Discharged Hospital Patients Research Articles

Clinico-Epidemiological Laboratory Findings of COVID- 19 Positive Patients in a Hospital in Saudi Arabia.

Understanding COVID-19's onset and clinical effects requires knowing host immune responses. To investigate the presence of IgM, IgG, and cytokine levels (IL-2 and IL-6) in individuals with COVID-19 who have had their diagnosis confirmed by PCR. This cross-sectional research included 70 adult ICU patients from King Abdullah Hospital in Bisha, Saudi Arabia. Subjects gave two blood samples. After hospital release, only 21 patients provided the second sample. Each patient provided a sample upon admission. Quantitative ELISAs evaluated IL-2, IL-6, and SARS-CoV-2-specific IgM and IgG antibodies. All patients were critically ill and unvaccinated against COVID-19. 46 (65.7%) of the patients were male, and their age range was 33-98 years (with a mean age of 66.5); 24.3%) were 51-61 years old. IgG was positive in all patients, although IgM predominated in 57/70 (81.4%) (6-1200 IU/mL). Total data analysis yielded these results. IL-6 was calculated at 10-1900 ng/mL, whereas IL-2 was 4-280. Discharged hospital patients had a statistically significant increase in IgM and IgG (P = 0.01, 0.004) but a statistically insignificant decline in IL-6 and IL-2 (P = 0.761, 0.071). Low IgM levels increased hospital stays. The study found lengthier hospital stays with higher IgG levels. The identification of IgM and IgG antibodies, greater IL-6 levels, and lower IL-2 levels can help diagnose and monitor COVID-19 infection.

Carriage Duration and Household Transmission of Enterobacterales Producing Extended-Spectrum Beta-Lactamase in the Community: A Systematic Review and Meta-Analysis.

An attributing factor to Enterobacterales producing extended-spectrum beta-lactamase (ESBL-E) community spread is human-to-human transmission. This systematic review and meta-analysis aimed to estimate the duration of ESBL-E carriage in the community and the rate of household transmission. Literature search was performed on PubMed, EMBASE, and Scopus. Dose-response meta-analysis was planned to model the proportion of ESBL-E carriers and household transmission over time. Twenty-six studies (n = 2,505 participants) were included. The median carriage duration was 2 months. Approximately 22% (95% confidence interval: 16-28) had persistent carriage after 12 months. Travelers had significantly shorter carriage (median 1-2 months) than discharged hospital patients (median 6 months) at all measured time points. There were insufficient data to robustly meta-analyze household transmission. Nonetheless, five longitudinal studies reported 18.4% to 35.2% of contacts acquired ESBL-E within 4 to 36 months from hospital discharge of index case. Transmission events from travelers to their contacts appeared lower. Travelers with travel-acquired ESBL-E had significantly faster decolonization rate than discharged patients, suggesting that travel-associated import of multidrug-resistant pathogen may have limited contribution to community transmission of ESBL-E. The substantial prevalence of persistent carriers warrant consideration for additional measures to mitigate exposure risk of ESBL-E from discharged patients in the community and from readmitting patients in the hospital.

Research based on existing clinical data and biospecimens: a systematic study of patients’ opinions

BackgroundThe aim of the present survey was to investigate newly discharged hospital patients’ opinions on secondary use of their hospital data and biospecimens within the context of health research in general and, more specifically, on genetic research, data sharing across borders and cooperation with the health industry.MethodsA paper questionnaire was sent to 1049 consecutive newly discharged hospital patients.ResultsThe vast majority of the respondents preferred to be informed (passive consent) or to receive no notification at all for secondary research on their health data and biospecimens (88% and 91% for data and biospecimens respectively). The rest wanted to be asked for active consent. The same trend applied for the other aspects also. 81% of respondents were positive towards genetic research without active consent. 95% were positive towards cooperating with the health industry, and 90% were positive towards data sharing.ConclusionsThese results suggest that hospital patients generally are very positive to secondary research and support the concept of opting out rather than opting in.

More than 2,000 pharmacies sign up for smoking cessation service in first two months

More than 2,000 community pharmacies in England are now providing a smoking cessation service (SCS) for discharged hospital patients, government documents have revealed. The figure emerged in an announcement of a government tender, published on 27 May 2022, that will look at digital requirements to support the current community pharmacy contract. According to the announcement, […]

Pharmacy professionals’ views regarding the future of NHS patient medicines helpline services: A multimethod qualitative study

Abstract Introduction Patient medicines helpline services (PMHS) have been established at some National Health Service (NHS) hospitals in England, to provide medicines-related support to recently discharged hospital patients and carers. However, findings suggest that, due to a lack of resources, considerable variation exists in the operation of PMHS, and that their access, availability, and promotion do not meet national standards regarding helpline provision (1, 2). To develop recommendations for service improvement, this qualitative study sought to examine pharmacy professionals’ views regarding the future of PMHS. Aim To examine pharmacy professionals’ perceptions of the future of PMHS, and develop recommendations for service improvement. Methods University ethics and Health Research Authority approval were obtained before commencement. Participants comprised pharmacy professionals from acute, mental health, specialist, and community NHS Trusts that provided a PMHS. Invitations to participate in an online qualitative survey and subsequent semi-structured telephone interview were sent via email to pharmacy services at all Trusts that provided a PMHS. Within the survey and the interview schedule was one question “How do you see patient medicines helplines at NHS Trusts developing in the future?” and only the data generated from this open-ended question were analysed for this study. Survey data were collected via SurveyMonkey (n=100). Individuals interested in participating in an interview contacted the research team, resulting in 34 interviews. Interviews were conducted from May-October 2018, and ranged from 16 to 53 minutes. Braun and Clarke’s inductive reflexive thematic analysis was used to analyse the data. Guidelines for enhancing the validity and trustworthiness of qualitative research were used. Results Two themes were generated from the survey and interviews. Enhancing value for service users identifies suggestions for improving the value of PMHS for service users. These include providing access methods beyond the telephone, and providing patients/carers with post-discharge follow-up calls from a pharmacist. Improving efficiency identifies that, in the future, and in line with NHS plans for efficiency and shared resources, PMHS may become centralised or provided by community pharmacies. Centralised services were considered to likely have more resources available to provide a patient medicines information service compared to hospital pharmacies. Participants often referred to the Carter report and sustainability and transformation plans, which promote the sharing of resources within regions. However, such a change was perceived to only increase efficiency if patient information can be shared between relevant healthcare settings. Conclusion PMHS are perceived by pharmacy professionals as likely to become centralised in the future (i.e., provided regionally or nationally) or provided by community pharmacies. This is dependent upon patients’ information being shared between hospitals and the centralised PMHS or pharmacies. To enhance the value of PMHS for service users, providers could establish other methods of access, such as email and video consultation. A limitation of this study is that it did not seek the perspectives of pharmacy professionals who do not provide a PMHS, other healthcare professionals, nor patients and carers. Considering the uncertainty around the future of PMHS, research should establish the best way to support all patients and carers regarding medicines following hospital discharge.

The accuracy, completeness and timeliness of discharge medication information and implementing medication reconciliation: A cross-sectional survey of general practitioners.

General practitioners (GPs) require accurate medication information to care for recently discharged hospital patients. Pre-discharge medication reconciliation improves the accuracy of patient medication lists that GPs receive. This study aimed to explore GPs' perceptions of the accuracy, completeness and timeliness of hospital discharge medication information, and how they undertake medication reconciliation. Using a cross-sectional online survey, quantitative and qualitative data were collected from a convenience sample of GPs practising across the Gold Coast, Australia. Data were analysed using descriptive statistics and content analysis. Twelve GPs were recruited. Patient hospital discharge medication information was mostly accurate and complete, but delays in receiving this information affected the ability of GPs toundertake medication reconciliation. Receiving accurate and timely patient discharge medication information can reduce errors. Optimising the communication of medication information to GPs may improve patient safety.

Duration of carriage of multidrug resistant Enterobacterales in discharged hospital and general practice patients and factors associated with clearance

SummaryObjectivesDutch guidelines recommend contact precautions in patients with multidrug resistant microorganisms cultured during the previous 12 months. To evaluate this policy, duration of carriage of multidrug resistant Enterobacterales was assessed among discharged hospital patients and patients attending their general practitioner (GP). Additionally, we assessed factors associated with clearance.MethodsFrom January 2013 until May 2016, rectal or faecal samples accompanied by questionnaires on patient characteristics were obtained at time of study inclusion and 3, 6 and 12 months later, in 72 patients with multidrug resistant Enterobacterales. Clearance was defined as one or more negative cultures without a subsequent positive culture at 12 months after study inclusion. The percentage of clearance, intermittent carriage and persistence was determined and associated factors were assessed by logistic regression analysis.ResultsClearance was found in 31 patients (43.1% [95%CI: 32.3–54.6]) of which 23 patients had two or more subsequent negative cultures. Twelve patients were classified as intermittent carriers (16.7% [95%CI: 9.8–26.9]) and 29 patients (40.3% [95% CI: 29.7–51.8]) as persistent carriers. Of the intermittent carriers, the majority (n=9) had two negative cultures during the study period. There was no difference in clearance between discharged hospitalized patients and GP patients. The only factor associated with clearance at 12 months in both univariable and multivariable analyses was not traveling to a foreign country (OR=3.5 [95%CI: 1.0–12.4]).ConclusionActive screening for clearance of multidrug resistant Enterobacterales in patients within the health care setting is probably not beneficial due to high levels of intermittent and persistent carriage.

Developing a New Version of the SF-6D Health State Classification System From the SF-36v2: SF-6Dv2.

The objective of this study was to develop the classification system for version of the SF-6D (SF-6Dv2) from the SF-36v2. SF-6Dv2 is an improved version of SF-6D, one of the most widely used generic measures of health for the calculation of quality-adjusted life years. A 3-step process was undertaken to generate a new classification system: (1) factor analysis to establish dimensionality; (2) Rasch analysis to understand item performance; and (3) tests of differential item function. To evaluate robustness, Rasch analyses were performed in multiple subsets of 2 large cross-sectional datasets from recently discharged hospital patients and online patient samples. On the basis of factor analysis, other psychometric evidence, cross-cultural considerations, and amenability to valuation, the 6-dimension classification used in SF-6D was maintained. SF-6Dv2 resulted in the following modifications to SF-6D: a simpler classification of physical function with clearer separation between levels; a more detailed 5-level description of role limitations; using negative wording to describe vitality; and using pain severity rather than pain interference. The SF-6Dv2 classification system describes more distinct levels of health than SF-6D, changes the descriptions used for a number of dimensions and provides clearer wording for health state valuation. The second stage of the study has developed a utility value set using discrete choice methods so that the measure can be used in health technology assessment. Further work should investigate the psychometric characteristics of the new instrument.

Meeting the challenges posed by an escalating diabetes healthcare burden: A mixed methods study

Background: The ongoing escalation in the incidence of diabetes is contributing to a growing burden on health services because patients with diabetes as a co-morbidity are now spread throughout the hospital (rather than being located in specific areas). Thus, there is a need for expertise in diabetes care throughout services to ensure optimal care and reduce threats to patient safety.Aims and objectives: To identify new strategies to maintain optimal care for patients with diabetes while in hospital.Design: Mixed methods underpinned by Appreciative Inquiry.Methods: The Diabetes Knowledge Questionnaire Survey (DKQS) (n = 173); focus group interviews with nurses and midwives (n = 40), and individual interviews with recently discharged hospital patients (n = 6). Quantitative data were analysed using descriptive statistics and qualitative data by thematic analysis.Results: Highlight a need to enhance knowledge and confidence of diabetes management among nursing, midwifery, medical and ancillary staff through the introduction of focused education strategies. This, together with improved communication and team work, is required to relieve the burdens on frontline nursing staff and patients caused by delays in prescribing and reviewing insulin requirements and in accessing needed food for people with diabetes.Conclusions: In seeking solutions to the challenges in caring for hospitalised patients with diabetes there is a need to work across the entire hospital workforce and to develop effective and efficient methods for ensuring appropriate skills and knowledge of diabetes management for staff across complex and rapidly changing hospital systems.Relevance to clinical practice: The introduction and implementation of innovative educational and organisational strategies are needed to assist in meeting the challenges posed by an escalating diabetes healthcare burden. The safety of patients with diabetes can be optimised with the timely availability of appropriate meals and snacks, and enhanced coordination and communication between and within multidisciplinary teams.

Comprehension Context and Sponsor Effects in a Hospital Mental Health Study

Although a wealth of literature exists studying the effect of sponsor characteristics on self-reports of mental health, little work assesses a related but potentially powerful effect: a context comprehension effect, that is, a change in the respondent’s interpretation of a survey question, given the concept elicited by the interviewer. Further, most studies of sponsor effects assess mean differences in responses according to sponsor type; no work has studied how these effects can affect the reliability of a psychometric instrument, which are of general importance to sociological studies of health. Here, using a study of 169 recently discharged hospital patients, we find that both effects are likely to have affected responses and, together, negated the reliability of a psychometric instrument. Future studies should consider the effect of not only sponsor characteristics upon responses but also consider how questions might be interpreted given in an interview context.

Abstract 4218: Racial similarities in the effects of depression on hospital cost of breast cancer

Abstract Objective: Breast cancer (BC) incidence is reported to have declined in the nation. However, the role of depression on hospital costs for BC by race remains unknown. In this presentation, we examine two issues: (i) prevalence of BC with comorbid depression among discharged hospital patients; (ii) racial variation in the effect of co-morbid depression on hospital costs of BC patients. Methods: We extracted data on depression and breast cancer from the 2008 Tennessee Hospital Discharge Data System (HDDS). The BC sample (n=2,523) patients were mostly white (86%) with an average age of 63 years. We computed age-adjusted BC prevalence rates per CDC methodology, and compared the hospital costs for BC patients with vs. without depression. Results: Age adjusted BC rates (per 100,000) were higher among white than black patients (92.2 vs. 43.3, p<.000). Nearly one-fourth (23%) of BC patients had depression (no racial differences: (25% white vs. 24% black BC patients). Hospital costs for BC patients were 17% higher compared to non-BC patients, and cost was 55% higher among BC patients with co-morbid depression compared to non-depressed BC patients ($64,439 vs. $41,344). The higher cost for depressed BC patients was similar across both white and black BC females. Conclusion: BC is higher among white females compared to black females. BC patients cost with depression tended to be significantly higher compared to non-depressed patients regardless of race. Since nearly one-fourth of BC patients were depressed with higher hospital cost, these results point to possible significant costs savings by treating depression before the need for hospitalization among BC patients. Citation Format: Baqar A. Husaini, Oscar Miller, Meggan Novotny, Robert Levine. Racial similarities in the effects of depression on hospital cost of breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4218. doi:10.1158/1538-7445.AM2017-4218

Characteristics of Individuals With Mental Illness in Tokyo Homeless Shelters.

Japan has the largest number of psychiatric beds in the world and has been in the process of deinstitutionalization since 2004. The majority of psychiatric inpatients are elderly long-term patients, who are at risk of homelessness after they are discharged. There is little information about homeless people with mental illnesses in Japan, and the aim of this study was to describe characteristics of people with a mental illness in homeless shelters in Tokyo. A face-to-face survey was conducted from December 2012 to March 2013 by the staff of a nonprofit organization (NPO) that helps socially isolated persons. Of the 1,056 people who received help during the study period, 684 completed the survey. Eighteen percent of the 684 survey participants had a mental illness. Of the 210 individuals who lived in shelters, one-third had a mental illness. The mean age of shelter users with mental illness was 64.9; they tended to be referred from hospitals, and their mental well-being was poorer than other NPO service users in the study. Among the service users with mental illness, those living in shelters were older than those living in the community and more likely to have a history of trouble with alcohol, poor family relationships, and impaired instrumental activities of daily living. Unmet mental health needs were noted among discharged hospital patients living in Tokyo homeless shelters. An integrated and community-based support system with more effective health care delivery, including critical time interventions, is needed.

Establishing a referral system for MTM services

Last month's MTM Pearls column discussed how patients may be more willing to attend a pharmacist-managed MTM service if their physician or primary care provider encouraged or referred them to the service. Establishing a referral system is not an easy task and requires some effort and ongoing communication with other providers. Benefits of a successful referral system are an increase in patient acceptance and number of MTM interventions, and ultimately improvement in drug therapy. In a recent article, authors described their process for establishing a referral system for MTM services in an integrated health system.

Phone calls to a hospital medicines information helpline: analysis of queries from members of the public and assessment of potential for harm from their medicines

To find out what questions the public ask of pharmacists on a hospital medicines information helpline, and to assess the potential for improving individuals' management of medicines through telephone helpline support. We analysed consecutive phone calls made by members of the public over 6 months to a hospital pharmacy medicines information helpline. Calls were coded for type of medicine, reason for phoning and any error revealed in the call. We also looked at which medicines were associated with harm and/or potential for harm had the caller not enquired about appropriate action to take. Five hundred of the 923 consecutive calls to the helpline were from members of the public (including discharged hospital patients). Antimicrobial agents, analgesics and cardiovascular medicines accounted for approximately half of all calls. The reason for phoning was most often to ask about interactions (22%), directions for use (21%) or advice on adverse effects (15%). In a third of calls it is possible an error had occurred (including patient error and directions missing from a dispensed item). Forty-eight per cent of calls were concerned with harm or judged to have potential for harm had professional information not been available. Four of these cases (0.8%), one of which was patient error and three of which were adverse effects reported by the caller, were categorised as Harm Index category F, defined as requiring intervention and referral. Our medicines information helpline appears to be a valuable resource for discharged patients and public and the advice given may be expected to improve safety with medicines and reduce harm. Our results reveal gaps in patient education about their medicines, some of which could be addressed by dispensing staff or the pharmacist at discharge. The data provide a baseline for measuring improvements in medicines management and will be useful in identifying patients who may benefit from follow-up call support from pharmacists.

Clinical Features, Treatment Practices, and Hospital and Long‐Term Outcomes of Older Patients Hospitalized with Decompensated Heart Failure: The Worcester Heart Failure Study

To examine age-specific differences in clinical presentation, receipt of therapeutic practices and lifestyle recommendations, and hospital and long-term survival in patients hospitalized for acute heart failure HF. Population-based study. The Worcester Heart Failure Study, a population-based study of residents of the a large Central New England metropolitan area hospitalized for decompensated HF at 11 greater-Worcester medical centers. Four thousand five hundred thirty-four patients hospitalized for decompensated HF during 1995 and 2000. Medical records were reviewed for demographic, clinical, and treatment characteristics and hospital survival status. Long-term follow-up of discharged hospital patients was conducted through 2005. Patients were compared according to four age groups (<65, 65-74, 75-84, and > or =85). Mean age was 76; 24.0% were aged 85 and older. Patients aged 75 and older were more likely to be female and to have multiple comorbidities, a lower body mass index at the time of hospitalization, and higher ejection fraction findings. Older patients were significantly more likely to receive symptom-modifying medications and less likely to receive disease-modifying medications than younger patients. Older age was directly associated with higher in-hospital, 30-day, and 1-year death rates in crude and multivariable-adjusted analyses. The results of this community-wide study suggest that clinical, treatment, and prognostic factors differ according to age in patients hospitalized for decompensated HF. These high-risk patients warrant special attention in future studies to improve their management and long-term survival.

Physicians' Workload Has Increased at Facilities

Physicians' Workload Has Increased at Facilities

Long-term Survival After Heart Failure

Heart failure (HF) is a major public health problem that is associated with substantial morbidity, impaired quality of life, and diminished survival. Despite the considerable prevalence of HF in the United States, there are limited published data describing the contemporary long-term prognosis of patients hospitalized with decompensated HF. A total of 2445 residents in the Worcester metropolitan area discharged from 11 greater Worcester hospitals after confirmed acute HF during 2000 comprised the study sample. Follow-up of discharged hospital survivors was carried out through 2005. The mean age of the study population was 76 years, 43.4% were men, and approximately three quarters had been previously diagnosed as having HF. Among discharged hospital patients, 37.3% died during the first year after hospital discharge, while 78.5% died during the 5-year follow-up period. Several subgroups of patients were at significantly increased risk for dying during the first year after hospital discharge. This included older persons (> or =85 years) (adjusted odds ratio [OR], 2.11; 95% confidence interval [CI], 1.35-3.29), patients with a history of chronic obstructive pulmonary disease (OR, 1.39; 95% CI, 1.15-1.69) or HF (OR, 1.26; 95% CI, 1.00-1.59), and patients with elevated serum urea nitrogen levels during hospitalization (OR, 1.02; 95% CI, 1.01-1.03). The results of our community-wide study demonstrate the poor long-term prognosis of patients surviving hospitalization for decompensated HF. Despite advances in the therapeutic management of these patients, their long-term survival remains guarded. Efforts are needed to improve the long-term survival of patients with this clinical syndrome.

How Can We Ground the “Frequent Fliers”?

How Can We Ground the “Frequent Fliers”?

Adverse Events and Preventable Adverse Events in Children

Patient safety has been recognized as an important problem in health care. However, knowledge about adverse events and preventable adverse events in children is relatively limited. To describe the incidence and types of adverse events and preventable adverse events in children. Analysis of pediatric hospitalizations in the Colorado and Utah Medical Practice Study, which involved a retrospective, 2-level (nurse and physician) medical record review of a population-based, representative sample of all pediatric hospital discharges. Adverse events were defined as an injury caused by medical management rather than disease processes that resulted in either prolonged hospitalization or disability at discharge. A preventable adverse event was defined as an avoidable adverse event based on currently available knowledge and accepted practices. 3719 discharged hospital patients, 0-20 years old, and 7528 nonelderly (21-65 years old) discharged adult patients in Colorado and Utah. All hospitals in Colorado and Utah. Adverse events occurred in 1% of pediatric hospitalizations in Colorado and Utah; 0.6% were preventable. Preventable adverse events rates were 0.53% in neonates and infants (0-0.99 years), 0.22% in children 1-12 years of age, and 0.95% in adolescents 13-20 years of age, compared with a rate of 1.50% in nonelderly adults. Of preventable adverse event types, birth related (32.2%) and diagnostic related (30.4%) events were the most common and were significantly more common than surgically related preventable adverse events (3.5%). These data suggest that approximately 70,000 children hospitalized in the United States experience an adverse event each year; 60% of these events may be preventable. The epidemiology of adverse events and preventable adverse events in children is different than in adults. To reduce the adverse events that occur in hospitalized children, research should focus on adolescent hospitalized patients, birth-related medical care, and diagnostics in pediatric medicine.

The Effectiveness of a Directly Mailed Smoking Cessation Intervention to Australian Discharged Hospital Patients

Background. The objective was to assess the effectiveness of a directly mailed smoking cessation intervention to discharged hospital patients.Methods. A randomized controlled trial was used. In the 2 weeks after discharge, smokers in the intervention group were sent by mail a personally addressed letter from their medical consultant urging them to quit plus a self-help quitting manual, and smokers in the control group received usual care. Patients were surveyed about their smoking status at 6 and 12 months after discharge. A total of 1858 discharged patients responded to both questionnaires. The main outcome measures were self-reported smoking in past week at 6 and 12 months after discharge. Quitters at 12 months were biochemically tested for evidence of smoking.Results. The results failed to show that smoking cessation advice directly mailed to a broad cross-section of discharged hospital patients who smoke led to smoking cessation. However, the intervention increased cessation among smokers with medical conditions for which quitting is highly relevant. In general, patients who were more likely to quit were older, had entered the hospital as an emergency case, and had a medical diagnosis for which quitting is highly relevant.Conclusions. This study suggests that hospital patients who smoke and are also diagnosed with conditions which call for quitting are more likely to quit if they receive from their consultant a personalized letter advising them to quit and a self-help manual.