Medical Inpatients Research Articles

Enhancing interprofessional ward rounds by identifying factors associated with low satisfaction and efficiency: a quantitative and qualitative national survey of Swiss healthcare professionals

AIMS OF THE STUDY: Interprofessional ward rounds are a cornerstone of patient-centred care for medical inpatients and offer opportunities to discuss and coordinate patient treatment and further management. We aimed to identify factors associated with lower satisfaction and efficiency of interprofessional ward rounds, as reported by physicians and nurses. METHODS: An anonymous Swiss nationwide online survey of physicians and nurses was conducted in 28 Swiss internal medicine inpatient departments between 9 August and 19 October 2023. Analyses were conducted from November to December 2023. The primary outcome was physicians’ and nurses’ perceived lower satisfaction with ward rounds, which was assessed using visual analogue scales ranging from 0 to 10, with lower satisfaction defined as scores below the median. The main secondary outcome was perceived lower efficiency using a similar definition. Qualitative analysis was performed through inductive thematic analysis. RESULTS: The survey had a response rate of 21.6% (547/2530). Of the 547 physicians and nurses included in the final analysis, the median satisfaction was 7 points (interquartile range [IQR] 6–8). A total of 61% of physicians (156/254) and 76% of nurses (224/293) reported lower satisfaction. Lower satisfaction was reported significantly more frequently by nurses (adjusted odds ratio [OR] 2.33, 95% confidence interval [CI] 1.58–3.43; p ≤0.001) and female team members (adjusted OR 1.95, 95% CI 1.32–2.9; p <0.01). The median perceived efficiency of ward rounds was 7 points (IQR 5–8), and the nursing profession was associated with lower perceived efficiency (adjusted OR 1.95, 95% CI 1.3–2.93; p <0.01). Adherence to in-house guidelines for ward rounds was associated with satisfaction (adjusted OR for lower satisfaction 0.25, 95% CI 0.16–0.39; p <0.001) and perceived efficiency (adjusted OR for lower efficiency 0.27, 95% CI 0.17–0.43; p <0.001). Both physicians and nurses preferred to perform ward rounds as part of an interprofessional team. The qualitative analysis of the data revealed a preference for structured interprofessional ward rounds and the active involvement of nurses. CONCLUSIONS: This survey revealed an overall high preference for interprofessional ward rounds. In addition, we identified several factors that were associated with lower satisfaction and efficiency. Structured in-house protocols for ward rounds may increase the satisfaction and efficiency of interprofessional collaboration during ward rounds.

Same-day emergency care: a retrospective observational study of the incidence and predictors of venous thromboembolism following hospital-based acute ambulatory medical care.

Same-day emergency care (SDEC) is an expanding area of hospital acute medical care. It aims to minimize delays and manage medical emergency patients within the same day, enabling hospitalization to be avoided; the expectation is that the patients would have required inpatient hospitalization in the absence of the SDEC service. Venous thromboembolism (VTE) prevention is a key medical inpatient safety measure. Whether VTE prevention should be considered for SDEC patients is unknown. To examine the incidence and predictors of VTE diagnosed within 90 days of SDEC assessment. Data were obtained from electronic health records of people who received SDEC at our hospital during a 5-year period (April 2016 to March 2021). There were 40 045 attendance episodes by 33 715 individuals. Median age was 60 years (IQR, 41.0-76.0 years), and 55.2% were women. Three hundred forty-nine patients (0.9%) developed a VTE within 90 days of SDEC. Increased risk of VTE was associated with age more than 60 years, prior malignancy (adjusted odds ratio [OR], 4.12; 95% CI, 3.19-5.32; P< .0001), history of diseases of the circulatory system (adjusted OR, 2.92; 95% CI, 2.27-3.76; P< .0001), and having 1 or more additional SDEC attendances within 30 days (adjusted OR, 4.61; 95% CI, 3.65-5.82; P< .0001). In the 90 days prior to VTE diagnosis, 36.6% of patients had a separate inpatient admission in addition to SDEC. There was no association with completion of an electronic VTE risk assessment (adjusted OR, 0.96; 95% CI, 0.76-1.20). The incidence of VTE following SDEC is similar to that reported for symptomatic VTE in traditional medical inpatients without thromboprophylaxis.

EFFECT MODIFICATION OF AGE AND SEX BETWEEN AORTIC CALCIFICATION AND MORTALITY IN A COMMUNITY SAMPLE OF OLDER PATIENTS

Abstract Abdominal aortic calcification (AAC) is a useful cardiovascular risk assessor in opportunistic screening. As cardiovascular risk changes with increasing age, effective AAC use depends on understanding influential factors on AAC and mortality. This study evaluated modification of age and sex on the relationship between aortic calcification and mortality. This sample includes 6647 Michigan Medicine patients age ≥ 65 years, without cardiovascular disease, and who received an abdominal computed tomography scan between 1999-2022. AAC was elevated if calcification exceeded 19.26% of the aortic wall at the L3 vertebral level. Cox regression was used to assess AAC and mortality (adjusted for body mass index and Charlson Comorbidity Index) and stratified by age group (65-79, 80+ years) and sex. In the sample, 18.3% (n=1219) were 80+ years and the mortality rate was 38.0%. Those with elevated AAC had 99% higher mortality hazard than those with unelevated AAC [HR 1.99 (95% CI 1.66, 2.41)]. A statistically significant interaction was observed between age category, sex, and AAC status. Among patients 80+ years, elevated AAC was protective for mortality [HR 0.79 (95% CI 0.62, 0.98)]. Further, elevated AAC was associated with 35% lower mortality hazard in females age 80+ [HR 0.65 (95% CI 0.46, 0.92)] but was not significant in males age 80+. Important effect modification by age and sex exists on the relationship between AAC and mortality. This suggests the impact of AAC as a risk factor for mortality may decrease with age and be less important in 80+ year old females relative to males.

Trustworthiness of a machine learning early warning model in medical and surgical inpatients

Abstract Objectives In the general hospital wards, machine learning (ML)-based early warning systems (EWSs) can identify patients at risk of deterioration to facilitate rescue interventions. We assess subpopulation performance of a ML-based EWS on medical and surgical adult patients admitted to general hospital wards. Materials and Methods We assessed the scores of an EWS integrated into the electronic health record and calculated every 15 minutes to predict a composite adverse event (AE): all-cause mortality, transfer to intensive care, cardiac arrest, or rapid response team evaluation. The distributions of the First Score 3 hours after admission, the Highest Score at any time during the hospitalization, and the Last Score just before an AE or dismissal without an AE were calculated. The Last Score was used to calculate the area under the receiver operating characteristic curve (ROC-AUC) and the precision-recall curve (PRC-AUC). Results From August 23, 2021 to March 31, 2022, 35 937 medical admissions had 2173 (6.05%) AE compared to 25 214 surgical admissions with 4984 (19.77%) AE. Medical and surgical admissions had significant different (P &amp;lt;.001) distributions of the First Score, Highest Score, and Last Score among those with an AE and without an AE. The model performed better in the medical group when compared to the surgical group, ROC-AUC 0.869 versus 0.677, and RPC-AUC 0.988 versus 0.878, respectively. Discussion Heterogeneity of medical and surgical patients can significantly impact the performance of a ML-based EWS, changing the model validity and clinical discernment. Conclusions Characterization of the target patient subpopulations has clinical implications and should be considered when developing models to be used in general hospital wards.

‘The upside-down’ healthcare professional students’ experiences of delirium: an all-Ireland focus group study

BackgroundDelirium is a complex neuropsychiatric syndrome characterised by an acute state of confusion, with a substantial impact on medical inpatients. Despite its growing recognition as a global healthcare concern, delirium remains underdiagnosed, partly due to a lack of awareness among healthcare professionals. The aim of this study was to explore how healthcare professional students experience caring for individuals experiencing delirium, the influence of their current pre-registration healthcare education, and importance of interprofessional teamwork in their role.MethodsThis qualitative study used a focus group approach to collect data from 40 healthcare professional students, including nursing, pharmacy, and medical students, across two universities in Ireland. The focus groups explored participants’ experiences of caring for people with delirium, their delirium education, and their collaboration with interdisciplinary teams. The data were analysed using a reflexive thematic analysis approach.ResultsFollowing thematic analysis, three themes are reported. The first is “The Upside Down,” revealing student perceptions of caring for people with delirium who are facing distressing situations. The second team reported is, “Teamwork Makes the Dream Work,” emphasising the critical role of interprofessional collaboration in delirium management and patient outcomes. Finally, the theme of “A Little Is Not Enough,” highlighted students’ critiques of current delirium education in their pre-registration training. Collectively, these themes illuminate challenges in delirium care, advocate for teamwork in healthcare settings, and call for improvements in educational preparation for future healthcare professionals.ConclusionsThis study contributes to the existing literature by providing insights into the perspectives of healthcare professional students on delirium care. The findings also highlight the challenging nature of caring for individuals with delirium and the need for improved delirium education and interdisciplinary collaboration.

Prediction of human disease complication incorporating machine learning and local network structures

Abstract Complications have long haunted physicians and patients in clinical medicine. However, the evaluation of complications caused by specific diseases is typically relied on the experience of clinicians or clinical cases. Especially, vast complication diseases involve multiple human body systems, increasing the difficulty of the clinical confirmation. Based on a large scale human disease complication network extracted from the clinical medicine knowledge database, we propose a nonlinear model combined local topological structures and machine learning to explore latent disease-complication relations. As an example, we apply the model to predict unidentified complications of COVID-19 and to detect potential extrapulmonary complications which are significant in the post-pandemic period. Our approach provides an efficient method to identify the candidate complications from the structure of complex network.

Portable Medical Orders and Inpatient Cost at End of Life in Acute Myeloid Leukemia and Myelodysplastic Syndromes.

We previously demonstrated that early completion of portable medical orders, known as Medical Orders for Life-Sustaining Treatment (MOLST), was associated with lower-intensity care at the end of life (EOL) for patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). The purpose of this study was to investigate the impact of a MOLST form completed before hospitalization on the cost of inpatient care during the last 30 days of life for patients with AML and MDS. We conducted a retrospective study of 271 adult patients with a diagnosis of AML or MDS who died between January 1, 2014, and December 31, 2019, and received care for their hematologic malignancy at the University of Rochester Medical Center (URMC). Costs were hospital charges for inpatient care at URMC. Nonparametric Wilcoxon rank-sum tests were used to compare costs between diagnosis and age subgroups (AML v MDS, ≥60 years old v <60 years old). A multivariate linear regression model was used to assess the association of MOLST form completion before hospitalization (v not) with cost of inpatient care. Among patients hospitalized within the last 30 days of life (n = 229), the median cost of inpatient care within the last 30 days of life was $24,054 in US dollars (USD). Median cost was lower for patients who completed a MOLST form before hospitalization than for patients who had not ($17,808 v $33,283 USD; P < .0001). On multivariate analysis, completion of a MOLST form before hospitalization was associated with lower cost of inpatient care (, -.65; SE, 0.16; P < .0001). Completion of a MOLST form before hospitalization was associated with lower inpatient costs at EOL for patients with AML and MDS.

Incidence, Risk Factors, and Outcomes of Thrombocytopenia in Older Medical Inpatients: A Prospective Cohort Study.

Thrombocytopenia, defined as a platelet count of less than 150 × 109/L, is a frequent condition among hospitalized patients and presents unique challenges in diagnosis and management. Despite its commonality, data on incidence and related risk factors in medical inpatients remain limited, especially in older people. A 2-year prospective cohort study with a 3-year follow-up was conducted on inpatients aged ≥65 years admitted to a medical ward. Clinical data were collected, including demographics, comorbidities, laboratory results, and outcomes. Multivariate logistic regression analysis assessed risk factors associated with non-resolution of thrombocytopenia and mortality. The study included 961 older inpatients with a mean age of 82 years. Thrombocytopenia occurred in 22.6% of the study population. The most common causes were infections (57.4%) and drug-induced thrombocytopenia (25.3%). The non-resolution of thrombocytopenia was noted in 59% of patients. In-hospital and 3-year mortality was significantly higher in this subgroup compared to the rest (24.5% vs. 12.7%, p = 0.015) and (72.4% vs. 59.8%, p = 0.04, respectively). In multivariate analysis, nadir platelet count and hematologic disease were independent factors associated with the non-resolution of thrombocytopenia. Furthermore, in individuals with thrombocytopenia, the administration of norepinephrine (p < 0.001) and a higher clinical frailty score (p < 0.001) were observed as independent mortality predictors. Thrombocytopenia in older medical inpatients is associated with poor prognosis, particularly in those with non-resolution thrombocytopenia. Early identification and targeted management may improve outcomes.

Upper Limb Deep Venous Thrombosis Associated With Peripherally Inserted Central Catheters in Hospitalised Surgical Patients.

Introduction Surgical inpatients frequently require peripherally inserted central catheters (PICCs) for parenteral feeding and administration of medication. PICCs may cause upper limb deep venous thrombosis (ULDVT), which impacts patient morbidity. We investigated the risk and prevention of PICC-ULDVT in hospitalised surgical inpatients. Methods We conducted a retrospective analysis of 168 consecutive surgical inpatients who received a PICC over the same four-year period. Data from 136 additional consecutive general medical inpatients with PICCs over the same period were included for comparison. We observed and compared the incidence of ULDVT confirmed on dedicated upper limb venous imaging in the cohort of surgical patients compared to a time matched cohort of medical patients. We extracted data including patient demographics, details of admission, and insertion site of the PICC from the hospital electronic notes. Results The incidence of ULDVT in surgical patients was 4.7% compared to 1.5% in medical patients despite increased age (p=0.001) and comorbidity burden (p=0.001) in the latter group. Ninety percent of surgical patients had abdominal surgery within 30 days of PICC placement. Regression multivariate analysis identified concurrent cancer (p=0.048), median Charlson Comorbidity Index (CCI) (p=0.034), admission with malignant bowel obstruction (p=0.002), and catheter insertion into the brachial vein (p=0.033) as significant risk factors for PICC-ULDVT in hospitalised surgical patients. Standard pharmacological venous thromboembolic events (VTE) prophylaxis, as per national guidelines, did not reduce the risk of PICC-ULDVT. Conclusion Our study indicates that surgical inpatients are at greater risk of developing PICC-associated upper limb deep vein thrombosis (ULDVT) compared to medical inpatients, with limited evidence supporting the effectiveness of pharmacological thromboprophylaxis in reducing this risk. PICCs should be used with caution in patients with cancer, cancer-related bowel obstruction, and surgical patients with a higher comorbidity index. PICCs inserted via the basilic vein may reduce ULDVT risk, but further studies are needed on the preferential site of insertion in surgical patients.

Novel photopeak-independent correction method for internal activity calculation of 99mTc: a simulation study.

This paper presents a new method for correcting the contribution of scattered radiation to the measurement of 99mTc internal activity in nuclear medicine patients using gamma cameras. So, this study aims to derive scattering correction factors by Monte Carlo simulation for anterior and posterior count rates (${I}_{\mathrm{A}}$ and ${I}_{\mathrm{P}}$) in the conjugate view method, enabling more precise estimation of activity A(t) compared to traditional trapezoidal and triangular approximations. The new approach eliminates the need to use photopeak for determining the fraction of scattered photons. Our results showed differences of <3% with respect to the real activity and 11% for the trapezoidal and triangular approaches.

Pharmacist-initiated naloxone discharge prescribing for high-risk hospitalized internal medicine patients.

Pharmacists nationwide may play a critical role in expanding naloxone access after several states enacted legislation to allow pharmacist prescribing of opioid antagonists. This created a unique opportunity for inpatient pharmacists to participate in combating the opioid epidemic by prescribing naloxone at hospital discharge. A multifaceted intervention was developed to identify and educate hospitalized patients eligible for naloxone prescribing. After implementation, 22 of 40 eligible patients (55 percent) were prescribed naloxone by inpatient pharmacists during the 3-month study period. With this pharmacist-driven intervention, there was an 848 percent increase in the number of hospitalized chronic opioid patients with naloxone prescriptions on discharge.

Assessing the impact of workload and clinician experience on patient throughput: A multicenter study.

Various strategies have attempted to address increased patient lengths of stay (LOS), but effectiveness varies. Factors related to work design and workforce experience may also play significant roles. Utilizing data from the Discharge in the A.M. trial, we aimed to validate an electronic measure of workload (i.e., note count) and assess the relationship of workload, patient complexity, and physician years of experience to LOS. Retrospective observational study at three large academic hospitals with hospital medicine physicians and patients they care for during the study. Workload as measured by electronic note count and physician years of experience; patient LOS. From February 9, 2021 to July 31, 2021, 59 physicians completed daily surveys for 93% of 2318 scheduled shifts. We observed a moderate correlation (r: .56) between starting morning census and note counts but no association with LOS. We observed an effect modification between note count and the Charlson Comorbidity Index (CCI), with LOS increasing by 2.3% (95% CI: 0.3%, 4.3%; p = .02) and 3.9% (95% CI: 2.0%, 5.9%; p < .0001) per patient for every 1 unit increase in note count for patients with a moderate CCI or severe CCI, respectively. Years since training was associated with a 0.7% decrease in LOS (95% CI: -1.3%, -0.1%, p = .03). Physician workload, as measured by note count, was associated with longer LOS with higher CCI, while more years of experience was associated with shorter LOS. Original Clinical Trial Registration: ClinicalTrials.gov number, NCT05370638.

Traditional Chinese medicine combined with chemotherapy for breast cancer after operation: A systematic review and meta-analysis.

This systematic review aims to explore the effect of traditional Chinese medicine combined with chemotherapy on the clinical efficacy of breast cancer postoperative patients, providing theoretical basis for the treatment of breast cancer postoperative patients with traditional Chinese medicine. A comprehensive search was conducted on databases such as China National Knowledge Infrastructure, Wanfang Database, VIP Database, Chinese Biomedical Literature Database, PubMed, and the Cochrane Library from their inception to August 2023 to screen RCTs comparing the effect of traditional Chinese medicine combined with chemotherapy with that of chemotherapy alone on the clinical efficacy of breast cancer postoperative patients. The included literature was systematically reviewed. A total of 22 RCTs involving 1834 breast cancer postoperative patients were finally included, with 918 patients in the traditional Chinese medicine combined with chemotherapy group (treatment group) and 916 patients in the chemotherapy alone group (control group). Meta-analysis showed that compared with the control group, therapeutical effective rate, CD3, CD4, CD4/CD8, and adverse reactions in the treatment group were all improved, and the incidence of leukopenia and thrombocytopenia after chemotherapy were all reduced, with statistically significant differences. Traditional Chinese medicine combined with chemotherapy is superior to chemotherapy alone in improving the therapeutical effective rate after breast cancer surgery, reducing chemotherapy adverse reactions, and enhancing immune function.

Effect of goal-directed mobilisation versus standard care on physical functioning among medical inpatients: the GoMob-in randomised, controlled trial

ObjectiveTo assess the effect of goal-directed mobilisation (GDM) on physical functioning in medical inpatients.DesignRandomised, controlled, single-centre, parallel, superiority trial with a 3-month follow-up and blinded outcome assessment.SettingGeneral internal medicine wards...

Prevalence, associated factors, and impact of vitamin B12 deficiency in older medical inpatients.

This retrospective cohort study aims to explore the prevalence of vitamin B12 deficiency in older hospitalized adults and identify key factors associated with this deficiency, as well as its impact on frailty and functional decline. Data were collected from older adults (≥65years) sequentially admitted to the Internal Medicine Department of a tertiary university hospital. Clinical and laboratory characteristics, including age, sex, somatometric data, cause of admission, past medical history, chronic medication use, and laboratory tests, were recorded. Frailty and functional status were assessed using the Fried Frailty Scale (FFS), Clinical Frailty Scale (CFS), Barthel Index, and Katz Index. Vitamin B12 levels on admission were categorised as deficient (<200pg/ml), borderline (200-300pg/ml), normal (300-999pg/ml), and high (≥1000pg/ml). A total of 894 patients were included. The median age was 83years and 487 (54.5%) were females. The prevalence of vitamin B12 deficiency was found in 9.1%, while 17.3% of the sample had borderline levels. Multivariate analysis identified polypharmacy (≥5 drugs), low albumin levels/Geriatric Nutritional Risk Index (GNRI), and nursing home residency as independent factors associated with low B12 levels. Multivariate analyses showed that B12 deficiency was significantly associated with higher frailty rates and lower functional status. Vitamin B12 deficiency is prevalent among hospitalized older patients and is significantly associated with increased frailty and reduced functional status. These findings underscore the importance of routine screening for B12 deficiency in this vulnerable population to improve clinical outcomes and quality of life.

Putting skin in the game: a descriptive study of lower extremity ulcers in general medical inpatients.

Lower extremity ulcers contribute a significant burden to patient care. Targeted investigation and management are pertinent to improving patient outcomes. We evaluated the aetiology, risk factors, investigations and management of lower extremity ulcers in general medicine patients. There was evidence of under-ordering of appropriate investigations, and over-treatment for infection. We proposed a quality improvement initiative to optimise lower extremity ulcer care.

Association of phenylalanine and tyrosine metabolism with mortality and response to nutritional support among patients at nutritional risk: a secondary analysis of the randomized clinical trial EFFORT.

Elevated phenylalanine serum level is a surrogate marker of whole-body proteolysis and has been associated with increased mortality in critically ill patients. Tyrosine is a metabolite of phenylalanine and serves as a precursor of thyroid hormones and catecholamines with important functions in the oxidative stress response among others. Herein, we examined the prognostic significance of phenylalanine, tyrosine, as well as its metabolites nitrotyrosine, L-3,4-dihydroxyphenylalanine (DOPA), and dopamine regarding clinical outcomes and response to nutritional therapy in patients at nutritional risk. This is a secondary analysis of the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), a randomized controlled trial investigating individualized nutritional support compared to standard care in patients at risk of malnutrition. The primary outcome was 30-day all-cause mortality. We analyzed data of 238 patients and found a significant association between low plasma levels of phenylalanine [adjusted HR 2.27 (95% CI 1.29 to 3.00)] and tyrosine [adjusted HR 1.91 (95% CI 1.11 to 3.28)] with increased 30-day mortality. This association persisted over a longer period, extending to 5 years. Additionally, trends indicated elevated mortality rates among patients with low nitrotyrosine and high DOPA and dopamine levels. Patients with high tyrosine levels showed a more pronounced response to nutritional support compared to patients with low tyrosine levels (HR 0.45 versus 1.46, p for interaction = 0.02). In medical inpatients at nutritional risk, low phenylalanine and tyrosine levels were associated with increased short-and long-term mortality and patients with high tyrosine levels showed a more pronounced response to nutritional support. Further research is warranted to gain a deeper understanding of phenylalanine and tyrosine pathways, their association with clinical outcomes in patients at nutritional risk, as well as their response to nutritional therapy. www.clinicaltrials.gov, identifier NCT02517476.

Outcomes of Universal Suicide Risk Screening in Medical Inpatients

Objectives Universal screening for suicide risk has not been shown to reduce suicide rates or reliably predict suicide, but there have been few studies assessing other potential benefits of this practice. We aimed to investigate the feasibility of implementing a universal inpatient suicide risk screening protocol and determine if a positive suicide screen was predictive of the need for psychiatric admission, and if it reduced the length of stay prior to psychiatric admission. Methods We conducted a retrospective chart review of non-psychiatric admissions over 1 year at a tertiary care academic hospital. We calculated the proportion of patients screening positive for suicidal ideation (SI), and among those screening positive, the proportion receiving a psychiatric consult and being admitted to psychiatry. Length of stay among groups was determined. We performed chi square analysis and adjusted multivariate logistic regression comparing different demographics. Results 97.2% of patients were screened, with 2.6% screening positive. Of these patients, 44.6% received a psychiatric consultation and 9.2% were admitted to psychiatry. Psychiatric admissions who screened positive for SI averaged 5.7 days until transfer to psychiatry, compared to 17.9 days for those who screened negative. Suicide risk screening had a sensitivity of 62.0%, specificity of 97.6%, positive predictive value of 9.2%, and a negative predictive value of 99.8% for psychiatric admission. Conclusions Universal suicide risk screening is feasible and may help identify patients requiring psychiatric care sooner, reducing length of stay of those requiring psychiatric admission.

The role of a Macmillan senior pharmacy technician in a regional cancer centre in Northern Ireland: an evaluation

Abstract Introduction In the UK, up to two-thirds of all cancer patients have at least one comorbidity, with around half having multiple long-term conditions (LTCs).1 Older people with cancer often require multiple medications including cancer-specific treatments, supportive care medications, and medications for pre-existing LTCs. They are therefore at higher risk of the adverse effects of polypharmacy, inappropriate prescribing, drug-drug interactions, and drug-disease interactions. Complexity of medication regimens and treatment burden can cause confusion and medicines mismanagement, thereby influencing a patient's ability to adhere to treatment with the outcome being an increased chance of treatment failure. It is thus essential that medicines be optimised in these patients.2 The Oncology Pharmacy Team based in the North West Cancer Centre, located on the Altnagelvin acute hospital site in the Western Health and Social Care Trust, Northern Ireland, secured Macmillan funding to provide a specialist medicines optimisation service to older patients about to start cancer treatment (the Medicines Optimisation in Older People with Cancer [MOOC] Service). A pharmacy technician and pharmacist were recruited and the service implemented from October 2023. The roles are new and innovative and require extensive evaluation. Aim To evaluate the introduction of the Macmillan senior pharmacy technician into the oncology pharmacy team, analysing impact on medicines optimisation and patient safety. Methods A census approach was taken to include all patients with a new cancer diagnosis and medicines reconciliation (MedRec) completed by the pharmacy technician during the study period. The technician identified and rectified any issues prior to the patient’s first scheduled treatment. Patients with significant medicines-related concerns, or aged ≥65 years and taking ≥8 drugs, were referred to the Macmillan pharmacist for holistic medication review. Data collected included number of MedRecs completed by the pharmacy technician (relative to total completed by the team weekly), cancer diagnosis, medicines-related problems identified, interventions made, other activities completed, and time directed away from the pharmacist. Analysis of patient age and number of medications taken informed whether inclusion criteria for MOOC pharmacist referral were appropriate. Results The specialist medicines optimisation service started in October 2023, however, data collection for the purpose of this study commenced on 1st January and took place over a two-month period.101 patients (aged 69.0 ± 5.7 years, range 57 -74 years)) taking an average of 12.6 medicines (range = 8-18), and recently diagnosed with cancer were reviewed by the pharmacy technician. On average, the technician completed 76.4% of medicines reconciliations each week. 120 medicines-related problems were identified, and 178 interventions made. The service yielded net cost savings of £826.34 (pharmacist time saved). Nine patients were referred to the MOOC pharmacist service; a further five patients did not consent to referral. Discussion / Conclusion Although the evaluation of the MOOC service is ongoing, this interim analysis demonstrated that integration of the pharmacy technician into the oncology team yielded cost savings and reduced and improved provision of patient-centred healthcare and safety. Inclusion criteria for the MOOC pharmacist review were confirmed via analysis of patient age and number of medicines taken.

Association of physical function with hospital readmissions among older adults: A systematic review.

Hospital readmissions pose significant burdens on healthcare systems, particularly among older adults. While efforts to reduce readmissions have historically focused on medical management, emerging evidence suggests physical function may also play a role in successful care transitions. However, there is a limited understanding of the relationship between functional measures and readmission risk. This systematic review aims to assess the association between physical function impairments and hospital readmissions. This systematic review aims to assess the association between physical function impairments and hospital readmissions. A systematic review was conducted following PRISMA guidelines, with studies identified through databases including PubMed, CINAHL, Embase, and others published January 1, 2010-December 31, 2022. Inclusion criteria encompassed observational studies of adults aged 50 and older in the United States, reporting readmissions within 90 days of discharge and assessing physical function across domains of the International Classification of Function model. Data extraction and risk of bias assessment were independently conducted by two authors using theScottish Intercollegiate Guidelines Network (SIGN) tool. Seventeen studies, representing 80,008 participants, were included in this systematic review. Patient populations included a wide array of medical populations, including general medical inpatients and those undergoing cardiac surgery. Across various functional measures assessed before or during admission, impairments were consistently associated with increased risk for hospital readmissions up to 90 days after admission. Measures of participation, including life-space mobility, were also associated with increased readmission risk. Functional impairments are robust predictors of hospital readmissions in older adults. Routine assessment of physical function during hospitalization can improve risk stratification and may support successful care transitions, particularly in older adults.