Hospital Discharge Research Articles

Severe Maternal Morbidity and Other Perinatal Complications Among Black, Hispanic, and White Birthing Persons With and Without Physical Disabilities.

Background: People with physical disabilities are at increased risk of adverse perinatal outcomes, including severe maternal morbidity (SMM). Risks may be even greater for disabled people in minoritized racial or ethnic groups, but little is known about this intersection. Methods: We analyzed linked hospital discharge and vital records data from California, 2008-2020. We identified physical disabilities using diagnosis codes for maternal congenital anomalies, major injuries, musculoskeletal disorders, or nervous system disorders. We compared birthing persons in five groups (Black and Hispanic with and without physical disabilities, White with physical disabilities) to a reference group of non-Hispanic Whites without disabilities. We used Poisson regression to assess associations with SMM and other outcomes, with and without adjusting for sociodemographic and clinical covariates. Results: Disabled Black and Hispanic birthing persons had particularly high relative risks (RRs) of SMM (Black disabled RR = 6.13, 95% confidence interval [CI]: 4.94, 7.61; Hispanic disabled RR = 3.67, 95% CI: 3.29, 4.10) as compared with nondisabled White persons. These risks were greater than those for nondisabled Black (RR = 2.05, 95% CI: 1.99, 2.11), nondisabled Hispanic (RR = 1.36, 95% CI: 1.34, 1.39), and disabled White birthing persons (RR = 2.44, 95% CI: 2.16, 2.77). For most other outcomes, risks were also largest for disabled Black birthing persons, followed by disabled Hispanic birthing persons. Conclusions: Black and Hispanic people with physical disabilities are highly likely to experience SMM and are at increased risk for other complications and adverse outcomes. Efforts are needed to understand underlying causes of these disparities and develop policies and practices to eliminate them.

Impact of COVID-19 Pandemic-Related Workflow Changes on a Clinically-Integrated Breastfeeding Peer Counselor Program.

To evaluate whether Covid-19 related workflow changes to a clinically-integrated breastfeeding peer counseling (ci-BPC) program were associated with poorer breastfeeding outcomes for Medicaid-enrolled patients. This retrospective chart review included patients who received ci-BPC care during January 2017-March 2020 ("Pre-Pandemic," N = 318); March 2020-September 2020 ("During-Peak," N = 53); and September 2020-May 2021 ("Post-Peak," N = 97). ANOVA evaluated differences in encounter type frequencies for each time point, as well as differences in breastfeeding initiation, exclusivity during inpatient admission, and continuation of breastfeeding at least 6 weeks post-delivery. In-person prenatal counseling significantly decreased from Pre-Pandemic to During-Peak (43.9-8.2%, p < 0.05). Breastfeeding at 6 weeks postpartum significantly increased from the Pre-Pandemic cohort to the During-Peak cohort (67-85%, p < 0.05), and returned to baseline for the Post-Peak cohort (74%). Covid-19 related workflow changes for the peer counselor did not decrease breastfeeding outcomes as anticipated.

Effectiveness of home-based exercise for functional rehabilitation in older adults after hip fracture surgery: A systematic review and meta-analysis of randomized controlled trials

This systematic review and meta-analysis was performed to assess effectiveness of home-based exercise compared with control interventions for functional rehabilitation in elderly patients after hip fracture surgery. Comprehensive literature search was performed on PubMed, EMBASE, Web of Science, Cochrane library, and Clinicaltrails.gov to identify eligible randomized controlled trials (RCTs). Standard mean difference (SMD) and risk ratio (RR) with 95% confidence interval (CI) was calculated. The certainty of evidence of each outcome was assessed by using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A total of 28 articles reporting 21 unique RCTs (n = 2470) were finally included. Compared with control interventions, home-based exercise significantly improved Berg balance scale (BBS, SMD = 0.28, 95%CI: 0.03 to 0.53, P = 0.030), timed-up-and-go test (TUG, SMD = -0.28, 95%CI: -0.50 to -0.07, P = 0.009), Short Fort-36 physical component score (SF-36 PCS, SMD = 0.49, 95%CI: 0.28 to 0.70, P&lt;0.001), and knee extensor strength (SMD = 0.23, 95%CI: 0.09 to 0.37, P = 0.001). No significant improvement was observed in gait speed, 6-minute walking test, short physical performance battery performance (SPPB), activities of daily living (ADL), or fear of falling in the home exercise group. Risk of adverse events, including emergency department visits, hospital readmissions, and falls, did not differ between both groups. According to GRADE, the overall certainty of evidence was moderate for usual gait speed, SPPB, ADL, fear of falling, and SF-36 PCS, and was low or very low for the other outcomes. Our meta-analysis demonstrated home-based exercise had positive effect on physical function after hip fracture surgery. Home-based rehabilitation might be recommended for rehabilitation of fractured patients after hospital discharge.

Lung ultrasound on first postoperative day predicts out-of-hospital pulmonary complications following video-assisted thoracic surgery: A prospective cohort study.

The integration of enhanced recovery after surgery (ERAS) protocols into the peri-operative management of video-assisted thoracic surgery (VATS) has facilitated rapid patient recovery, enabling discharge within 48 h. However, postoperative pulmonary complications (PPCs) postdischarge pose significant concerns for patient welfare. Despite the established utility of lung ultrasound (LUS) in diagnosing the causes of dyspnoea, the effectiveness of quantitative LUS in predicting PPCs after VATS remains uncertain. To determine whether quantitative LUS performed 24 h after surgery can identify patients with a higher risk of developing PPCs within 30 days after discharge from hospital. Single-centre prospective cohort study. Academic tertiary care medical centre. Adults scheduled for elective VATS under general anaesthesia from November 2022 to January 2023. This primary aim was to verify the association between lung ultrasound score (LUSS) on postoperative day 1 (POD1) and PPCs. The secondary aim was to identify other relevant peri-operative factors closely related to PPCs and establish a model capable of predicting the risk of PPCs in patients undergoing fast-track VATS. Of the 200 recruited patients, 182 completed the LUS examination and 30-day follow-up. Of these, 66 (36.2%) developed various types of PPCs. These patients had a higher LUSS on POD 1 (P < 0.001), and more subpleural consolidation areas compared to those without PPCs (P < 0.001). Receiver-operating characteristics (ROC) analysis identified the optimal LUSS cut-off value at 6 points for predicting the occurrence of PPCs, with an area under the curve (AUC) of 0.838 (95% CI, 0.768 to 0.909). Patients with PPCs had higher rates of immune system diseases and ARISCAT score, longer hospital stay and procalcitonin levels, increased frequency of lobar resection, longer durations of surgical and mechanical ventilation, and greater incidence of unplanned hospital readmissions within 30 days postdischarge, compared with those without PPCs (all P < 0.001). Multivariable logistic regression analysis indicated that the comorbidity of immune system disease, along with postoperative 24 h LUSS, were independent risk factor for PPCs within 30 days after VATS. LUSS on POD 1 emerged as an independent risk factor for PPCs in fast-track VATS patients and reliably predicted the occurrence of PPCs within 30 days of hospital discharge. ClinicalTrials. gov No. ChiCTR2200065865.

Music therapy Embedded in the Life Of Dementia Inpatient Care (MELODIC) to help manage distress: A mixed methods study protocol for co-designing a complex intervention

ABSTRACT Introduction Best practice guidelines state that psychosocial interventions should be the first line of treatment for people with dementia who are experiencing distress. However, little research explores psychosocial support for those experiencing the most complex symptoms of distress in inpatient mental health wards. Music therapy may reduce behaviours of distress and staff report it to be helpful, yet interventions are not common in the National Health Service (NHS) in the United Kingdom, and the type and method of delivery vary. Methods and design This study, funded by the National Institute for Health and Care Research, will co-develop and pilot a standardised protocol and guide, MELODIC (Music Therapy Embedded in the Life Of Dementia Inpatient Care), for music therapy in NHS inpatient mental health dementia wards. Two reviews, using realist and systematic methods, will be conducted to increase understanding of the current evidence base. Focus groups will then be facilitated to explore experiences of distress and the use of music on wards. MELODIC v1 will then be co-designed with experts by experience and stakeholders, and piloted on two NHS wards with differing experiences of music therapy. Mixed methods data collection will support protocol and theory refinement and establish the appropriateness of the methods to inform a future trial. Ethical approval has been received for all research activities. Discussion The protocol and findings will be disseminated in academic, clinical and public spaces. MELODIC can then be tested for feasibility and acceptability, with clinical and cost-effectiveness ultimately established in a definitive randomised controlled trial. Registration Realist review: CRD42023409635; systematic review: CRD42023429983.

Mental health in children admitted with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS): a follow-up study at 6 months of the Swissped-RECOVERY trial

BackgroundPIMS-TS presents with features considered to pose a risk for the development of unfavourable long-term mental health outcomes which haven’t been prospectively investigated. These include neurological symptoms (headache, confusion, and delirium), systemic inflammation, and critical illness requiring PICU support. Therefore, we set out to investigate mental health at 6-month follow-up in patients recruited into Swissped-RECOVERY trial.MethodsThis is a pre-planned analysis of the Swissped-RECOVERY trial (clinicaltrial.gov, NCT 04826588) investigating intravenous immunoglobulins versus intravenous methylprednisolone in patients with PIMS-TS. Mental health was assessed 6 months after hospital discharge using the Strength and Difficulties Questionnaire (SDQ), leading to a score concerning mental well-being (total score scale 0–40 points, subdomains 0–10 points). At population level it is expected that 80% of children belong to the normal, 10% to the borderline, and 10% to the abnormal band of the SDQ scores.FindingsSeventy-five patients were included, 66 (88%) parent-reported and 26 (78.8%) self-reported SDQs were returned. The median total difficulty score was 7.0 [4.0, 11.8] for parent-reported and 11.0 [7.0, 14.8] for self-reported SDQ. The total difficulty score was borderline or abnormal in 12/58 (20.7%) of parent-reported and 7/26 (26.9%) of self-reported SDQs. Emotional problems were reported borderline or abnormal in 19% and 27% of the parent- and self-reported SDQ, respectively, and for hyperactivity/inattention 21% and 27%, respectively.ConclusionEmotional problems and hyperactivity/inattention appeared to be the pressing concerns. Potential interference with daily activities such as home life, friendship, etc., makes early identification important to ensure adequate support.Trail registrationClinicalTrials.gov, ID NCT04826588, https://clinicaltrials.gov/study/NCT04826588.

Early Continuous Electroencephalography, Clinical Parameters, and Short-Term Functional Outcomes in Pediatric Traumatic Brain Injury: Single-Center, Retrospective Cohort, 2010-2020.

Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality. This study first investigates clinical characteristics and continuous electroencephalography (cEEG) parameters associated with short-term functional outcomes in pediatric patients following TBI. Second, we use these data for a hypothesis-generating model about outcomes. Retrospective cohort study. PICU within a quaternary care hospital. Pediatric patients (< 18 yr) admitted from January 2010 to December 2020 with TBI who underwent cEEG within 72 hours of admission. None. Patient demographics, clinical parameters, hospital course, and cEEG features were reviewed for associations with mortality and new disability (as defined by change in Functional Status Score between admission and discharge of ≥ 3 points). A statistical prediction model for patient outcome was created combining cEEG parameters with admission Glasgow Coma Scale (GCS) score and radiographic findings. We included 142 patients: 100 (70%) of whom had no new disability at hospital discharge; 42 (30%) had a new disability, including eight deaths. Univariate analysis showed favorable outcomes were associated with normal electroencephalogram background, reactivity, and sleep features (p < 0.001 for each). A model inclusive of these electroencephalogram parameters and GCS had high predictive ability for outcome with 0.94 with 95% CI (0.90-0.98). Specific cEEG findings observed acutely after injury, in combination with other clinical characteristics, may serve as biomarkers for short-term functional outcomes after pediatric TBI. Further validation of the model in another population is now required.

Acupuncture for hypoxic ischemic encephalopathy in neonates.

Peripartum asphyxia affects three to five per 1000 live births, with moderate or severe hypoxic ischemic encephalopathy (HIE) occurring in 0.5 to 1 per 1000 live births, and is associated with high mortality and morbidity. Therapeutic hypothermia is an effective treatment, but alternative therapies such as acupuncture are also used. To determine the benefits and harms of acupuncture (e.g. needle acupuncture with or without electrical stimulation; laser acupuncture; non-penetrating types of manual or embedded acupressure) on mortality and morbidity in neonates with HIE, compared with 1) no treatment, 2) placebo or sham treatment, 3) any pharmacologic treatment, or 4) different types of acupuncture. We searched CENTRAL, PubMed, Embase, ClinicalTrials.gov, and the WHO ICTRP in March 2023. We conducted a search of the grey literature to identify reports of trials conducted by or referenced in research by CORDIS EU, National Institute for Health and Care Excellence (NICE), and NHSGGC Paediatrics for Health Professionals. We also checked the reference lists of relevant articles to identify additional studies. We included randomized controlled trials (RCTs) or quasi-RCTs and cluster-randomized trials. We included studies where participants were term infants (37 weeks or greater) and late preterm infants (34 + 0 to 36 + 6 weeks' gestation) 10 days of age or less, with evidence of peripartum asphyxia. We included studies on acupuncture (e.g. needle acupuncture with or without electrical stimulation; laser acupuncture; non-penetrating types of manual or embedded acupressure). We included studies where acupuncture was compared with: 1) no treatment; 2) placebo or sham treatment; 3) any pharmacologic treatment; or 4) different types of acupuncture. We used standard Cochrane methods. Our primary outcomes were all-cause mortality at the latest follow-up, major neurodevelopmental disability in children aged 18 to 24 months and aged 3 to 5 years, adverse events until hospital discharge, and length of hospital stay. We included four studies (enrolling 464 infants) that compared acupuncture with no treatment. The studies ranged in size from 60 to 200 infants. Three studies were conducted in China and one in Russia. None of the four studies reported on any of the prespecified outcomes of our review. We did not identify any ongoing studies. There is limited availability of studies addressing this specific population. The included studies did not assess mortality, long-term neurodevelopmental outcomes, or adverse effects of acupuncture. We are unable to draw any conclusions about the benefits and harms of acupuncture for HIE in neonates. In light of the current limitations, clinicians are urged to approach the use of acupuncture in neonates with HIE cautiously, as there is no evidence to support its routine application. The available trials assessed surrogate outcomes that have a relatively small impact on newborns, and failed to report important outcomes such as mortality and long-term neurodevelopmental outcomes. Other available trials were performed on older infants who had experienced neonatal HIE. Given the lack of available evidence, well-designed randomized controlled trials with relevant outcomes such as mortality and neurodevelopmental outcomes are essential to evaluate the efficacy and safety of acupuncture for HIE in neonates.

Context-Aware Electronic Health Record—Internet of Things and Blockchain Approach

Hospital inpatient care relies on constant monitoring and reliable real-time data. Continuous improvement, adaptability, and state-of-the-art technologies are critical for ongoing efficiency, productivity, and readiness growth. When appropriately used, technologies, such as blockchain and IoT-enabled devices, can change the practice of medicine and ensure that it is performed based on correct assumptions and reliable data. The proposed electronic health record (EHR) can obtain context information from beacons, change the user interface of medical devices according to their location, and provide a more user-friendly interface for medical devices. The data generated, which are associated with the location of the beacons and devices, were stored in Hyperledger Fabric, a permissioned distributed ledger technology. Overall, by prompting and adjusting the user interface to context- and location-specific information while ensuring the immutability and value of the data, this solution targets a decrease in medical errors and an increase in the efficiency in healthcare inpatient care by improving user experience and ease of access to data for health professionals. Moreover, given auditing, accountability, and governance needs, it must ensure when, if, and by whom the data are accessed.

Survival Differences in Asian and Hispanic Patients With In-Hospital Cardiac Arrest.

Although they are fast-growing populations in the United States, little is known about survival outcomes of Hispanic and Asian patients after in-hospital cardiac arrest. In Get With The Guidelines-Resuscitation, we identified Asian, Hispanic, and White adults with in-hospital cardiac arrest during 2005 to 2023. Using multivariable models, we compared rates of survival to discharge separately for Asian and Hispanic patients versus White patients, as well as rates of sustained return of spontaneous circulation for ≥20 minutes and favorable neurologic survival as secondary outcomes. Of 189 557 in-hospital cardiac arrests, 167 640 (88.4%), 16 800 (8.9%), and 5117 (2.7%) patients were White, Hispanic, and Asian, respectively. Compared with the survival rate to discharge for White patients (22.0%), rates were lower for Hispanic (19.4%; adjusted odds ratio [OR], 0.93 [95% CI, 0.89-0.97]; P<0.001) and Asian patients (17.8%; adjusted OR, 0.90 [95% CI, 0.83-0.97]; P=0.008), and these differences were attenuated after accounting for the hospital at which patients received care (adjusted OR: Hispanic patients, 0.95 [95% CI, 0.91-1.00]; Asian patients, 0.91 [95% CI, 0.84-0.99]). Although there were no differences in rates of return of spontaneous circulation between White (68.7%), Hispanic (69.0%), and Asian patients (69.7%), both Asian and Hispanic patients were less likely to have favorable neurologic survival (White: 18.3%; Hispanic: 15.4%; adjusted OR, 0.88 [95% CI, 0.84-0.93]; Asian: 13.2%; adjusted OR, 0.80 [95% CI, 0.73-0.87]). These differences were also attenuated after accounting for hospital site. Compared with White patients, Hispanic and Asian patients with in-hospital cardiac arrest had lower rates of overall survival and favorable neurologic survival. Some of these differences were associated with the hospital at which patients received care.

Real-World Data on Patients With Acquired Haemophilia A in Japan Undergoing Rehabilitation or With Low Activities of Daily Living Scores: The ORIHIME II Study.

Acquired haemophilia A (AHA) is characterized by the development of autoantibodies against factor VIII, reducing its activity and potentially resulting in bleeding. To assess the characteristics of people with AHA undergoing rehabilitation and/or with low activities of daily living (ADL) scores, thereby characterizing unmet needs in the management of AHA and informing treatment optimization. ORIHIME II, the largest epidemiological and treatment survey of AHA in Japan, is a descriptive, retrospective, observational study conducted using health claims data from April 2008 to October 2021. The primary outcome measures were rehabilitation practice and ADL scores on hospital admission and discharge; use of haemostatic agents and immunosuppressive therapy were also assessed. Overall, 427 patients in Japan were eligible for the study. Median (Q1-Q3) age was 78.0 (70.0-84.0) years; 264 patients (61.8%) were male. Median (Q1-Q3) time to start rehabilitation was 9 (4-21) and 14 (6-31) days for those with an admission ADL score of<85 and ≥85, respectively. Of the 427 patients, 249 underwent rehabilitation. The most common rehabilitation type was for disuse syndrome; haemostatic agents were more commonly used in patients undergoing earlier rehabilitation. The physical condition of the patient at hospitalization was associated with rehabilitation practice and the ability of the patient to perform day-to-day activities independently. Treatment strategies should be optimized to allow initiation of rehabilitation as early as possible in the course of AHA.

The limited clinical utility of a routine creatine kinase (CK) on admission to a psychiatric inpatient unit

BackgroundCreatine kinase (CK) is an intracellular enzyme expressed most commonly in tissues such as skeletal muscle. CK can be used as an investigation to support the diagnosis of conditions such as neuroleptic malignant syndrome (NMS), a rare idiosyncratic drug reaction – classically to antipsychotic medications – which can be fatal. Routine screening of CK in psychiatric inpatients is a known practice, but its value is uncertain. We aimed to ascertain whether such screening resulted in new diagnoses of NMS or other conditions, and changes in clinical management.MethodsUsing an electronic case register, we conducted a descriptive retrospective cohort study, identifying all psychiatric inpatient admissions in a South London mental health trust over a four-year period where a CK test was conducted within 48 h of admission. We extracted the demographic and clinical characteristics (e.g., diagnosis) of those who met inclusion criteria. Free-text review was performed on all those with a CK potentially suggestive of NMS (CK ≥ 4x upper limit of normal reference range (ULN)) to determine the impact of this abnormal result on subsequent management and diagnosis (including NMS if identified).ResultsOf 14,236 inpatient episodes in the specified window, 2358 (16.6%) had a CK test within 48 h of admission. This was ≥ 4x ULN in 327 (13.8%) cases (free-text successfully reviewed in 318). There were no cases of NMS identified. An abnormal CK result led to a new alternative diagnosis, such as dehydration or catatonia, in only 14 patients (4.4% raised CK sample, 0.6% total CK sample). Impact on subsequent management appeared limited, with the most common adjustment being an increase in frequency of physical observations in 47 instances (14.8%).ConclusionsThe clinical utility of untargeted screening using a serum CK for psychiatric inpatients appears limited, with poor specificity in detection of NMS and a minimal impact on subsequent clinical management.

Pregnancy Outcomes and Maternal Characteristics in Women with Pregestational and Gestational Diabetes: A Population-Based Study in Spain, 2016–2022

Background/Objectives: The objective of this study was to compare trends in the incidence of deliveries and in obstetric interventions and outcomes in women with and without type 1 diabetes (T1DM), type 2 diabetes (T2DM), and gestational diabetes (GDM). Methods: This was an observational study using the Spanish National Hospital Discharge Database (2016–2022). Results: A total of 1,995,953 deliveries were recorded between 2016 and 2022 (6495 mothers with T1DM, 5449 with T2DM, and 124,172 with GDM). The incidence of T1DM and GDM increased over time, although it remained stable in women with T2DM. Women with T2DM were more likely to have obstetric comorbid conditions (72.93%) than women with GDM (63.04%), women with T1DM (59.62%), and women who did not have diabetes (45.3%). Pre-eclampsia, previous cesarean delivery, and arterial hypertension were the most prevalent conditions in all types of diabetes. The highest frequency of cesarean delivery was recorded for women with T1DM (55.04%), followed by women with T2DM (44.94%), and those with GDM (28.13%). The probability of cesarean delivery was 2.38, 1.79, and 1.19 times greater for T1DM, T2DM, and GDM, respectively, than for women who did not have diabetes. The adjusted rate for severe maternal morbidity was significantly higher for women with T1DM (RR 2.31; 95%CI 2.02–2.63) and T2DM (RR 1.58; 95%CI 1.34–1.87) than for women without diabetes. Conclusions: The incidence of deliveries in women with T2DM remained unchanged between 2016 and 2022; the incidence of deliveries increased in women with T1DM and GDM. The prevalence of comorbidity and obstetric factors increased over time in women with T1DM and GDM.

Difficulty in financing fracture care in south-western Nigeria: a prospective cohort study of predictors and recommendations for improvement

BackgroundBone fractures remain a significant global public health issue despite preventive measures, leading to substantial health and economic consequences. Effective treatment options are difficult to access in most sub-Saharan African countries, leading to reliance on unqualified practitioners and resulting in serious complications that worsen poverty. In Nigeria, the main challenge is the need for out-of-pocket payment for healthcare, which is the primary method of health financing. However, anecdotal evidence suggests that some patients find it easier to finance their fracture care than others. This study aimed to identify the factors that predict difficult fracture-care financing among patients treated operatively for long-bone fractures (LBFs) in southwestern Nigeria.MethodsThe study collected socio-demographic and clinical data on 690 consecutive adult patients with LBFs treated with SIGN nails between July 2014 and June 2024 at a mission teaching hospital in southwestern Nigeria. A literature review and preliminary interviews were conducted with patients, caregivers, and hospital staff to understand potential risk factors for difficult fracture-care financing. The patients were divided into two cohorts – easy fracture-care financing (EF) and difficult fracture-care financing (DF) – based on their promptness in paying the in-patient care bills. Potential risk factors for DF identified in the initial univariate analysis were entered as covariates into a binary logistic regression to determine the significant predictors of DF.ResultsThe mean age of the patients was 45.1 years (SD = 17.52). The DF cohort comprised 321 (46.5%) patients. Significant predictors of DF included younger age (p = 0.018), male gender (p = 0.002), lack of formal education or low level of education (p < 0.001), residence in the hospital city (p < 0.001), absence of health insurance (p = 0.013), lack of extended family support (p < 0.001), previous traditional bone setting treatment (p = 0.005), concomitant injury (p = 0.017), and a post-operative hospital stay longer than one week (p = 0.036).ConclusionsThe findings suggest that improving people’s socioeconomic status through job creation, women’s empowerment, reduction of gender inequality, higher education, comprehensive health insurance coverage, and stronger family bonds, as well as preventive strategies to reduce the occurrence and severity of injuries, can improve fracture-care financing in low-resource settings.

Racial and Ethnic Disparities in Child Abuse Identification and Inpatient Treatment.

Child abuse is a leading cause of morbidity in early childhood. Accurate detection remains challenging. To describe racial and ethnic disproportionalities in suspicion for child abuse (SCA) in pediatric patients admitted after traumatic injury. This retrospective, multicenter cross-sectional study performed between 2022 and 2024 examined a representative national sample of children and adolescents (aged <18 years) admitted for pediatric trauma indications from 2006 to 2019. Data were from the Kids' Inpatient Database (KID), the largest publicly available all-payer pediatric inpatient care database. Patient demographics, injury severity, and hospitalization characteristics were classified by race and ethnicity and compared using univariate and multivariate regression. Statistical analysis was performed between March 2022 and October 2024. The SCA subgroup was identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes corresponding to child and adolescent maltreatment. The primary outcome was the racial and ethnic composition of pediatric patients admitted after traumatic injury with SCA vs those without SCA. Among the weighted total of 634 309 pediatric patients with complete data included in the study, 13 579 patients had injuries attributable to SCA (SCA subgroup; mean [SD] age, 1.70 [0.04] years; 7650 male [56.3%]; 2868 Black [21.1%], 2293, Hispanic [16.9%], and 5675 White [41.8%]) and 620 730 patients did not (non-SCA subgroup; mean [SD] age, 9.70 [0.01] years; 395 158 male [63.7%]; 86 376 Black [13.9%], 108 406 Hispanic [17.5%], and 298 748 White [48.1%]). The racial and ethnic distribution of the non-SCA subgroup was similar to that of the 2010 US Census. In the SCA subgroup, Black patients (odds ratio [OR], 1.75; 95% CI, 1.65-1.85; P < .001) and Hispanic patients were overrepresented (OR, 1.11; 95% CI, 1.05-1.18; P < .001) and White patients were underrepresented compared with the Census. After controlling for socioeconomic factors and hospital characteristics among 504 365 (weighted) observations in White, Black, and Hispanic patients (493 530 patients without and 10 835 patients with SCA), Black race remained an independent risk factor associated with SCA (OR, 1.10; 95% CI, 1.03-1.17; P = .004), whereas Hispanic race was found to be a protective factor associated with decreased odds of SCA (OR, 0.71; 95% CI, 0.67-0.76; P < .001). Compared with White patients in the SCA subgroup, Black patients had a 26.5% (95% CI, 11.0%-44.3%) longer length of stay (P < .001) for mild to moderate injuries and a 40.1% (95% CI, 16.4%-68.5%) longer length of stay (P < .001) for serious injury. In this study, Black children and adolescents were suspected to have experienced child abuse at higher rates than children and adolescents of other racial and ethnic backgrounds. More research is necessary to understand the origins of these disparities to reduce them in child abuse identification.

Income Elasticity of Out-of-Pocket Healthcare Expenditure for Different Provider Types in Bangladesh.

The impact of income on health expenditure has been studied extensively using national-level data; however, studies estimating the household-level income elasticity of health expenditure, particularly by provider types, remain limited. Analysing nationally representative household survey data, we examine outpatient and inpatient out-of-pocket (OOP) expenses across healthcare providers and by various income levels. We employed the Heckman two-step model and OLS regression to estimate income elasticity separately for outpatient and inpatient services. Our findings indicate that income elasticity varies significantly by service type, provider, and income level. Outpatient care at private facilities is a luxury good for the lower-income households, while outpatient expenses for public and informal outpatient care providers remain inelastic across income levels. Private inpatient care is also income inelastic, whereas public inpatient care shows non-uniform elasticity. Overall, lower-income households showed greater elasticity than wealthier ones. The results imply, during income shocks, poorer households switch to cheaper public and informal care. Inpatient care is prioritised over other expenses, increasing the risk of poverty among low-income households. The study suggests the dire need for financial protection measures, particularly for low-income groups, as OOP health expenditure often becomes catastrophic for those households. In addition, higher income resulting from economic growth will increase the demand for private outpatient services, suggesting quality improvement for public health facilities as well as the importance of adapting healthcare policies to evolving income dynamics.

Setting the balance of care for older adults at risk of hospitalization and delayed discharge: A mixed-methods research protocol.

Delayed hospital discharge is a persistent care quality issue experienced across health systems worldwide and remains a priority area to be addressed in Canada. Often associated with a decrease in services while waiting to leave the hospital, delayed discharge from hospital can lead to increased frailty, physical and cognitive decline, and caregiver burnout. Optimizing availability of and timely access to community-based health and social care are avenues that could reduce initial admissions to the hospital and length of hospital stay, and facilitate hospital discharges. This research will explore the ways in which community resources could be leveraged to potentially avoid hospitalization and delayed hospital discharge for older adults using sequential mixed-methods including co-design. To better understand the characteristics and needs of older adults, the research team will first identify sub-populations of older adults (65 years old or older) at risk of hospitalization and delayed discharge using comprehensive, longitudinal administrative health data. From these health data, risk profiles and personas will be created and then shared with key partners (e.g., older adults, caregivers, healthcare providers, healthcare decision-makers), who will be engaged to identify, leverage, and create targeted care solutions. The barriers and facilitators to the implementation of these care solutions will then be explored. Delayed hospital discharge has been a critical care quality issue across Canada for decades. The current research will provide health system leaders with an approach to better allocate services to older adults in order to avoid delayed hospital discharge and identify gaps in health and social care resources based on the characteristics, needs, and preferences of older adults, their caregivers, and providers.

Resources, support, and integration as potential barriers and facilitators to the implementation of blended therapy in the routine care of inpatients: a qualitative study

While research on blended therapy (BT), i.e. the combination of face-to-face and digital treatment, has grown rapidly, integrating BT into routine practice remains limited, especially in inpatient settings. This study seeks to investigate the potential barriers healthcare providers and patients are confronted with in implementing BT to inpatients. Here, a retrospective, explorative qualitative research design was employed to gain insights into the experiences of healthcare professionals and inpatients in a real-world clinical setting. Specifically, we utilized semi-structured interviews to explore three key aspects: time resources, organizational support, and integration. A total of 11 therapists and 6 patients were interviewed. To our knowledge, this is one of the first studies to examine the implementation of blended therapy in the routine care of inpatients. We found that therapists emphasized several barriers including overwhelming workloads with insufficient time allocated for the work with the digital tools, inadequate time adjustments, a lack of ongoing training, and the necessity for a well-defined concept and setting of how to implement blended therapy. Interestingly, fewer barriers were reported by patients, who viewed the e-mental health platform as a valuable addition to their standard therapy. They also judged guidance and integration by their therapists as satisfactory and appreciated the adaptability offered in managing their workload in a flexible setting.

Association between fine particulate matter (PM2.5) and violence cases in South Korea: A nationwide time-stratified care-crossover study.

Several studies reported the roles of short-term exposure to fine particulate matter (PM2.5) on violent behaviors; however, existing findings had a limitation in assessing the population-representative association between violence and PM2.5 due to the limited data availability: most studies have been based on homicides in monitored urban areas. This study collected violence data from the National Hospital Discharge In-depth Injury Survey in South Korea (2015-2019), based on population-representative samples. To cover unmonitored areas, we used the daily modeled PM2.5, the predicted result driven by a machine-learning ensemble model covering all inland districts in South Korea (R2>0.94). We evaluated the national association between short-term exposure to PM2.5 and violence cases with a time-stratified case-crossover design. A total of 2,867 violence cases were included. We found an approximately linear association between short-term exposure to PM2.5 (lag 0-2 days) and an increased risk of violence, with an estimated odd ratio (OR) per 10 μg/m3 of PM2.5 of 1.07 with 95% CI: 1.02-1.12. This relationship was more prominent in males and individuals aged 64 years or less than in females and individuals aged 65 years or older for the most part. The estimated excess fraction of violence cases attributable to PM2.5 was 14.53% (95% CI: 4.54%-22.92%), and 6.42% (95% CI: 1.97%-10.26%) of the excess violence was attributable to non-compliance with the WHO guidelines (daily PM2.5 > 15 μg/m3). Our findings might be evidence of the need to establish elaborate action plans and stricter air quality guidelines to reduce the hazardous impacts of PM2.5 on violence in South Korea.

Prognostic Impact of Hospital Discharge After Heart Failure Admission Without Structured Heart Failure Follow-Up

Prognostic Impact of Hospital Discharge After Heart Failure Admission Without Structured Heart Failure Follow-Up