Discharge Outcomes In Patients Research Articles

The adversarial alliance: developing therapeutic relationships between families and the team in brain injury rehabilitation.

Families of individuals who have survived brain injuries experience significant distress, and may resist accepting their relative's neurobehavioural deficits. Staff who work with brain-injured patients and their relatives are charged with the seemingly paradoxical task of helping families support rehabilitative efforts and be goal-oriented, while simultaneously communicating often negative realities about prognosis. In the midst of what may be an intermittently conflict-laden relationship, families and staff must become synergistically involved in a therapeutic partnership. This paper defines aspects of this 'adversarial alliance' which is often established between families and staff. The relationship between patient discharge outcome and perceived family stress and satisfaction with the rehabilitation programme was reviewed. Data analyses yielded the following conclusions: families evaluated retrospectively to have been 'highly stressed' were also perceived to experience more conflict with the rehabilitation team; family stress was related to poorer adjustment to the patient's disability (at admission); greater family/team conflict correlated with lower cognitive and physical functioning at admission, longer length of stay, younger patient age, and lower programme satisfaction. Implications for programme development and treatment guidelines are discussed.

HOMOCYSTINURIA: A NEW INBORN ERROR OF METABOLISM ASSOCIATED WITH MENTAL DEFICIENCY.

<b>Background:</b> We have previously found that both obstructive sleep apnea (OSA) and central sleep apnea (CSA) have high prevalence in hospitalized patients with heart failure with reduced ejection fraction (HFrEF) and that SDB predicted post discharge mortality and readmissions. The role of SDB in post discharge outcomes in patients with HFpEF remains less well understood. <b>Methods:</b> We used an established inception prospective cohort of hospitalized heart failure patients who had inpatient testing for SDB (The OSU-Sleep Heart Program) to identify a subgroup of HFpEF (EF &lt; 45%) who underwent sleep testing. Patients who underwent sleep studies had their readmissions and vital status tracked post discharge. <b>Results:</b> Between 2009 and 2013, 1569 patients admitted for heart failure underwent sleep studies during hospitalization. Of those, 400 had HFpEF. 69 (17.3%) patients had CSA, and 204 (51%) had OSA. The remainder had no SDB (apnea hypopnea index &lt;15) (Table-1) The rate ratio for 6 month readmissions was 3.22 (95% CI 1.66, 6.25) (p&lt;0.001) in CSA patients compared to no SDB. This rate ratio is adjusted for age, sex, diabetes, chronic kidney disease and coronary artery disease. The adjusted rate ratio for 6 month readmissions was 2.08 (95% CI 1.23, 3.5) (p=0.01) in OSA patients compared no SDB (Table-2). <b>Conclusion:</b> In hospitalized HFpEF patients, OSA was more prevalent that CSA. Similar to patients with HFrEF, both OSA and CSA were independent predictors of readmissions.