Hospital Discharge Research Articles

Association between temperature and air pollutants with atrial fibrillation presentations to emergency departments.

Understanding the impact of environmental exposures on disease incidence is important for environmental guidelines, health services management, and advising patients. We aimed to assess the relationship between daily mean temperature and common pollutants with atrial fibrillation (AF) presentations to emergency departments (EDs). The study included consecutive adult patients presenting with AF to EDs from 1/1/2014 to 31/12/2020 with linkage to hospital and emergency discharge diagnosis data. A time series quasi-Poisson regression with a distributed lag nonlinear model was fitted to assess the association between AF with mean air temperature and five common pollutants, overall and according to sex and region, with adjustment for season, day of the week, long-term trend, and co-pollutants. In 82 575 AF presentations to EDs during the study period, mean (standard deviations [SD]) (SD) age was 69.6 (SD 14.7) years and 50.7% were female. AF presentations were associated with elevated levels of Particulate Matter (PM) 2.5 (≥57.7 µg/m3) and nitrous dioxide (NO2) (≥16.5 parts per billion), but not mean air temperature or other pollutants (carbon monoxide, sulphur dioxide, or ozone). The attributable fraction of AF presentations relating to above optimal NO2 and PM 2.5 levels was 7.24% and 3.81% resulting in 854 and 450 annual excess AF presentations, respectively. High levels of NO2 and PM 2.5 are associated with increased risk of AF presentations to EDs. These findings have important implications for environmental policies and advice to patients susceptible to AF presentations to EDs, especially in regions with higher baseline levels of PM 2.5 or NO2.

Characterization of Telecare Conversations on Lifestyle Management and Their Relation to Health Care Utilization for Patients with Heart Failure: Mixed Methods Study.

Telehealth interventions where providers offer support and coaching to patients with chronic conditions such as heart failure (HF) and type 2 diabetes mellitus (T2DM) are effective in improving health outcomes. However, the understanding of the content and structure of these interactions and how they relate to health care utilization remains incomplete. This study aimed to characterize the content and structure of telecare conversations on lifestyle management for patients with HF and investigate how these conversations relate to health care utilization. We leveraged real-world data from 50 patients with HF enrolled in a postdischarge telehealth program, with the primary intervention comprising a series of telephone calls from nurse telecarers over a 12-month period. For the full cohort, we transcribed 729 English-language calls and annotated conversation topics. For a subcohort (25 patients with both HF and T2DM), we annotated lifestyle management content with fine-grained dialogue acts describing typical conversational structures. For each patient, we identified calls with unusually high ratios of utterances on lifestyle management as lifestyle-focused calls. We further extracted structured data for inpatient admissions from 6 months before to 6 months after the intervention period. First, to understand conversational structures and content of lifestyle-focused calls, we compared the number of utterances, dialogue acts, and symptom attributes in lifestyle-focused calls to those in calls containing but not focused on lifestyle management. Second, to understand the perspectives of nurse telecarers on these calls, we conducted an expert evaluation where 2 nurse telecarers judged levels of concern and follow-up actions for lifestyle-focused and other calls (not focused on lifestyle management content). Finally, we assessed how the number of lifestyle-focused calls relates to the number of admissions, and to the average length of stay per admission. In comparative analyses, lifestyle-focused calls had significantly fewer utterances (P=.01) and more dialogue acts (Padj=.005) than calls containing but not focused on lifestyle management. Lifestyle-focused calls did not contain deeper discussions on clinical symptoms. These findings indicate that lifestyle-focused calls entail short, intense discussions with greater emphasis on understanding patient experience and coaching than on clinical content. In the expert evaluation, nurse telecarers identified 24.2% (29/120) of calls assessed as concerning enough for follow-up. For these 29 calls, nurse telecarers were more attuned to concerns about symptoms and vitals (19/29, 65.5%) than lifestyle management concerns (4/29, 13.8%). The number of lifestyle-focused calls a patient had was modestly (but not significantly) associated with a lower average length of stay for inpatient admissions (Spearman ρ=-0.30; Padj=.06), but not with the number of admissions (Spearman ρ=-0.03; Padj=.84). Our approach and findings offer novel perspectives on the content, structure, and clinical associations of telehealth conversations on lifestyle management for patients with HF. Hence, our study could inform ways to enhance telehealth programs for self-care management in chronic conditions.

Resting Heart Rate and Incident Atrial Fibrillation in Black Adults in the Jackson Heart Study

Resting heart rate (RHR) is a widely available measure of cardiovascular fitness that has been associated with several cardiovascular outcomes. RHR has previously been associated with the risk of atrial fibrillation (AF) among individuals of European ancestry, but little is known about this association in Black adults. To evaluate the association between RHR and incident AF in a large community-based sample of Black adults, independently of established risk factors. This cohort study uses data from the Jackson Heart Study, a prospective community-based cohort in Jackson, Mississippi. Participants without prevalent AF were included and were monitored for new-onset AF during follow-up, from 2000 through 2016. Data analysis was performed from August 1 to December 11, 2023. RHR was assessed from resting 12-lead electrocardiograms performed at examination 1 (2000-2004) and examination 3 (2009-2013). AF was identified from study electrocardiograms, hospitalization discharge diagnosis codes, and Medicare claims diagnosis codes. Cox regression was used to evaluate the association between baseline (examination 1) RHR and incident AF, adjusting for established AF risk factors. Among 4965 Black adults eligible for analysis, the mean (SD) age was 55 (13) years, 1830 (37%) were male, and the mean (SD) RHR at baseline was 65 (11) beats per minute (bpm). During a median (IQR) 14 (12-15) years of follow-up, there were 458 incident AF events, resulting in an incident rate of 7.5 per 1000 person-years (95% CI, 6.8-8.2 incidents per 1000 person-years). Each 10-bpm higher RHR was associated with a 9% higher risk of incident AF after adjustment for AF risk factors (hazard ratio, 1.09; 95% CI, 1.00-1.19). In a sensitivity analysis that excluded individuals with prior heart failure, prior myocardial infarction, and antiarrhythmic medication use at baseline, the hazard ratio was 1.14 (95% CI, 1.02-1.28). There was little evidence of effect modification of these associations by age, sex, body mass index, hypertension, or physical activity level. In this large prospective cohort study of Black adults, elevated baseline RHR was associated with increased risk of incident AF, consistent with findings from previous studies of European ancestry populations. Future research should focus on determining whether RHR can be used to screen patients at high risk of AF.

Corporate marketing in modern hospitals and satisfaction level of corporate clients in Bangladesh

The study's abstract emphasizes the Marketing Department's dual responsibility in creating external awareness and disseminating internal information in modern hospitals. To improve service quality and management decision-making, the department keeps an eye on patient happiness and oversees communication, advertising, corporate agreements and feedback methods. Key research findings show that while corporate patients generally value the department's cutting-edge technology and the expertise of its staff, they do have reservations about the department's responsiveness and punctuality, particularly with regard to inpatient care. Patients in the Outpatient Department (OPD) expressed greater levels of satisfaction than those in the Inpatient Department (IPD), where patients expressed greater dissatisfaction with personalized care and error correction. To increase general patient happiness, recommendations include enhancing service speed, providing personnel training, and attending to particular patient requirements.

Effect of integrated medicines management on quality of discharge medication information - a secondary endpoint in a randomized controlled trial.

High-quality discharge information is important to promote patient safety when patients are transferred from hospital to primary care. Patients with multiple long-term conditions are especially vulnerable to insufficient transfer of medication information, as they use many medications and have complex interactions with the healthcare services. The aim of this study was to investigate the effect of integrated medicines management provided to hospitalized multimorbid patients on the quality of the discharge medication information. Multimorbid patients ≥18 years, using a minimum of four regular medications from a minimum of two therapeutic medication classes were recruited from the Internal Medicine ward, Oslo University Hospital, Norway, from August 2014 to March 2016 and randomly assigned, 1:1, to the intervention or control group. Intervention patients received integrated medicines management throughout the hospital stay. Control patients received standard care. This paper reports the results of a pre-specified secondary endpoint analysis of a randomized controlled trial; the difference between the intervention and control group in the quality of discharge medication information. The analysis population comprised 384 patients. Integrated medicines management improved the discharge summary quality score of the medication information from 5.8 ± 1.5 to 8.6 ± 2.6 (mean difference 2.7, 95% CI 2.3-3.2, p < 0.001). In total 171 intervention patients (89%) received a patient discharge information letter, compared to 66 control patients (35%), p < 0.001. The quality score of the medication information in the patient discharge information letter was improved from 6.0 ± 1.8 in the control group to 10.0 ± 1.3 in the intervention group (mean difference 4.0, 95% CI 3.6-4.4, p < 0.001). Integrated medicines management delivered to multimorbid patients during a hospital stay improved the quality of the medication information in discharge summaries as well as patient discharge information letters and ensured that a discharge information letter in lay language was prepared for almost all patients who were involved in the management of their medications after discharge.

Cognitive and Functional Capacity Assessment of Individuals Who Were Admitted to the Intensive Care Unit Due to COVID-19: A Prospective Cohort Study.

The goal of this study was to identify changes in cognitive and functional capacity after hospital discharge in those infected with COVID-19 who were admitted to the ICU. This is a prospective cohort study carried out with individuals who were admitted to a hospital, from July 2021 to May 2022. The evaluations happened in three moments: at hospital discharge, 30 days after discharge and 90 days after discharge. The instruments applied are the following: handgrip dynamometer, Montreal Cognitive Assessment Basic questionnaire (MoCA-B), Barthel Index (BI), timed up and go test (TUG), hospital anxiety and depressive scale (HADS) and 36-Item Short Form Health Survey questionary (SF-36). 74 individuals were eligible to participate in the study, 25 of which were followed for 90 days. Based on the results of the MoCA-b, there were no relevant cognitive changes after 3 months. According to the Barthel Index applied to each of the evaluations, the percentage of subjects that were classified as independent or minimally dependent was 48%, 92% then 96%, respectively, demonstrating that individuals can achieve a good degree of functional independence after 3 months. Despite that, the SF-36 demonstrated a score below the South Brazilian normal in some domains. The individuals studied did not present persistent cognitive changes after 3 months and functional capacity showed significant improvement during this period. However, when the assessment is about the self-perceived quality of life, the majority of domain values are still below expectations, deserving attention by the health professionals involved.

Cost analysis of oncological outpatient neurosurgery under general anesthesia with Hospital-at-Home based postoperative care.

This study evaluates the efficiency and cost-effectiveness of an oncological outpatient neurosurgery (OON) protocol using Enhanced Recovery After Surgery (ERAS) principles in a European healthcare setting. Additionally, it assesses the impact of incorporating Hospital at Home (HaH) for perioperative follow-up on program efficiency and costs. We analyzed a case cohort of patients who underwent OON with HaH-based postoperative follow-up for tumor removal or biopsy at a tertiary care center since 2019. A control cohort treated under standard inpatient care was also examined. Costs associated with surgery and postoperative care were meticulously calculated for both groups. The case (n=17) and control (n=38) cohorts had comparable demographics and clinical profiles. Surgical costs, including operating room, anesthesia, and surgeon fees, were similar across groups. However, post-operative monitoring was significantly shorter for the outpatient cohort, leading to reduced observation costs (p<0.001). While the duration of follow-up care was similar, outpatient follow-up via HaH was more cost-effective, reducing overall surgery costs by approximately €2958 per patient (p<0.001) compared to inpatient care. No significant differences were observed in costs related to treatment, radiology, or lab tests between groups. Outpatient neurosurgery with HaH follow-up offers substantial cost savings without compromising care quality in a public health setting. Inpatient care's higher costs are largely due to bed utilization, while the integration of HaH does not add significant costs, making it a viable alternative for postoperative management.

Cerebral Embolic Protection by Geographic Region

Transcatheter aortic valve replacement (TAVR) is an established treatment option for many patients with severe symptomatic aortic stenosis; however, debris dislodged during the procedure can cause embolic stroke. The Sentinel cerebral embolic protection (CEP) device is approved for capture and removal of embolic material during TAVR but its efficacy has been debated. To explore regional differences in the association of CEP utilization with stroke outcomes in patients undergoing TAVR. This post hoc analysis of a prospective, postmarket, randomized clinical trial evaluating TAVR performed with or without the CEP took place at 51 hospitals in the US, Europe, and Australia from February 2020 to January 2022. Patients with symptomatic aortic stenosis treated with transfemoral TAVR were included. Randomization was stratified according to center, operative risk, and intended TAVR valve type. Patients were excluded if the left common carotid or brachiocephalic artery had greater than 70% stenosis or if the anatomy precluded placement of the CEP device. Data for this post hoc study were analyzed from August to October 2024. TAVR with or without CEP. The primary end point was the rate of all stroke events at hospital discharge or 72 hours post-TAVR, whichever came first. Neurological examinations were performed at baseline and postprocedure to identify stroke, disabling stroke, and other neurological outcomes. The Stroke Protection With Sentinel During Transcatheter Aortic Valve Replacement (PROTECTED TAVR) trial enrolled and randomized 3000 patients (1803 [60.1%] male; mean [SD] age, 78.9 [7.8] years): 1833 in the US cohort (TAVR alone: 919, TAVR with CEP: 914) and 1167 patients in the outside the US (OUS) cohort (TAVR alone: 580, TAVR with CEP: 587). Patients in the US cohort were younger, more predominantly male, had a lower prevalence of atrial fibrillation, and had a higher prevalence of bicuspid aortic valve, diabetes, and peripheral vascular disease compared with the OUS cohort. In the main trial, the incidence of stroke within 72 hours after TAVR or before discharge did not differ significantly between the CEP group and the control group, and there was no interaction by geographic region. In this post hoc analysis, patients treated with CEP in the US cohort exhibited a 50% relative risk reduction for overall stroke and a 73% relative risk reduction for disabling stroke compared to TAVR alone; a treatment effect on stroke risk reduction was not observed in the OUS cohort. The PROTECTED TAVR trial could not show that the use of CEP had a significant effect on the incidence of periprocedural stroke during TAVR. Although there was no significant interaction by geographic region, this exploratory post hoc analysis suggests a trend toward greater stroke reduction in the US cohort but not in the OUS cohort. These findings are hypothesis generating, and further research is needed to determine if regional differences in patient characteristics or procedural practices affect CEP efficacy. ClinicalTrials.gov Identifier: NCT04149535.

Preterm infant attachment is independent of breast milk intake during neonatal care

Background Following preterm birth, breast milk feeding is recommended because it confers broad health benefits to preterm infants. Breast milk has been suggested to promote secure attachment in infancy, but this is uncertain. Elucidating the relationship between breast milk intake and infant attachment is crucial for supporting parents of preterm infants to make feeding choices and providing accurate counselling when breast milk is not available. We aimed to investigate if breast milk exposure during neonatal care associates with attachment outcomes derived from infants’ responses to the Still-Face Paradigm (SFP) at nine months of age. Methods We studied 77 preterm (&lt; 33 weeks’ gestation) and 71 term infants. Preterm infant feeding data were collected from birth until hospital discharge. Infant responses to the SFP were videocoded at nine months corrected age. Infants’ distress, fretfulness, attentiveness to caregivers and attachment classification were compared between preterm infants who received exclusive breast milk for ≥ 75% of inpatient days, those who received exclusive breast milk for &lt; 75% of inpatient days, and term infants. Milk intake thresholds were chosen based on our previous work demonstrating positive associations between breast milk intake and MRI markers of brain maturation. Results There were no significant differences in infant distress, fretfulness, attentiveness to caregivers (p-values &gt; 0.19), or in the odds of secure versus insecure attachment classification (relative risk ratio = 0.57–0.89, p-values = 1.00) between preterm infants with high or low breast milk exposure, or term comparators. Conclusions Attachment outcomes at nine months were similar between term and preterm infants, and breast milk exposure did not associate with attachment in the preterm group. Although breast milk feeding has clear benefits, these findings may alleviate some of the pressures experienced by parents who are unable to provide breast milk for infants cared for in the neonatal unit.

Postoperative nursing in robot‐assisted urologic surgery: Are there any platform‐based differences?

AbstractMany robotic platforms are currently available for urologic surgery, each with its technical characteristics. It can be hypothesised that these characteristics might affect postoperative nursing, as they affect several aspects of surgery. They could, therefore, impact the surgical outcomes and wound characteristics, involving aspects of postoperative care such as mobilization, nutrition and length of stay. Although data are available on surgical technique aspects and intraoperative nursing, studies have yet to offer insights and considerations about the potential effect of having different robotic platforms on postoperative nursing care. We aimed to verify whether the technical features of the available robots could impact postoperative nursing. We conducted an integrative review on PubMed, CINAHL and Scopus, using Medical Subject Headings (MeSH) and free‐text terms; wildcards and boolean operators were also used. Studies of any design were included. Fifteen papers were retrieved; the key themes emerging from the literature regard trocar setup, technical characteristics of the robots (e.g. single or multiple ports), pneumoperitoneum and Trendelenburg degree. According to the literature, none of these characteristics produce differences in postoperative nursing. The fundamental concepts of postoperative care in surgical inpatients stay the same no matter the robotic platform used. Having competing platforms able to ensure reduced complications without impacting postoperative nursing allows health care facilities to adopt the newest technologies without the need for differentiated nursing protocols. This is an advantage in times of global nursing shortage as it avoids the need for additional platform‐based nursing training.

Healthcare Resource Utilization Among Patients With Agitation in Alzheimer Dementia

Background: Agitation in Alzheimer dementia is common, but the associated healthcare burden remains unclear. Objective: This retrospective analysis evaluated baseline characteristics, healthcare resource utilization, and costs among patients with agitation in Alzheimer dementia and those without agitation in Alzheimer dementia. Methods: Medicare beneficiaries from 100% of the Medicare Fee-for-Service claims database (2009-2016) with 2 or more claims 30 or more days apart for both Alzheimer’s disease and dementia and continuous enrollment with medical/pharmacy coverage for 6 months before and 12 months after the index diagnosis were included. Patients with agitation in Alzheimer dementia were identified by 2 or more claims 14 or more days apart using International Classification of Diseases-9-CM/-10-CM codes based on the provisional International Psychogeriatric Association agitation definition. Patients with severe psychiatric disorders were excluded. Two cohorts of patients (with and without agitation) were then defined, and patient characteristics, healthcare resource utilization, and costs were compared in a descriptive exploratory analysis. Results: Of 2 684 704 Fee-for-Service patients with Alzheimer dementia, 769 141 met all inclusion criteria; among these, 281 042 (36.5%) had agitation. The mean age in patients with and without agitation in Alzheimer dementia was 83 years. Most patients in both groups were female, but the proportion of males was slightly higher in the agitation in Alzheimer dementia group (30.3% vs 28.2%, respectively). Patients with agitation in Alzheimer dementia were more likely than those without agitation in Alzheimer dementia to have lower socioeconomic status (dual eligibility for Medicaid, 45.0% vs 41.7%, respectively) or be disabled (10.5% vs 9.4%). Overall, healthcare costs were higher in the agitation in Alzheimer dementia population compared with those without agitation in Alzheimer dementia (mean cost PPPY, $32 322 and $30 121, respectively), with the largest differences observed in inpatient and post-acute care costs. Conclusions: These exploratory findings underscore the substantial economic burden of agitation in Alzheimer dementia and highlight the need for treatment options for the agitation in Alzheimer dementia population to improve associated health outcomes.

Healthcare Resource Utilization Among Patients With Agitation in Alzheimer Dementia

Background: Agitation in Alzheimer dementia is common, but the associated healthcare burden remains unclear. Objective: This retrospective analysis evaluated baseline characteristics, healthcare resource utilization, and costs among patients with agitation in Alzheimer dementia and those without agitation in Alzheimer dementia. Methods: Medicare beneficiaries from 100% of the Medicare Fee-for-Service claims database (2009-2016) with 2 or more claims 30 or more days apart for both Alzheimer’s disease and dementia and continuous enrollment with medical/pharmacy coverage for 6 months before and 12 months after the index diagnosis were included. Patients with agitation in Alzheimer dementia were identified by 2 or more claims 14 or more days apart using International Classification of Diseases-9-CM/-10-CM codes based on the provisional International Psychogeriatric Association agitation definition. Patients with severe psychiatric disorders were excluded. Two cohorts of patients (with and without agitation) were then defined, and patient characteristics, healthcare resource utilization, and costs were compared in a descriptive exploratory analysis. Results: Of 2 684 704 Fee-for-Service patients with Alzheimer dementia, 769 141 met all inclusion criteria; among these, 281 042 (36.5%) had agitation. The mean age in patients with and without agitation in Alzheimer dementia was 83 years. Most patients in both groups were female, but the proportion of males was slightly higher in the agitation in Alzheimer dementia group (30.3% vs 28.2%, respectively). Patients with agitation in Alzheimer dementia were more likely than those without agitation in Alzheimer dementia to have lower socioeconomic status (dual eligibility for Medicaid, 45.0% vs 41.7%, respectively) or be disabled (10.5% vs 9.4%). Overall, healthcare costs were higher in the agitation in Alzheimer dementia population compared with those without agitation in Alzheimer dementia (mean cost PPPY, $32 322 and $30 121, respectively), with the largest differences observed in inpatient and post-acute care costs. Conclusions: These exploratory findings underscore the substantial economic burden of agitation in Alzheimer dementia and highlight the need for treatment options for the agitation in Alzheimer dementia population to improve associated health outcomes.

An exploration of spirituality and spiritual care with rehabilitation inpatients

Purpose The aim of this study was to explore spirituality in inpatient rehabilitation care from the patient’s perspective. Materials and methods Participants were recruited from three inpatient rehabilitation services in Sydney, Australia. A qualitative research design was adopted. Demographic data collected included religious affiliation, age and gender. Participants completed a short survey, where they indicated the level of acceptability for 14 items which could be used in a spiritual history. This was followed by a semi-structured interview where participants discussed how they would like to be asked about spirituality, and by whom. Results Eighteen participants were recruited (10 females, 8 males; mean age 68.8 years) and were undertaking either general rehabilitation (n = 9) or neurorehabilitation (spinal cord injury n = 6, traumatic brain injury n = 3). The impact of loss and existential struggle was evident for participants with long-lasting injuries. These participants could identify sources of spiritual strength which helped them engage with hardship and described how staff could facilitate access to these sources of strength. Conclusions Rehabilitation inpatients are willing to explore issues around spirituality. Staff can support inpatients to access sources of spiritual strength by creating a safe and trusting environment and finding out what is most meaningful to the patient.

Forecasting Patient Early Readmission from Irish Hospital Discharge Records Using Conventional Machine Learning Models

Background/Objectives: Predicting patient readmission is an important task for healthcare risk management, as it can help prevent adverse events, reduce costs, and improve patient outcomes. In this paper, we compare various conventional machine learning models and deep learning models on a multimodal dataset of electronic discharge records from an Irish acute hospital. Methods: We evaluate the effectiveness of several widely used machine learning models that leverage patient demographics, historical hospitalization records, and clinical diagnosis codes to forecast future clinical risks. Our work focuses on addressing two key challenges in the medical fields, data imbalance and the variety of data types, in order to boost the performance of machine learning algorithms. Furthermore, we also employ SHapley Additive Explanations (SHAP) value visualization to interpret the model predictions and identify both the key data features and disease codes associated with readmission risks, identifying a specific set of diagnosis codes that are significant predictors of readmission within 30 days. Results: Through extensive benchmarking and the application of a variety of feature engineering techniques, we successfully improved the area under the curve (AUROC) score from 0.628 to 0.7 across our models on the test dataset. We also revealed that specific diagnoses, including cancer, COPD, and certain social factors, are significant predictors of 30-day readmission risk. Conversely, bacterial carrier status appeared to have minimal impact due to lower case frequencies. Conclusions: Our study demonstrates how we effectively utilize routinely collected hospital data to forecast patient readmission through the use of conventional machine learning while applying explainable AI techniques to explore the correlation between data features and patient readmission rate.

Caregivers’ Mastery in Handling Gastrostomy at Home after Educational Intervention: Qualitative Descriptive Study

Background: Effective hospital discharge planning is crucial, particularly in educating caregivers on handling medical devices. This education helps manage the patient’s signs and symptoms, prevents post-discharge complications, and reduces early readmissions. This study aimed to understand aspects involved in the acquisition of mastery by home caregivers, in handling care of a patient who just underwent gastrostomy, after educational intervention during hospitalization and telemonitoring upon return home. Methods: Qualitative descriptive study. It followed 15 caregivers of people with percutaneous endoscopic gastrostomy. The intervention took place between November 2022 and July 2023 in the neuromusculoskeletal unit of a Brazilian university hospital. Results: The educational intervention had four stages. In stage 1, caregivers felt confused and uncertain about managing PEG. By stage 2, they expressed a desire to be capable of handling care, especially in the event of potential complications, and showed increased awareness and engagement. Stage 3 highlighted the effectiveness of hands-on training with feedback from professionals. In stage 4, during monitoring, several complications were noted, including granuloma formation in the stoma, tube obstruction, and accidental tube loss. However, caregivers demonstrated the ability to handle these situations, indicating the effectiveness of the training and telemonitoring interventions. Conclusions: Nursing professionals should consider various factors when training caregivers in a hospital setting, including providing adequate space, allocating sufficient time for educational interventions, offering both theoretical and practical demonstrations, ensuring effective communication, and taking into account the caregivers’ context, as they play a direct role in acquiring a safe and effective skill set.

Large-bore Mechanical Thrombectomy Versus Catheter-directed Thrombolysis in the Management of Intermediate-risk Pulmonary Embolism: Primary Results of the PEERLESS Randomized Controlled Trial.

There is a lack of randomized controlled trial (RCT) data comparing outcomes of different catheter-based interventions for intermediate-risk pulmonary embolism (PE). PEERLESS is a prospective, multicenter, RCT that enrolled 550 intermediate-risk PE patients with right ventricular dilatation and additional clinical risk factors randomized 1:1 to treatment with large-bore mechanical thrombectomy (LBMT) or catheter-directed thrombolysis (CDT). The primary endpoint was a hierarchal win ratio (WR) composite of the following: 1) all-cause mortality, 2) intracranial hemorrhage, 3) major bleeding, 4) clinical deterioration and/or escalation to bailout, and 5) postprocedural intensive care unit (ICU) admission and length of stay, assessed at the sooner of hospital discharge or 7 days post-procedure. Assessments at the 24-hour visit included respiratory rate, mMRC dyspnea score, NYHA classification, right ventricle (RV)/left ventricle (LV) ratio reduction, and RV function. Endpoints through 30 days included total hospital stay, all-cause readmission, and all-cause mortality. The primary endpoint occurred significantly less frequently with LBMT vs CDT (WR 5.01 [95% CI: 3.68-6.97]; P<0.001). There were significantly fewer episodes of clinical deterioration and/or bailout (1.8% vs 5.4%; P=0.04) with LBMT vs CDT and less postprocedural ICU utilization (P<0.001), including admissions (41.6% vs 98.6%) and stays >24 hours (19.3% vs 64.5%). There was no significant difference in mortality, intracranial hemorrhage, or major bleeding between strategies, nor in a secondary WR endpoint including the first 4 components (WR 1.34 [95% CI: 0.78-2.35]; P=0.30). At the 24-hour visit, respiratory rate was lower for LBMT patients (18.3±3.3 vs 20.1±5.1; P<0.001) and fewer had moderate to severe mMRC dyspnea scores (13.5% vs 26.4%; P<0.001), NYHA classifications (16.3% vs 27.4%; P=0.002), and RV dysfunction (42.1% vs 57.9%; P=0.004). RV/LV ratio reduction was similar (0.32±0.24 vs 0.30±0.26; P=0.55). LBMT patients had shorter total hospital stays (4.5±2.8 vs 5.3±3.9 overnights; P=0.002) and fewer all-cause readmissions (3.2% vs 7.9%; P=0.03), while 30-day mortality was similar (0.4% vs 0.8%; P=0.62). PEERLESS met its primary endpoint in favor of LBMT vs CDT in treatment of intermediate-risk PE. LBMT had lower rates of clinical deterioration and/or bailout and postprocedural ICU utilization compared with CDT, with no difference in mortality or bleeding.

Strengths and weaknesses of computerized clinical decision support systems: insights from a digital control center (C3 COVID-19) for early and personalized treatment for COVID-19.

Clinical Decision Support Systems (CDSS) are computer-based tools that leverage the analysis of large volumes of health data to assist healthcare professionals in making clinical decisions, whether preventive, diagnostic, or therapeutic. This review examines the impact of CDSS on clinical practice, highlighting both their potential benefits and their limitations and challenges. We detail the experience of clinical medical professionals in the development of a virtual control center for COVID-19 patients (C3 COVID-19) in Spain during the SARS-CoV-2 pandemic. This tool enabled real-time monitoring of clinical data for hospitalized COVID-19 patients, optimizing personalized and informed medical decision-making. CDSS can offer significant advantages, such as improving the quality of inpatient care, promoting evidence-based clinical and therapeutic decision-making, facilitating treatment personalization, and enhancing healthcare system efficiency and productivity. However, the implementation of CDSS presents challenges, including the need for physicians to become familiar with the systems and software, and the necessity for ongoing updates and technical support of the systems.

Omission of intraoperative drain placement during robotic partial nephrectomy and robotic radical prostatectomy is safe: an analysis of 18,000 patients

PurposePlacement of a drain during robotic assisted partial nephrectomy (RAPN) and robotic assisted radical prostatectomy (RARP) is standard practice for many urologists and can aid in assessment and management of complications such as urine leak, lymphocele, or bleeding. However, drain placement can cause discomfort and delay patient discharge, with questionable benefit. We aim to assess the correlation between drain placement with post operative complications.MethodsThe NSQIP targeted database was queried for patients who underwent RAPN or RARP from 2019 to 2021. Our primary outcomes included 30-day complication rates stratified by intraoperative drain placement. Secondary outcomes included procedure-specific complications, length of stay (LOS), and readmissions. Multivariable regression analyses, with Bonferroni correction, were performed for each post-operative complication.ResultsWe identified 4738 and 13,948 patients who underwent RAPN and RARP, respectively. Drains were not placed in 2258 (47.7%) and 6700 (48%) patients, respectively. On adjusted multivariable analysis in the RAPN cohort, omission of drain placement was associated with decreased LOS (β -0.45; 99.58% CI [-0.59, -0.32]) but no difference in overall complication rates. After adjusted analysis in the RARP cohort, omission of drain placement was associated with decreased risk of any complication (OR 0.73 [0.62–0.87]), infectious complication (OR 0.66 [0.49–0.89]), and LOS (β -0.30 [-0.37, -0.24]).ConclusionsUsing a large contemporary database, this study demonstrates that omission of drains during RAPN and RARP was safe without increased risk of postoperative complications. Despite inherent selection bias in this cohort, our data suggests that routine drain placement is not necessary for these procedures.

Using Existing Clinical Data to Measure Older Adult Inpatients’ Frailty at Admission and Discharge: Hospital Patient Register Study

Background Frailty is a widespread geriatric syndrome among older adults, including hospitalized older inpatients. Some countries use electronic frailty measurement tools to identify frailty at the primary care level, but this method has rarely been investigated during hospitalization in acute care hospitals. An electronic frailty measurement instrument based on population-based hospital electronic health records could effectively detect frailty, frailty-related problems, and complications as well be a clinical alert. Identifying frailty among older adults using existing patient health data would greatly aid the management and support of frailty identification and could provide a valuable public health instrument without additional costs. Objective We aim to explore a data-driven frailty measurement instrument for older adult inpatients using data routinely collected at hospital admission and discharge. Methods A retrospective electronic patient register study included inpatients aged ≥65 years admitted to and discharged from a public hospital between 2015 and 2017. A dataset of 53,690 hospitalizations was used to customize this data-driven frailty measurement instrument inspired by the Edmonton Frailty Scale developed by Rolfson et al. A 2-step hierarchical cluster procedure was applied to compute e-Frail-CH (Switzerland) scores at hospital admission and discharge. Prevalence, central tendency, comparative, and validation statistics were computed. Results Mean patient age at admission was 78.4 (SD 7.9) years, with more women admitted (28,018/53,690, 52.18%) than men (25,672/53,690, 47.81%). Our 2-step hierarchical clustering approach computed 46,743 inputs of hospital admissions and 47,361 for discharges. Clustering solutions scored from 0.5 to 0.8 on a scale from 0 to 1. Patients considered frail comprised 42.02% (n=19,643) of admissions and 48.23% (n=22,845) of discharges. Within e-Frail-CH’s 0-12 range, a score ≥6 indicated frailty. We found a statistically significant mean e-Frail-CH score change between hospital admission (5.3, SD 2.6) and discharge (5.75, SD 2.7; P&lt;.001). Sensitivity and specificity cut point values were 0.82 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.85. Comparing the e-Frail-CH instrument to the existing Functional Independence Measure (FIM) instrument, FIM scores indicating severe dependence equated to e-Frail-CH scores of ≥9, with a sensitivity and specificity of 0.97 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.92. There was a strong negative association between e-Frail-CH scores at hospital discharge and FIM scores (rs=–0.844; P&lt;.001). Conclusions An electronic frailty measurement instrument was constructed and validated using patient data routinely collected during hospitalization, especially at admission and discharge. The mean e-Frail-CH score was higher at discharge than at admission. The routine calculation of e-Frail-CH scores during hospitalization could provide very useful clinical alerts on the health trajectories of older adults and help select interventions for preventing or mitigating frailty.

Economic burden of suicide in Sweden in 2022

Abstract Background Suicide and suicidal behaviors bring massive human, social and economic impacts. Estimates of the cost of suicide can give some guidance as to where research on developing new interventions might be focused to give the greatest potential gain. The aim of the study is to quantify the economic cost of suicide in Sweden in 2022. Methods Incidence of suicide attempts and mortality due to suicide, intentional and undetermined (ICD10 X60-X84 and Y10-Y34) were sourced from the Swedish National Board of Health and Welfare databases for 2022. Cost were estimated from a societal perspective, including costs for inpatient and outpatient care, medication, police and justice activities as well as productivity losses due to early mortality. Results In 2022, a total of 1,569 suicide death were registered in Sweden (1,102 men and 467 women). The incidence rate remains stable during the last ten years, 17 death per 100 000. In total, 18,854 patients (10, 359 women and 8,459 men) were treated in inpatient and outpatient hospital care with suicide-related diagnoses, generated 32,843 days in inpatient care and 11,471 outpatient care visits. Direct costs for suicide death including forensic examination, emergency services, police investigation and property damage were estimated as €6,02 million, while indirect costs for productivity losses totaled €690 million. Direct healthcare costs for suicide related treatment were estimated at €54.3 million. Overall, suicide and suicide attempts cost around €750 million per year to society. Conclusions Estimates of the economic burden of suicide are needed for the Swedish setting, and these amounted to €60.3 million in direct costs and €690 million in indirect costs in 2022. The cost might be underestimated because the societal cost of suicide bereaved persons was not considered. These cost estimates can provide useful inputs to a cost-effectiveness analysis of a specific preventive intervention, and to its subsequent evaluation. Key messages • Economic burden of suicide is substantial for society. • Public health policies aimed at the prevention of suicide should be increased.