Post-hospital Discharge Research Articles

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Int J Cardiovasc Sci. 2022 Issue vol 33(2), pages 175-184. In Original Article “Predictors of Post-Discharge 30-Day Hospital Readmission in Decompensated Heart Failure Patients”, with DOI number: https://doi.org/10.36660/ijcs.20180088, published in International Journal of Cardiovascular Science, 33(2) in page 175-84. Correct the author’s name “Wayner Viera de Souza” to “Wayner Vieira de Souza”. […] ERRATUM

Managing the child born preterm after hospital discharge

ABSTRACT Given the prevalence of preterm birth, all pediatric speech-language pathologists (SLPs) will work with children who were born preterm. Although most children born preterm do not experience developmental problems, more will experience feeding and language problems, and, to a lesser extent, voice, and speech problems, than children born at term, often in the context of broader developmental and medical concerns. As SLPs examine, assess, and treat children who are preterm post-hospital discharge and into the early years of life and beyond, they will benefit from a more holistic understanding of this population’s developmental challenges across domains. In this review, we will discuss the medical, social, and developmental underpinnings to working with a child born preterm in addition to describing the background and current evidence for assessing and treating feeding, language, speech, voice, and fluency disorders in this population.

A Cross-Sectional Survey Reporting on the Value of Patient-Centered Ostomy Programs: A Smooth Transition After Ostomy Surgery.

PURPOSE:The purpose of the study was to evaluate a postsurgical ostomy patient support program in regard to postsurgical experience, education, skin care, pouching system and accessory use, insurance issues, supplier assistance, hospital readmission status, and the benefit of multiple interactions.DESIGN:Cross-sectional design.SUBJECTS AND SETTING:Potential respondents were randomly selected from a group of adults 18 years or older who underwent ostomy surgery within 6 months prior to survey completion. Nine hundred seventy-one individuals met inclusion criteria, and 297 were selected for analysis, based on having 1 or more program interactions. Data were collected between the second and third quarters of 2020. All participants were residents of the United States.METHODS:Participants were contacted by e-mail containing an invitation to participate in a survey; the e-mail also described the intent of the survey. Survey distribution was conducted by the sponsor and linked to a third-party survey management organization for compilation. The survey questionnaire, developed specifically for the purpose of this study, comprised 73 items that queried demographic and pertinent clinical data, participation in an industry-sponsored patient support program, and their post–hospital discharge experiences including unplanned health care provider visits, emergency department visits, and hospital readmissions.RESULTS:Eighty-three percent (n = 237) of respondents did not have postsurgical ostomy-related emergency department visits, 75% (n = 223) did not have related unplanned physician visits, and 90% (n = 268) did not have related hospitalizations. Participants with 2 or more interactions were more likely to contact a program representative for issues of stoma care, leakage and skin care, ostomy products/accessories, and supplier issues than their single-interaction counterparts.CONCLUSIONS:Study findings suggest that patients with new ostomies benefited from engagement in an industry-sponsored patient support program. The benefit appears to arise from personal interactions and respondents; 2 or more interactions were shown to have greater benefit than a single interaction.

Association of request for opioid medications refill after hospital discharge with race in patients with prostate cancer treated with robotic-assisted laparoscopic radical prostatectomy.

Request for refills of opioids is one of the indicators of possible misuse. We aimed to investigate racial variations in request for refills of opioids after hospital discharge from robotic-assisted laparoscopic radical prostatectomy (RALP). We conducted a retrospective study of a contemporary cohort of patients treated with RALP for prostate cancer and post-operative standardized pain control that employed nonopioid medications. Patients' request for refills of opioids (within 30 days) after discharge was examined, accounting for race, age, pain control after surgery, alcohol intake, marijuana consumption, pre-existing behavioral health diagnoses, and pre-existing chronic pain disorders using multivariate analysis. p-Value of < 0.05 was considered significant. We included a total of 282 adult patients in this study. African Americans (AA) patients comprised 24.5 percent of our post-prostatectomy individuals. Of the total cohort, 94.3 percent of patients reported adequate pain control in the hospital after surgery, and only 5.7 percent requested refills of opioid medications after discharge. No racial variations in request of refills were identified. Only pre-existing chronic pain disorders were found to be a significant predictor of requesting an opioid medication refill for pain control after discharge from the hospital. A combination of minimally invasive surgery and nonopioid heavy pain management leads to low level of post-hospital discharge request for refills of opioid medication in patients treated with RALP across racial groups. Awareness and better control of chronic pain perioperatively are needed to ensure better postdischarge pain control.

Abstract P342: Virtual Cardiac Rehabilitation For Heart Failure - Real World Experience Of Medication Adherence, Blood Pressure Control And Exercise Tolerance

Introduction: India has a high burden of young-onset heart failure owing to an increased incidence of ischemic heart disease(IHD) in young and older adults (&lt;60 years). Hypertension affects 207 million adults in India; less than 20% have controlled blood pressure. Cardiac rehabilitation (CR) effectively improves outcomes in patients with heart failure but is very scarce; there is only one spot for every 360 IHD patients/year, with more than 3 million CR spaces needed each year. Methods: Virtual cardiac rehabilitation is administered via a mobile application, Numen Health. This is a physician-led program delivered by a multi-disciplinary team of experts. The experts provide multi-faceted interventions for IHD patients, targeting increased medication adherence, behavior changes, reinforced lifestyle modification, blood pressure control through diet, exercise, and building mental resilience with continued care post-hospital discharge. Results: Between April 2021 and March 2022, 42 patients with low ejection fraction (LVEF&lt;45%) heart failure registered on the program. They represented nearly 10% of 426 IHD patients who had joined the program. Over a median duration of 90 days, target blood pressure control was achieved in 39/42 (93%). Zero hospital re-admissions were encountered; 17/42(40%) achieved improved cardiac and exercise tolerance compared to baseline exercise tolerance time. It had increased from 15 minutes to 30 minutes, 200% from baseline. The median MET score on day 90 was 13 (9-17). Physical activity duration per week increased; to 90 minutes on average; It had risen from the ability to do for &lt;5 minutes at baseline. Medication adherence and clinical follow-up were 100% of the prescribed. A self-rated satisfaction scale scored the program at 90 - 95 /100 on day 30 by all. Conclusions: Virtual Cardiac Rehabilitation in India is feasible and possibly effective in delivering integrated CR services at home. Numen health shows promise in bridging the gap of negligent CR services across India.

Physical recovery across care pathways up to 12 months after hospitalization for COVID-19: A multicenter prospective cohort study (CO-FLOW).

SummaryBackgroudThe sudden COVID-19 pandemic forced quick development of care pathways for patients with different needs. Trajectories of physical recovery in hospitalized patients for COVID-19 following different care pathways are unknown. We aimed to assess trajectories of physical recovery and levels of physical function reached within the different care pathways. Additionally, we assessed differences in physical function across care pathways at follow-up visits.MethodsThis multicenter prospective cohort study of adults who had been hospitalized for COVID-19 was performed in 10 centers, including 7 hospitals (1 academic and 6 regional hospitals) and 3 rehabilitation centers (1 medical rehabilitation center and 2 skilled nursing facilities), located in the Netherlands. Study visits were performed at 3, 6, and 12 months post-hospital discharge and included assessment of cardiorespiratory fitness (6 min walk test [6MWT], 1 min sit-to-stand test [1MSTST]), muscle strength (maximum handgrip strength [HGS]) and mobility (de Morton Mobility Index [DEMMI]).FindingsWe report findings for 582 patients who had been discharged from hospital between March 24, 2020 and June 17, 2021. Patients had a median age of 60·0 years, 68·9% (401/582) were male, 94·6% (561/582) had received oxygen therapy, and 35·2% (205/582) mechanical ventilation. We followed patients across four different rehabilitation settings: no rehabilitation (No-rehab, 19·6% [114/582]), community-based rehabilitation (Com-rehab, 54·1% [315/582]), medical rehabilitation (Med-rehab, 13·7% [80/582]), and rehabilitation in a skilled nursing facility (SNF-rehab, 12·5% [73/582]). Overall, outcomes in 6MWT (14·9 meters [95% CI 7·4 to 22·4]), 1MSTST (2·2 repetitions [1·5 to 2·8]), and HGS (3·5 kg [2·9 to 4·0]) improved significantly (p<0·001) from 3 to 6 months and only HGS from 6 to 12 months (2·5 kg [1·8 to 3·1]; p<0·001). DEMMI scores did not significantly improve over time. At 3 months, percentage of normative values reached in 1MSTST differed significantly (p<0.001) across care pathways, with largest impairments in Med- and SNF-rehab groups. At 12 months these differences were no longer significant, reaching, overall, 90·5% on 6MWD, 75·4% on 1MSTST, and 106·9% on HGS.InterpretationOverall, physical function improved after hospitalization for COVID-19, with largest improvement within 6 months post-discharge. Patients with rehabilitation after hospital discharge improved in more than one component of physical function, whereas patients without rehabilitation improved solely in muscle strength. Patients who received rehabilitation, and particularly patients with Med- and SNF-rehab, had more severe impairment in physical function at 3 months, but reached equal levels at 12 months compared to patients without follow-up treatment. Our findings indicate the importance of rehabilitation.FundingZonMw, Rijndam Rehabilitation, Laurens (The Netherlands).

The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6-23 Months in Sub-Saharan Africa and South Asia.

Background: Current guidelines for the management of childhood wasting primarily focus on the provision of therapeutic foods and the treatment of medical complications. However, many children with wasting live in food-secure households, and multiple studies have demonstrated that the etiology of wasting is complex, including social, nutritional, and biological causes. We evaluated the contribution of household food insecurity, dietary diversity, and the consumption of specific food groups to the time to recovery from wasting after hospital discharge. Methods: We conducted a secondary analysis of the Childhood Acute Illness Network (CHAIN) cohort, a multicenter prospective study conducted in six low- or lower-middle-income countries. We included children aged 6–23 months with wasting (mid-upper arm circumference [MUAC] ≤ 12.5 cm) or kwashiorkor (bipedal edema) at the time of hospital discharge. The primary outcome was time to nutritional recovery, defined as a MUAC > 12.5 cm without edema. Using Cox proportional hazards models adjusted for age, sex, study site, HIV status, duration of hospitalization, enrollment MUAC, referral to a nutritional program, caregiver education, caregiver depression, the season of enrollment, residence, and household wealth status, we evaluated the role of reported food insecurity, dietary diversity, and specific food groups prior to hospitalization on time to recovery from wasting during the 6 months of posthospital discharge. Findings: Of 1286 included children, most participants (806, 63%) came from food-insecure households, including 170 (13%) with severe food insecurity, and 664 (52%) participants had insufficient dietary diversity. The median time to recovery was 96 days (18/100 child-months (95% CI: 17.0, 19.0)). Moderate (aHR 1.17 [0.96, 1.43]) and severe food insecurity (aHR 1.14 [0.88, 1.48]), and insufficient dietary diversity (aHR 1.07 [0.91, 1.25]) were not significantly associated with time to recovery. Children who had consumed legumes and nuts prior to diagnosis had a quicker recovery than those who did not (adjusted hazard ratio (aHR): 1.21 [1.01,1.44]). Consumption of dairy products (aHR 1.13 [0.96, 1.34], p = 0.14) and meat (aHR 1.11 [0.93, 1.33]), p = 0.23) were not statistically significantly associated with time to recovery. Consumption of fruits and vegetables (aHR 0.78 [0.65,0.94]) and breastfeeding (aHR 0.84 [0.71, 0.99]) before diagnosis were associated with longer time to recovery. Conclusion: Among wasted children discharged from hospital and managed in compliance with wasting guidelines, food insecurity and dietary diversity were not major determinants of recovery.

Outpatient clinic attendance and outcomes among patients hospitalized with diabetic foot ulcers

BackgroundThere are limited data on post-hospital discharge clinic attendance rates and outcomes among patients with diabetic foot ulcers (DFUs). MethodsRetrospective study of patients hospitalized with a DFU from 2016 to 2019 in a large public hospital. We measured rates and predictors of clinic attendance with providers involved with DFU care within 30 days of hospital discharge (“30-day post-discharge clinic attendance”). Log-binomial regression was used to estimate risk ratios (RR) and 95 % confidence intervals (CI). ResultsAmong 888 patients, 60.0 % were between 45 and 64 years old, 80.5 % were Black, and 24.1 % were uninsured. Overall, 478 (53.8 %) attended ≥1 30-day post-discharge clinic appointment. Initial hospital outcomes were associated with clinic attendance. For example, the RR of 30-day post-discharge clinic attendance was 1.39 (95%CI 1.19–1.61) among patients who underwent a major amputation compared to patients with DFUs without osteomyelitis and did not undergo an amputation during the initial hospitalization. Among 390 patients with known 12-month outcome, 71 (18.2 %) had a major amputation or died ≤12 months of hospital discharge. ConclusionWe found a low post-discharge clinic attendance and high post-discharge amputation and death rates among patients hospitalized with DFUs. Interventions to increase access to outpatient DFU care are needed and could prevent amputations.

Coordination of Oral Anticoagulant Care at Hospital Discharge (COACHeD): protocol for a pilot randomised controlled trial

BackgroundOral anticoagulants (OACs) are commonly prescribed, have well-documented benefits for important clinical outcomes but have serious harms as well. Rates of OAC-related adverse events including thromboembolic and hemorrhagic events are especially high shortly after hospital discharge. Expert OAC management involving virtual care is a research priority given its potential to reach remote communities in a more feasible, timely, and less costly way than in-person care. Our objective is to test whether a focused, expert medication management intervention using a mix of in-person consultation and virtual care follow-up, is feasible and effective in preventing anticoagulation-related adverse events, for patients transitioning from hospital to home.Methods and analysisA randomized, parallel, multicenter design enrolling consenting adult patients or the caregivers of cognitively impaired patients about to be discharged from medical wards with a discharge prescription for an OAC. The interdisciplinary multimodal intervention is led by a clinical pharmacologist and includes a detailed discharge medication reconciliation and management plan focused on oral anticoagulants at hospital discharge; a circle of care handover and coordination with patient, hospital team and community providers; and early post-discharge follow-up virtual medication check-up visits at 24 h, 1 week, and 1 month. The control group will receive usual care plus encouragement to use the Thrombosis Canada website.The primary feasibility outcomes include recruitment rate, participant retention rates, trial resources management, and the secondary clinical outcomes include adverse anticoagulant safety events composite (AASE), coordination and continuity of care, medication-related problems, quality of life, and healthcare resource utilization. Follow-up is 3 months.DiscussionThis pilot RCT tests whether there is sufficient feasibility and merit in coordinating oral anticoagulant care early post-hospital discharge to warrant a full sized RCT.Trial registrationNCT02777047.

The past and future use of perioperative opioids in gynecologic oncology patients after open surgery (535)

<b>Objectives:</b> As surgeons, it is our ethical imperative to minimize the harmful impact on patients and their communities through the prescription of perioperative opioid medication. This study reviews the perioperative opioid use in our gynecologic oncology surgical practice over the last decade. <b>Methods:</b> We undertook a chart review of adult gynecologic oncology patients who underwent open surgery from July 1, 2012, to August 26, 2021. Perioperative and patient characteristics were abstracted. Prospective phone surveys were completed from April through September 2021 in this patient population two to four weeks after surgery to assess self-reported opioid use post-hospital discharge. Quantities of oral and intravenous opioid medications are reported as oral morphine equivalents (OME). Data are presented as proportions or median results by year and compared using Chi-square tests or Wilcoxon rank-sum tests, respectively. <b>Results:</b> There were 1210 patients included in the chart review, and we completed 75 prospective surveys. From 2012 to 2021, the rate of non-steroidal anti-inflammatory drug use increased from 40.7% to 80% (p<0.01), and the use of epidurals and transversus abdominis plane (TAP) blocks increased from 46.5% to 93.9% (p<0.01, Figure 1a). The median length of hospital stay was decreased by 20% (5 to 4 days, p<0.01). The total amount of OME used per patient in the hospital decreased by 62.6% from 2012 to 2021 (412 OME in 2012 vs 154.3 OME in 2021, p<0.01). When divided by length of stay, the median OME used per day also decreased (84.7 OME in 2012 vs 42 OME in 2021, p<0.01). Opioid prescription sizes at the time of hospital discharge significantly decreased as well from 675 OME per patient in 2012 (equivalent to 90 doses of 5mg oxycodone tablets) to 150 OME per patient in 2021 (equivalent to 20 doses of 5mg oxycodone tablets, p<0.01, Figure 1b). From our prospective survey data, the actual amount of OME used by patients in 2021 after hospital discharge was a median of 22.5 OME (equivalent to 3 doses of 5mg oxycodone tablets per patient). There was a decrease in preoperative opioid use from 2012 to 2021 (41.9% in 2012 vs 28.7% in 2021, p=0.05). The refill rate for postoperative opioids did not significantly differ during this time period (18% in 2012 vs 10.4% in 2021, p=0.10). <b>Conclusions:</b> Patients in this study used fewer opioids in the perioperative period between 2012 and 2021, likely due to utilization of enhanced recovery after surgery pathways and increased awareness of the risks of opioid misuse. While our division reduced the median postoperative opioid prescription size from 2012 to 2021 by 77.7%, our findings suggest we could further reduce prescription sizes by an additional 85% and still adequately treat our patients' postoperative pain. Ongoing assessment of surgical patients' opioid medication needs and patterns of prescribing is essential for addressing our contributions to the opioid epidemic.

Acquisition of new medical devices among the persistently critically ill: A retrospective cohort study in the Veterans Affairs.

Patients who develop persistent critical illness remain in the ICU predominately because they develop new late-onset organ failure(s), which may render them at risk of acquiring a new medical device. The epidemiology and short-term outcomes of patients with persistent critical illness who acquire a new medical device are unknown.We retrospectively studied a cohort admitted to the Veterans Affairs (VA) ICUs from 2014 to 2019. Persistent critical illness was defined as an ICU length of stay of at least 14 days. Receipt of new devices was defined as acquisition of a new tracheostomy, feeding tube (including gastrostomy and jejunostomy tubes), implantable cardiac device, or ostomy. Logistic regression models were fit to identify patient factors associated with the acquisition of each new medical device. Among hospitalized survivors, 90-day posthospitalization discharge location and mortality were identified.From 2014 to 2019, there were 13,184 ICU hospitalizations in the VA which developed persistent critical illness. In total, 30.4% of patients (N = 3998/13,184) acquired at least 1 medical device during their persistent critical illness period. Patients with an initial higher severity of illness and prolonged hospital stay preICU admission had higher odds of acquiring each medical device. Among patients who survived their hospitalization, discharge location and mortality did not significantly differ among those who acquired a new medical device as compared to those who did not.Less than one-third of patients with persistent critical illness acquire a new medical device and no significant difference in short-term outcomes was identified. Future work is needed to understand if the acquisition of new medical devices is contributing to the development of persistent critical illness.

Initial experience and validation of a novel tool to assess patient experience in the catheterization laboratory (PATCATH), in patients undergoing coronary angiography or angioplasty.

Abstract Funding Acknowledgements Type of funding sources: None. Background Patient-reported experience metric (PREM) questionnaires are an important tool for evaluating patient experience. Purpose Validated PREM tools may help to identify areas of quality improvement within healthcare. Methods A novel tool developed by the Patient Initiative Committee of the European Association of Percutaneous Intervention (EAPCI), in association with the European Society of Cardiology Patient Forum was designed to capture patient experience in the catherization laboratory. The questionnaire is divided into 3 domains assessing experience before, during and after coronary angiography or angioplasty (Figure 1, Panels A-C). Responses were recorded on a scale of strongly agree, agree, disagree, or strongly disagree. Consecutive patients undergoing a coronary angiography or angioplasty received the questionnaire to complete anonymously during recovery following catheterization. Results A total of 100 valid responses were received over a four week pilot experience. Most patients had an angiogram procedure (80%). A total of 52% were grouped in the higher age category (≥66 years) (Table 1). Patient response indicated a high level of satisfaction with the experience before the procedure: 98.6% of patients strongly agreed or agreed with statements assessing positive experience reflecting a level of knowledge of why the procedure was recommended and perceived level of support (Figure 1, Panel A). 98.5% strongly agreed or agreed with statements assessing positive experience of comfort, safety, communication and understanding during the procedure (Figure 1, Panel B). A total of 9.6% of patients within the higher age category provided no response regarding their understanding for why a treatment decision was made, whilst all patients in the lower age category responded. After the procedure, 59.3% strongly agreed or agreed with statements assessing positive experience: with lower levels of positive experience for questions related to lifestyle changes (60%), comprehension of a rehabilitation program (46%), medication prescription (58%) and treatment duration (53%) (Figure 1, Panel C). However, 15.2% of questions in this domain had no response, particularly those related to prescribed medication. A lower positive experience was observed between higher versus lower age categories respectively (44.2% &amp; 77.1%) regarding an understanding of necessary lifestyle changes. Conclusion The results of our initial experience with a novel PREMs tool highlight high levels of positive experience before and after diagnostic angiography and a lower level of positive experience in the period after the procedure. Completing this tool at a later stage or post-hospital discharge (i.e., following additional education interventions) may help to capture a higher positive response related to after the intervention. To validate these findings, this PREM tool should be evaluated further in additional patient cohorts across multiple sites.

Automated telephone follow-up programs after hospital discharge: Do older adults engage with these programs?

Health systems have developed automated telephone call programs to screen and triage patients' post-hospital discharge issues and concerns. The aims of our study were to determine whether and how older adults engage with automated post-hospital discharge telephone programs and to describe the prevalence of patient-reported post-discharge issues. We identified all telephone calls made by an urban academic medical center as part of a post-hospital discharge program between May 1, 2018 and April 30, 2019. The program used automated telephone outreach to patients or their caregivers that included 11 distinct steps 3 days post-discharge. All adults discharged home from the hospital, were included, and we categorized patients into ≤64 years, 65-84 years, and ≥85 years age groups. We then compared call reach rate, completeness of 11-step calls and patient-reported issues between age groups. Eighteen thousand and seventy six patients were included. More patients 65-84 years old were reached compared to patients ≤64 years old (84.3% vs. 78.9%, AME 5.52%; 95%CI: 3.58%-7.45%). Completion rates of automated calls for those ≥85 years oldwere also high. Patients ≥85 years old were more likely to have questions about their follow-up plans and need assistance scheduling appointments compared to those ≤64 years old (19.0% vs. 11.9%, AME 7.0% (95%CI: 2.7%-11.3%). Post-hospital automated telephone calls are feasible and effective at reaching older adults. Future work should focus on improving discharge communication to ensure older adults are aware of their follow-up plan and appointments.

Cumulative Risk And Associated Factors For Fall-Related Fractures In Stroke Survivors After Discharge From Rehabilitation Wards: A Retrospective Study With A 6-Year Follow-Up.

ObjectiveTo investigate the long-term cumulative risk and factors associated with fall-related fractures in stroke survivors discharged from convalescent rehabilitation wards.DesignRetrospective cohort study.ParticipantsA total of 786 stroke survivors discharged from a rehabilitation hospital.MethodsData regarding fall-related fractures post-hospital discharge were collected using self-reported questionnaires. The Kaplan–Meier method was used to calculate the cumulative incidence of fall-related fractures, and risk factors were analysed using Cox proportional hazard regression analysis.ResultsOf 1,861 consecutive stroke survivors who had been discharged from hospital, 786 (42.2%) provided information concerning fall-related fractures. Duration from time of discharge to time of collection of questionnaires ranged from 1 to 6 years (mean 38.0 months). The cumulative incidence of fall-related fractures at 1-, 2-, 3-, 4-, and 5-years post-discharge was 4.2%, 7.9%, 10.8%, 12.5% and 13.7%, respectively. Cox proportional hazard regression analysis indicated that female sex (hazard ratio (HR) 1.69) and moderate lower limb paresis (HR 3.08) were significant risk factors.ConclusionThe cumulative risk of fall-related fractures in stroke survivors post-discharge from a rehabilitation hospital was notably high. Intensive preventive intervention should be considered for female stroke survivors with moderate lower limb paresis.LAY ABSTRACTThis study aimed to investigate the risk of fall-related fractures and associated factors in stroke survivors who had been discharged from rehabilitation wards. A questionnaire was sent by post to 1,861 post-discharge stroke survivors to investigate their experiences of fall-related fractures, to which 786 stroke survivors responded. The incidence of fall-related fractures at 1, 2, 3, 4, and 5 years post-discharge was 4.2%, 7.9%, 10.8%, 12.5% and 13.7%, respectively. The presence of moderate lower limb paresis and female sex were associated with 3.08- and 1.69-times higher risk of developing a fall-related fracture, respectively. Intensive preventive intervention should be considered for female stroke survivors with moderate lower limb paresis following discharge from rehabilitation wards.

Assistance in patients with traumatic brain injury in public health of gurupi city – to

The post-hospital discharge treatment of traumatic brain injury is multidisciplinary and requires training to achieve the skills that are usually lost. In this bias, rehabilitation includes four categories of tasks: physical, mental, affective and social. Physical function refers to sensory skills necessary for the performance of daily tasks and tools that are advanced skills and are considered important for the independence of the individual in society (RUIZ, 2018). Therefore, the aim of this research is to analyze the post-hospital discharge care of patients who are victims of TCE in basic health units in the city of Gurupi-TO. This is a qualitative research conducted with the head nurses who attend the Basic Health Units where integrated multiprofessional residence in family and community health (RMISFC) and Residence in Family and Community Medicine of the University of Gurupi - UnirG (Basic Health Units Vila Iris, João Manoel, Pedroso, Vila Nova and Seville). The sample had 5 Units, in each UBS there are 2 head nurses, totaling 10 participants in the research. The analysis allowed us to conclude that there is no protocol to be followed and the commitment necessary to provide the user of the health system with quality care for individuals and families.

Cardiovascular Biomarkers for Prediction of in-hospital and 1-Year Post-discharge Mortality in Patients With COVID-19 Pneumonia.

AimsWhile COVID-19 affects the cardiovascular system, the potential clinical impact of cardiovascular biomarkers on predicting outcomes in COVID-19 patients is still unknown. Therefore, to investigate this issue we analyzed the prognostic potential of cardiac biomarkers on in-hospital and long-term post-discharge mortality of patients with COVID-19 pneumonia.MethodsSerum soluble ST2, VCAM-1, and hs-TnI were evaluated upon admission in 280 consecutive patients hospitalized with COVID-19-associated pneumonia in a single, tertiary care center. Patient clinical and laboratory characteristics and the concentration of biomarkers were correlated with in-hospital [Hospital stay: 11 days (10; 14)] and post-discharge all-cause mortality at 1 year follow-up [FU: 354 days (342; 361)].Results11 patients died while hospitalized for COVID-19 (3.9%), and 11 patients died during the 1-year post-discharge follow-up period (n = 11, 4.1%). Using multivariate analysis, VCAM-1 was shown to predict mortality during the hospital period (HR 1.081, CI 95% 1.035;1.129, p = 0.017), but not ST2 or hs-TnI. In contrast, during one-year FU post hospital discharge, ST2 (HR 1.006, 95% CI 1.002;1.009, p < 0.001) and hs-TnI (HR 1.362, 95% CI 1.050;1.766, p = 0.024) predicted mortality, although not VCAM-1.ConclusionIn patients hospitalized with Covid-19 pneumonia, elevated levels of VCAM-1 at admission were associated with in-hospital mortality, while ST2 and hs-TnI might predict post-discharge mortality in long term follow-up.

Increased Hospitalization for IBD Patients Seen in the ER During the COVID-19 Pandemic.

BackgroundDuring the COVID-19 pandemic, the focus of many health care systems shifted in order to prioritize and allocate resources toward treating those affected by COVID-19. What this has meant for other patient populations remains unclear. We aimed to determine if there have been changes to acute care access for patients with inflammatory bowel disease (IBD) during the COVID-19 pandemic.MethodsA retrospective cohort study was performed in IBD patients seen during (March 1, 2020 to August 31, 2020) and before (March 1, 2019 to August 31, 2019) the COVID-19 pandemic. IBD-related emergency room (ER) access, hospitalization, inpatient care and follow-up and post-discharge ER access were assessed.ResultsA total of 1229 participants were included. A higher proportion of patients accessed ER during the pandemic (44.6% versus 37.2%, P = 0.0097). A higher proportion of hospitalizations resulted from IBD-related ER visits during the pandemic period (41.6% versus 32.4%, OR = 1.48, 95% CI = 1.14 to 1.94, P = 0.0047), though length of stay was shorter (7.13 ± 8.95 days versus 10.11 ± 17.19 days, P = 0.015) and use of rescue infliximab was less. No change was seen in inpatient surgical intervention. Despite similar proportions of follow-up appointments post-hospital discharge (pre-pandemic, 77.9% versus pandemic, 78.3%), more ER visits occurred in the first 30 days following hospitalization for patients in the pandemic cohort (24.4% versus 11.1%, P = 0.0015).ConclusionThese data highlight the need for ER services and hospitalization amongst IBD patients during the COVID-19 pandemic. This suggests that a return to pre-pandemic IBD care infrastructure is needed to mitigate the need for acute care access.

Management of nonoperative cervical spine fractures: An institutional analysis of follow-up duration and image acquisition.

Background: How long do nonoperative cervical fractures have to be followed and with how many imaging studies?Methods: We reviewed 69 adult patients with 122 (31 occiptocervical and 91 sub-axial) cervical fractures; at least one of the cervical fractures was managed nonoperatively. Outcomes were assessed along with the optimal follow-up duration and frequency of various diagnostic studies.Results: An average of four follow-up visits occurred on average 28-, 66-, 94-, and 158-day post hospital discharge. The average time between discharge and orthotic clearance was 70 days (±32.4 days). Radiographic studies were obtained at follow-up visits, respectively, in, 82.6%, 83.6%, 94.7%, and 100% of patients.Conclusion: The trend for managing nonoperative cervical fractures was an unduly prolonged follow-up duration that included obtaining too many imaging studies.

P1675: POST-HOSPITAL DISCHARGE EVALUATION OF COVID-19 SURVIVORS WHO SUFFERED ACUTE VENOUS THROMBOEMBOLISM (VTE) DURING HOSPITALIZATION: THE BERGAMO EXPERIENCE

Background: Acute COVID-19 manifestations are well known, while post-COVID clinical and laboratory consequences are less clear. Due to the strict association of COVID-19 with thrombosis, the Hemostasis Service of Bergamo hospital had a central role in guiding anticoagulant treatments in patients during the acute and post-discharge phases. Aims: In the post-hospital discharge setting, in a cohort of COVID-19 survivors who experienced VTE during the acute phase and were followed up at our outpatient clinic, we aim to evaluate whether alterations in coagulation and inflammatory parameters were occurring and were possibly associated with disease severity. Methods: An outpatient service specifically dedicated to follow-up of COVID-19 survivors was set up at our Institution. A retrospective analysis of a cohort of 1563 patients enrolled from May 2020 to November 2020 was performed. Data were obtained on the occurrence or not of acute COVID-19 -associated VTE, the site of thrombosis, ongoing anticoagulant treatments, and the results of laboratory tests performed at the first post-discharge assessment visit, including blood cell count, D-dimer, fibrinogen, CRP and LDH. The severity degree of COVID-19 at the onset was defined by the need of Continuous Positive Airway Pressure devices (C-PAP) or tracheal intubation as compared to no-oxygen need, or use of nasal flow, reservoir mask, or Venturi Mask. Statistical analyses were performed using SPSS v21 software. Results of lab tests were expressed as median values (5th-95th percentile). Results: Of the 1563 enrolled outpatient COVID-19 survivors [974 M/589 F, median age of 60 years (35.5-81)], 56 subjects [43M/13F; median age 62 years (42-80.5)] had had VTE during COVID-19 acute phase (3.58%), as follows: 9 isolated proximal DVT (4 in upper extremity), 45 isolated PE (34 subsegmental and/or segmental PE; 11 central pulmonary artery thrombosis), 2 DVT+PE. Concerning COVID-19 severity, 33 of 56 patients needed C-PAP or tracheal intubation. At the follow-up visit, patients were still on anticoagulation (76% with DOAC). Laboratory data analyses revealed that 25% of VTE-subjects had increased levels of both D-dimer and fibrinogen, and 11% had elevated levels of CRP, while no abnormalities were observed in the platelet and leucocyte counts. CRP significantly correlated with fibrinogen and D-Dimer levels. According to COVID-19 severity, only platelet count was significantly higher in patients with severe disease, who needed C-PAP or tracheal intubation, as compared to those with less severe disease. No patients had VTE recurrence or bleeding complications at the time of follow up. Summary/Conclusion: Our data suggest persistence of pro-coagulant and inflammatory laboratory patterns in a proportion of patients with COVID-19-related VTE, in spite of anticoagulant therapy. Further studies are needed to establish on whether monitoring these parameters may help in the decision on the duration of anticoagulation in this condition.

Outcome study of proximal femur fracture in patients having cardiac diseases

To assess the outcome of fracture in patients with cardiac diseases, evaluate delay in surgery &amp; study the quality of life post hospital discharge. A prospective review of the medical records of 32 cases who underwent surgery at Dayanand Medical college &amp; Hospital, Ludhiana was performed. Patients were selected with proximal femur fracture having cardiac diseases after fulfilling the inclusion and exclusion criteria. After taking detailed history and examination, the patients were followed up after 4-6 weeks and 3-4 months. A detailed structured performa was filled and functional assessment was done using HHS. We had final follow up of all 32 patients which were included in the study managed by PFN. Modified HHS was accessed at 4-6 weeks and 3-4 months and found to be 41.19 (SD =12.89) &amp; 64.66 (SD =13.35) respectively. No mortality was observed during the follow up. Presence of cardiac comorbidities increased the chances of hip fracture and poor HHS was observed among the patients in the study. Although no significant difference on HHS was observed among the subtypes of cardiac diseases. Most common cause of delay in surgery was the use of antiplatelet agents and delay in surgery affected the HHS significantly in a way that more the delay, poor was the HHS. Presence of comorbidities like hypertension, diabetes mellitus decreased the mean HHS. Occurrence of complications also affected the HHS. More the complications, poor was the HHS. Patients with hip fracture with a diagnosis of CVD, have greater risk of hip fracture with longer length of hospital stay and hence higher cost per hospital stay. Presence of more comorbidities along with CVD shows a significant association in the functional outcome.