). The choice of these metrics is justified by the possibility of their acquisition via a teleinterview.&#x0D; RESULTS: 180 patients in total, including those who received a day hospital (DH) rehabilitation treatment (n=97; 64 women and 33 men; 55.111.9 years) and those who underwent telerehabilitation (TR) (n=83; 52 women and 31 men; 54.412.76 years) were included in the study. In the DH group, the mean patient-day was 12.6, mean number of sessions achieved 10. In these patients, a high compliance to the treatment was noted: only 5 (4.9%) of participants visited 5 sessions. As a result of treatment in the DH and the TR groups, a statistically significant improvement both according to the Borg score and to the EQ-5 was observed (p 0.05 compared to the beginning of the treatment). The mean improvement by the Borg scale achieved 3.65 in the DH group and 1.43 in the TR group (p=0.001). The between-group differences in the effectiveness of therapy by the EQ-5 were not statistically significant (p=0.341). The clinical form of COVID did not affect the effectiveness of the rehabilitation treatment. We also assessed the TR-patients' perception of the absence of a physical contact during the therapy: all the participants reported a high quality of medical care. Neither a patients age nor the treatment time affected the level of satisfaction. 12 patients expressed their desire to repeat the TR course. No stop-signs or adverse effects were registered during the rehabilitation period in both treatment groups.&#x0D; CONCLUSIONS: The use of telerehabilitation in the medical rehabilitation care for post-COVID patients is not less effective than an in-person (day-stay hospital) treatment. Given the high risks of infection during the COVID pandemic, it is possible to use such a method of rehabilitation, without an in-person medical examination. However, we emphasize that in general practice a patient should be examined manually by specialists of a multidisciplinary team at least twice: at the beginning and at the end of the rehabilitation treatment course.

Real-Life Data on Readmissions of Worsening Heart Failure Outpatients in a Heart Failure Clinic.

Introduction Recurrent hospitalizations for worsening heart failure (WHF) represent a major global public health concern, resulting in significant individual morbimortality and socioeconomic costs. This real-life study aimed to determine the rate and predictors of readmission for WHF in a cohort of outpatients with chronic heart failure (CHF) followed in a heart failure clinic (HFC) at a university hospital. Methods We conducted a longitudinal, observational, and retrospective study of all consecutive CHF patients seen at the HFC of the São Francisco Xavier Hospital, Lisbon, by a multidisciplinary team in 2019. The patients were followed for one year and were on optimized therapy. The inclusion criteria for the study were patients who had been hospitalized and subsequently discharged at least three months prior to their enrollment. Patient demographics, heart failure (HF) characterization, comorbidities, pharmacological treatment, treatments of decompensated HF in the day hospital (DH), hospitalizations for WHF, and death were recorded. We applied logistic regression analysis to assess predictors of hospital readmission for HF. Results A total of 351 patients were included: 90 patients (26%) had WHF requiring treatment with intravenous diuretics in the DH; 45 patients (mean age: 79.1 ± 9.0 years) were readmitted for decompensated HF within one year (12.8%) with no gender difference, while 87.2% of the patients (mean age: 74.9 ± 12.1 years) were never readmitted. Readmitted patients were significantly older than those who were not (p=0.031). Additionally, they had a higher New York Heart Association (NYHA) functional classification (p<.001), were on a higher daily dose of furosemide (p=0.008) at the time of the inclusion visit, were more frequently affected by the chronic obstructive pulmonary disease (COPD) (p=0.004); had been treated more often in the DH for WHF (p<.001) and had a higher mortality rate (p<.001) at one year. Conclusions This study aimed to determine WHF patient readmission rates and predictors. According to our results, a higher NYHA class, the need for treatment in the DH for WHF, a daily dose of furosemide equal to or greater than 80 mg, and COPD were predictors of readmission for WHF. CHF patients continue to experience WHF and recurrent hospitalizations despite therapeutic advances and close follow-up in the HFC with the multidisciplinary team. Besides COPD, the HF readmission risk factors found were mainly related to advanced disease. Furthermore, the structured and multidisciplinary approach of our disease management program likely contributed to our relatively low rate of readmissions.

Serum Potassium Trajectory during Acute Kidney Injury and Mortality Risk

Background: The association between potassium (sK) level trajectory and mortality or the need for kidney replacement therapy (KRT) during acute kidney injury (AKI) has not been adequately explored. Methods: In this prospective cohort, AKI patients admitted to the Hospital Civil de Guadalajara were enrolled. Eight groups based on the sK (mEq/L) level trajectories during 10 days of hospitalization were created (1) normokalemia (normoK), defined as sK between 3.5–5.5; (2) hyperkalemia to normoK; (3) hypokalemia to normoK; (4) fluctuating potassium; (5) persistent hypoK; (6) normoK to hypoK; (7) normoK to hyperK; (8) persistent hyperK. We assessed the association of sK trajectories with mortality and the need for KRT. Results: A total of 311 AKI patients were included. The mean age was 52.6 years, and 58.6% were male. AKI stage 3 was present in 63.9%. KRT started in 36% patients, and 21.2% died. After adjusting for confounders, 10-day hospital mortality was significantly higher in groups 7 and 8 (OR, 1.35 and 1.61, p < 0.05, for both, respectively), and KRT initiation was higher only in group 8 (OR 1.38, p < 0.05) compared with group 1. Mortality in different subgroups of patients in group 8 did not change the primary results. Conclusion: In our prospective cohort, most patients with AKI had alterations in sK⁺. NormoK to hyperK and persistent hyperK were associated with death, while only persistent hyperK was correlated with the need for KRT.