Post-discharge Follow-up Research Articles

Association of an Acute Kidney Injury Follow-up Clinic With Patient Outcomes and Care Processes: A Cohort Study

To determine whether attendance at an acute kidney injury (AKI) follow-up clinic is associated with reduced major adverse kidney events. Propensity-matched cohort study. Patients hospitalized with AKI in Ontario, Canada, from February 1, 2013, through September 30, 2017, at a single clinical center, who were not receiving dialysis when discharged. Standardized assessment by a nephrologist. Time to a major adverse kidney event, defined as death, initiation of maintenance dialysis, or incident/progressive chronic kidney disease. Propensity scores were used to match each patient who attended an AKI follow-up clinic to 4 patients who received standard care. Cox proportional hazards models were fit to assess the association between the care within an AKI follow-up clinic and outcomes. To avoid immortal time bias, we randomly assigned index dates to the comparator group. We matched 164 patients from the AKI follow-up clinic to 656 patients who received standard care. During a mean follow-up of 2.2±1.3 (SD) years, care in the AKI follow-up clinic was not associated with a reduction in major adverse kidney events relative to standard care (22.1 vs 24.7 events per 100 patient-years; HR, 0.91 [95% CI, 0.75-1.11]). The AKI follow-up clinic was associated with a lower risk of all-cause mortality (HR, 0.71 [95% CI, 0.55-0.91]). Patients aged at least 66 years who attended the AKI follow-up clinic were more likely to receive β-blockers (HR, 1.34 [95% CI, 1.02-1.77]) and statins (HR, 1.35 [95% CI, 1.05-1.74]), but not angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (HR, 1.21 [95% CI, 0.94-1.56]). Single-center study and residual confounding. Specialized postdischarge follow-up for AKI survivors was not associated with a lower risk of major adverse kidney events but was associated with a lower risk of death and increased prescriptions for some cardioprotective medications.

A COMPARISON OF SEQUENTIAL ORGAN FAILURE (SOFA) & QUICK SOFA SCORES IN PREDICTING HOSPITAL MORTALITY IN CRITICALLY ILL PATIENTS IN A TERTIARY CARE CENTRE

Background: To validate Q-SOFA for predicting In-hospital mortality in patients presenting with sepsis in an ICU setting and comparing it to SOFA (Sequential organ failure assessment) score. To compare the performance of the SOFA score and qSOFA scores for in-hospital mortality prediction among critically ill patients in an ICU setting in a tertiary care center. Aims And Objectives: To compare the performance of the SOFA score and qSOFA scores for in-hospital mortality prediction among critically ill patients in an ICU setting in a tertiary care center This study was done in the D Methodolgy: epartment of Medicine in Kurnool Medical College, Kurnool among patients with age > 18 years with suspected infection who were treated at the ICU of Government General Hospital. In our study Results: 2 scoring systems were used –QSOFA and SOFA –both of which are acceptable scoring systems in sepsis. Each of these scores was analyzed with mortality to determine which test predicted mortality better at discharge and at 28 days post-discharge follow-up. On comparing the SOFA score with mortality it was found that 81.82% of the patients who expired at discharge and 77.78 % of the patients who expired at 28 days postdischarge had a SOFA score more than 11(the median SOFA score). At discharge, the sensitivity along with the specicity of SOFA score was 81.8% and 97.4% respectively and at 28 days follow-up, the sensitivity, and specicity in predicting mortality were 77.78% and 100% respectively. On comparing Q-SOFA score with mortality it was found that 63.64% of the patients who expired at discharge and 77.78% of the patients who expired at 28 days post-discharge had a Q-SOFA score of more than 2. At discharge, the calculated sensitivity, as well as specicity of the Q-SOFA score, was 63.6% and 56.4% respectively and at 28 days post-discharge it was 77.78% and 66.7% respectively. AUROC was also calculated for the above-mentioned scoring systems in denoting its predictive power for mortality in sepsis patients. At both discharge and 28 days post-discharge follow-up, SOFA score was found better in predicting mortality followed by Q-SOFA score. Given that both SOFA and QSOFA have sensitivities close to each other for both In-hospital and 28-day mortality (81.8% vs. 63.6%) and (77.78% vs. 77.78%), the Q-SOFA could be used for rapid assessment before lab investigations are available for early goal-directed therapy, though SOFA is the most accurate score for predicting mortality 1. Sepsis scoring system Q-SOFA showed a sensitivi Conclusion: ty of 63.6 % at discharge and 70% at 28 days follow-up for predicting mortality in patients presenting with sepsis 2. Comparison of SOFA, Q-SOFA it was revealed that SOFA score predicted the mortality of sepsis the best both at discharge and at 28 days follow-up.

Association of Geriatric Emergency Department post-discharge referral order and follow-up with healthcare utilization.

Compared with younger adults who receive care in the emergency department (ED), older patients who are discharged home have greater risk of adverse health outcomes. Connecting older adults with outpatient care following ED discharge are among the guidelines of the Geriatric Emergency Department (GED). The objective of this study was to examine the association between referral order placed during the ED visit for older adults and post-discharge follow-up to the outcomes of 72-h ED revisit, 30-day ED revisit, and 30-day all cause and unplanned hospital admission. We conducted a retrospective cohort study. Ten accredited GEDs within one midwestern health system and all ED encounters of older adults aged 65 years and older who were discharged home from the ED between July 2019 and December 2020 were included. Predictor variables included age, sex, race, ISAR©, ED Length of Stay, post-ED referral order, and follow-up. Among the older adults discharged home from the ED, 17% of older adult encounters had an outpatient referral ordered in the ED, 48.4% attended a follow-up appointment. Referrals were ordered for 69 referral order types with orthopedic, family practice, and urology referrals as the top 3. In mixed-effect regression models, compared with older adults with follow-up, those with a referral order but no follow-up had 19% higher odds of having a 30-day ED revisit (OR=1.19; 95% CI=1.07-1.31) and 11% higher odds of having 30-day unplanned hospital admission (OR=1.11; 95% CI=0.98-1.26). Older adults who had an outpatient referral ordered prior to ED discharge and followed up had lower odds of a 30-day ED revisit and 30-day subsequent unplanned hospital admission. However, less than half of patients with a referral order attended a follow-up appointment. Designing interventions for older adults aimed at improving follow-up after an ED visit is needed.

Prompt initiation of triple therapy following hospitalization for a chronic obstructive pulmonary disease exacerbation in the United States: An analysis of the PRIMUS study.

BACKGROUND: Severe exacerbations requiring hospitalization contribute a substantial portion of the morbidity and costs of chronic obstructive pulmonary disease (COPD). Triple therapy (inhaled corticosteroid + long-acting β-agonist + long-acting muscarinic antagonist) is a recommended option for patients who experience recurrent COPD exacerbations or persistent symptoms. Few real-world studies have specifically examined the effect of prompt initiation of triple therapy, specifically among patients hospitalized for a COPD exacerbation. OBJECTIVE: To assess whether prompt initiation of triple therapy following a severe COPD exacerbation was associated with lower risk of subsequent exacerbations and lower health care use and costs and the effects of each 30-day delay of initiation. METHODS: Adults aged 40 years or older with COPD were identified in the Merative MarketScan Databases between January 1, 2010, and December 31, 2019, and were required to meet the following criteria: open or closed triple therapy (date of first closed prescription or last component of open=index treatment date), more than 1 inpatient admission with a primary COPD diagnosis (ie, severe exacerbation) in the prior 12 months (index exacerbation), 12 months of continuous enrollment before (baseline) and after (follow-up) index exacerbation, and absence of select respiratory diseases and cancer. Patients were stratified based on timing of open or closed triple therapy after the index exacerbation: prompt (≤30 days), delayed (31-180 days), or very delayed (181-365 days). Multivariable regression controlled for baseline characteristics (age, sex, insurance type, index year, comorbidities, prior treatment, and prior exacerbations) and estimated the odds of subsequent exacerbations, change in the number of exacerbations, and change in health care costs during 12-month follow-up associated with each 30-day delay of triple therapy initiation. RESULTS: A total of 6,772 patients met inclusion criteria (2,968 [43.8%] prompt, 1,998 [29.5%] delayed, and 1,806 [26.7%] very delayed). The adjusted odds of any exacerbation and a severe exacerbation during 12-month follow-up increased by 13% (odds ratio [95% CI]: 1.13 [1.11-1.15]) and 10% (1.10 [1.08-1.12]), respectively, for each 30-day delay in triple therapy initiation, and the mean number of exacerbations increased by 5.4% (95% CI = 4.7%-6.1%). There was a 3.0% increase (95% CI = 2.2%-3.8%) in mean all-cause costs and a 3.7% increase (95% CI = 2.9%-4.6%) in total COPD-related costs for each 30-day delay of triple therapy initiation. CONCLUSIONS: Longer delays in triple therapy initiation after a COPD hospitalization result in greater risk of subsequent exacerbations and higher health care resource use and costs. Adequate post-discharge follow-up care and earlier consideration of triple therapy may improve clinical and economic outcomes among patients with COPD. DISCLOSURES: This study was funded by AstraZeneca. Dr Evans is employed by Merative, formerly IBM Watson Health, and Mr Tkacz was employed by IBM Watson Health at the time of this study; Merative/IBM Watson Health received funding from AstraZeneca to conduct this study. Mr Pollack, Dr Staresinic, Dr Feigler, and Dr Patel are employed by AstraZeneca. Dr Touchette, Dr Portillo, and Dr Strange are paid consultants to AstraZeneca. Dr Strange also participates in research grants paid to the Medical University of South Carolina by AstraZeneca, CSA Medical, and Nuvaira, and is a consultant to GlaxoSmithKline, Morair, and PulManage regarding COPD.

Investigating the Association Between Telemedicine Use and Timely Follow-Up Care After Acute Cardiovascular Hospital Encounters

BackgroundTelemedicine use increased dramatically during the COVID-19 pandemic; however, questions remain as to how telemedicine use impacts care. ObjectivesThe purpose of this study was to examine the association of increased telemedicine use on rates of timely follow-up and unplanned readmission after acute cardiovascular hospital encounters. MethodsWe examined hospital encounters for acute coronary syndrome, arrhythmia disorders, heart failure (HF), and valvular heart disease from a large U.S., multisite, integrated academic health system among patients with established cardiovascular care within the system. We evaluated 14-day postdischarge follow-up and 30-day all-cause unplanned readmission rates for encounters from the pandemic “steady state” period from May 24, 2020 through December 31, 2020, when telemedicine use was high and compared them to those of encounters from the week-matched period in 2019 (May 26, 2019, through December 31, 2019), adjusting for patient and encounter characteristics. ResultsThe study population included 6,026 hospital encounters. In the pandemic steady-state period, 40% of follow-ups after these encounters were conducted via telemedicine vs 0% during the week-matched period in 2019. Overall, 14-day follow-up rates increased from 41.7% to 44.9% (adjusted difference: +2.0 percentage points [pp], 95% CI: −1.1 to +5.1 pp, P = 0.20). HF encounters experienced the largest improvement from 50.1% to 55.5% (adjusted difference: +6.5 pp, 95% CI: +0.5 to +12.4 pp, P = 0.03). Overall 30-day all-cause unplanned readmission rates fell slightly, from 18.3% to 16.9% (adjusted difference −1.6 pp; 95% CI: −4.0 to +0.8 pp, P = 0.20). ConclusionsIncreased telemedicine use during the COVID-19 pandemic was associated with earlier follow-ups, particularly after HF encounters. Readmission rates did not increase, suggesting that the shift to telemedicine did not compromise care quality.

Thirty-Year Survival After Cardiac Surgery in Children With Williams–Beuren Syndrome (from the Pediatric Cardiac Care Consortium Study)

Williams-Beuren syndrome (WBS)is a genetic condition frequently requiring interventions for associated congenital heart disease (CHD). Long-term survival data after cardiac interventions for children with WBS are sparse. This is a retrospective cohort study aiming to describe the 30-year survival outcomes ofchildren with WBSafterinterventions forCHD using thePediatric Cardiac Care Consortium (PCCC), a large North American-based registry of interventionsforpediatric heart diseases, between 1982and2009. Outcomes were obtained from the PCCC and by linkage with the National Death Index through2020. Survival of patients with WBS and their major subgroups was assessed by Kaplan-Meier survival curves and Cox regression. A total of 200 patients met the inclusion criteria of having their first intervention for CHD at a US PCCC center and age <21years at time of intervention. The most common lesions were left heart obstructive lesions (LHOL), either in isolation (37%) or in combination with right heart obstructive lesions (RHOL) (49.0%), whereas isolated RHOL accounted for 11% of the total. The first procedure was surgery for 85.5% of the group, and the remainder underwent a transcatheter procedure. There were 5 in-hospital deaths (2.5%), and among survivors to hospital discharge, 164 had sufficient identifiers for National Death Index linkage. Over a median period of postdischarge follow-up of 23.7years (interquartile range 18.7 to 27.3), 16 deaths occurred, with an overall 30-year survival rate of 90%. Survival rates ranged from 96.1% for isolated LHOL or RHOL to 83.4% for patients with combined disease (adjusted hazard ratio 4.7, 95% confidence intervals 1.35 to 16.59).

Visit Types in Primary Care With Telehealth Use During the COVID-19 Pandemic: Systematic Review.

Telehealth was rapidly incorporated into primary care during the COVID-19 pandemic. However, there is limited evidence on which primary care visits used telehealth. The objective of this study was to conduct a systematic review to assess what visit types in primary care with use of telehealth during the COVID-19 pandemic were reported; for each visit type identified in primary care, under what circumstances telehealth was suitable; and reported benefits and drawbacks of using telehealth in primary care during the COVID-19 pandemic. This study was a systematic review using narrative synthesis. Studies were obtained from four databases (Ovid [MEDLINE], CINAHL Complete, PDQ-Evidence, and ProQuest) and gray literature (NSW Health, Royal Australian College of General Practitioners guidelines, and World Health Organization guidelines). In total, 3 independent reviewers screened studies featuring telehealth use during the COVID-19 pandemic in primary care. Levels of evidence were assessed according to the Grading of Recommendations Assessment, Development, and Evaluation. Critical appraisal was conducted using the Mixed Methods Appraisal Tool. Benefits and drawbacks of telehealth were assessed according to the National Quality Forum Telehealth Framework. A total of 19 studies, predominately cross-sectional surveys or interviews (13/19, 68%), were included. Seven primary care visit types were identified: chronic condition management (17/19, 89%),existing patients(17/19, 89%), medication management(17/19, 89%), new patients(16/19, 84%), mental health/behavioral management (15/19, 79%), post-test result follow-up(14/19, 74%), and postdischarge follow-up(7/19, 37%).Benefits and drawbacks of telehealth were reported across all visit types, with chronic condition management being one of the visits reporting the greatest use because of a pre-existing patient-provider relationship, established diagnosis, and lack of complex physical examinations. Both patients and clinicians reported benefits of telehealth, including improved convenience, focused discussions, and continuity of care despite social distancing. Reported drawbacks included technical barriers, impersonal interactions, and semi-established reimbursement models. Telehealthwas used for different visit types during the COVID-19 pandemic in primary care, with most visits for chronic condition management, existing patients, and medication management. Further research is required to validate our findings and explore the long-term impact of hybrid models of care for different visit types in primary care. PROSPERO CRD42022312202; https://tinyurl.com/5n82znf4.

Identifying Key Domains and Implementation Challenges for a Live Discharge From Hospice Protocol.

Background: Hospice agencies lack an explicit live discharge process to guide practitioners in transitioning these patients and their primary caregivers (PCGs) out of hospice care. Based on previous research and input from an advisory committee, a live discharge protocol (LDP) was drafted with .three general areas of assessment: 1) concrete services; 2) psychosocial assessment; and 3) 30-day post discharge follow-up phone call. This study sought to gather perspectives from hospice social workers on the proposed assessment components and other needs in implementing a LDP. Methods: Purposive, convenience sampling occurred over 4 months. Participants were hospice social workers (n = 14) recruited through personal and professional contacts and social media. Four focus groups were conducted via Zoom. Data was analyzed using thematic analysis. Results: Three major themes appeared: 1) benefits and challenges of having a structured discharge protocol (n = 14); 2) need for specific LDP roles across team members (n = 11); and 3) education and clear boundaries for both patients/PCGs and professionals (n = 9). Conclusions: All three assessment components of the preliminary LDP were deemed necessary by participants; however, implementation challenges were both unique for each agency and reflective of the broader hospice culture. Further research is needed to measure the impact of the LDP.

Clinical characteristics and risks of the convalescent COVID-19 patients with re-detectable positive RNA test: a 430 patients with Omicron infected cross-sectional survey in Tianjin, China

BackgroundThe outbreak of severe acute respiratory syndrome coronavirus (SARS-CoV-2) Omicron variant occurred in Tianjin, China, at the beginning of 2022. In the present study, we identified risk factors that may affect positive (RP) RNA re-testing in recovered patients infected with Omicron variants during recovery in hospital. MethodsWe retrospectively analyzed the medical records of 425 patients with Omicron variant infection admitted to our medical center from January 21, 2022 to February 24, 2022, based on the recurrence of RT-PCR positive results for SARS-CoV-2 after cure and discharge. Patients were divided into re-tested positive (RP) and non-re-detectable positive patients (NRP) groups, and clinical data from both groups were analyzed to investigate the characteristics and risk factors of RP patients. ResultsUnivariate analysis showed significant differences in age, vaccination rate and dose, partial signs and symptoms, most co-existing disorders, and levels of CRP and IL-6 between the RP and NRP groups (all P < 0.05), while multifactorial logistic regression analysis showed that vaccination status and levels of IL-6 were independent risk factors for RP patients. ConclusionOur results suggested that clinicians should assess the probability of "re-positive" nucleic acid tests after discharge, taking the following indicators into account: pre-admission underlying diseases, unvaccinated status, and high levels of CRP and IL-6. Post-discharge isolation and follow-up should also be strengthened.

Abstract 10679: Do Hospitals Caring for a High Proportion of Black Adults Deliver Lower Quality Care for Heart Failure? An Analysis of the Get With the Guidelines-Heart Failure Registry

Introduction: Black individuals have higher hospitalization and mortality rates from heart failure (HF). Black adults receive care at a limited set of US hospitals (minority-serving hospitals [MSH]) and understanding quality of care at these sites could inform efforts to improve health equity. Using the Get With The Guidelines (GWTG) - HF Registry, we compared HF care quality and clinical outcomes at MSH vs. non-MSH. Methods: We identified adults ≥18 years hospitalized for HF at GWTG-HF sites. MSH were defined as the top quintile of proportion of hospitalizations for Black adults. We compared performance on GWTG-HF quality measures at MSH vs. non-MSH, adjusting for age, sex, comorbidities, and hospital characteristics, using GEE to account for clustering within sites. After restricting to adults ≥65 years and linking to Medicare FFS claims, we used multivariable Cox proportional hazard models to compare post-discharge outcomes. Results: Study population included 422,483 hospitalizations at 480 hospitals, of which 96 (with &gt;38% Black patients) were MSH. Care quality was similar between MSHs and non-MSHs for 10 of 13 GWTG-HF measures; MSH patients were less likely to be discharged with 7-day follow up, CRT device planning, or aldosterone antagonist (Figure). Overall defect-free care was similar across sites; there were no within-hospital disparities between Black vs. White patients at both MSH and non-MSH. Among 111,930 Medicare beneficiaries, risk-adjusted 30-day readmissions were higher at MSH compared with non-MSH (HR 1.14, 95% CI 1.02-1.26), but risk-adjusted 30-day mortality was similar (HR 0.92, 95% CI 0.84-1.02). Conclusions: Across GWTG-HF-participating hospitals, HF care quality and mortality were similar at MSH vs. non-MSH, but MSH 30-day readmissions were higher. Improving MSH post-discharge follow-up could improve equity in HF outcomes, though additional investigation to address higher MSH readmissions is needed.

Management of iron-deficiency anemia following acute gastrointestinal hemorrhage: A narrative analysis and review.

Many patients experiencing acute gastrointestinal bleeding (GIB) require iron supplementation to treat subsequent iron deficiency (ID) or iron-deficiency anemia (IDA). Guidelines regarding management of these patients are lacking. We aimed to identify areas of unmet need in patients with ID/IDA following acute GIB in terms of patient management and physician guidance. We formed an international working group of gastroenterologists to conduct a narrative review based on PubMed and EMBASE database searches (from January 2000 to February 2021), integrated with observations from our own clinical experience. Published data on this subject are limited and disparate, and those relating to post-discharge outcomes, such as persistent anemia and re-hospitalization, are particularly lacking. Often, there is no post-discharge follow-up of these patients by a gastroenterologist. Acute GIB-related ID/IDA, however, is a prevalent condition both at the time of hospital admission and at hospital discharge and is likely underdiagnosed and undertreated. Despite limited data, there appears to be notable variation in the prescribing of intravenous (IV)/oral iron regimens. There is also some evidence suggesting that, compared with oral iron, IV iron may restore iron levels faster following acute GIB, have a better tolerability profile, and be more beneficial in terms of quality of life. Gaps in patient care exist in the management of acute GIB-related ID/IDA, yet further data from large population-based studies are needed to confirm this. We advocate the formulation of evidence-based guidance on the use of iron therapies in these patients, aiding a more standardized best-practice approach to patient care.

Post−discharge mortality in the first wave of COVID−19 in Turkey

Objective: To determine post-discharge mortality and associated factors of the first-wave multicenter Turkish Thoracic Society (TTD)-TURCOVID study. Methods: In this retrospective cohort study, we analyzed the data of 18 of 26 centers included in the first TTD-TURCOVID study, and 1 112 cases diagnosed with COVID-19 between 11 March and 31 July 2020 participated in the study. All causes of death after COVID-19 discharge were recorded. Results: The mean age of the patients was (51.07±16.93) years, with 57.6% male patients. In the cohort group, 89.1% of COVID-19 treatment locations were hospital wards, 3.6% were intensive care units (ICUs), and 7.2% were community outpatients. In the longterm follow-up, the in-hospital mortality rate was 3.6% (95% CI 2.64.8), the post-discharge mortality rate was 2.8% (95% CI 1.9-3.9), and the total mortality was 6.3% (95% CI 5.0-7.8). After discharge, 63.3% of mortality overall occurred during the first six months. Mortality rates in post-discharge follow-ups were 12.7% (95% CI 8.0-30.6) in cancer patients, 10.8% (95% CI 6.3-22.9) in chronic obstructive pulmonary disease patients, 11.1% (95% CI 4.4-22.7) in heart failure patients, 7.8 (95% CI 3.8-14.3) in atherosclerotic heart disease patients, and 2.3% (95% CI 0.8-5.6) in diabetes mellitus patients. In smokers/ex-smokers, the all-mortality rates were higher than in non-smokers. Conclusions: This multicenter study showed that patients over 65 years of age, males, former/active smoker, ICU stay, lung, heart disease, and malignancy should be followed up for at least the first six months after discharge due to COVID-19.

Development and evaluation of a patient decision aid for pediatric interval appendectomy

ObjectiveOne option for the treatment of perforated appendicitis in pediatric patients is interval appendectomy (IA). A patient decision aid (PDA) can be useful in the decision-making process regarding IA. The...

Risk Factors for Readmission After Pulmonary Lobectomy: A Quality Collaborative Study

BackgroundPrevious studies have identified postoperative complications as being associated with readmission after lobectomy. However, these studies have not adequately accounted for the timing of complications or accounted for institutional effects. Our objectives were to examine readmission rates after lobectomy and identify factors associated with readmission. MethodsPatients aged >18 years undergoing lobectomy for lung cancer between 2015 and 2019 were identified from a statewide database. Patients with in-hospital mortality, missing data regarding discharge status, 30-day readmission status, and discharge location were excluded. Data regarding The Society of Thoracic Surgeons postoperative complications were abstracted by hospital data managers to determine the timing of occurrence (index admission vs readmission). Logistic mixed-model analysis, with hospitals as the random intercept to account for clustering data structure and assess hospital-specific effect on readmission, was performed. ResultsThe overall readmission rate was 6.9% (184 of 2686). The most common complication was air leak ≥5 days in 17.4% (467 of 2686). Variables significantly predictive of more readmission were predischarge postoperative complications and Zubrod score ≥1. Variables predictive of less readmission were increasing length of stay and having been operated on at institutions with higher cumulative volume or having postdischarge follow-up visit protocol ≤7 days from discharge. The C statistic for the final model was 0.80. ConclusionsPatients who experience postoperative complications are at increased risk for readmission, whereas follow-up ≤7 days was predictive of less risk for readmission. Efforts at reducing readmissions should focus on decreasing postoperative complication rates, the timing of discharge for patients experiencing complications, as well as decreasing length of time between discharge and clinic follow-up.

Postdischarge Racial and Ethnic Disparities in Pediatric Appendicitis: A Mediation Analysis

IntroductionSignificant racial and ethnic disparities exist for children presenting with acute appendicitis; however, it is unknown if disparities persist after initial management and hospital discharge. Materials and MethodsWe performed a retrospective cohort study of children (aged < 18 y) who underwent treatment for acute appendicitis in 47 U.S. Children's Hospitals between 2017 and 2019. Primary outcomes were 30-d emergency department (ED) visits and 30-d inpatient readmission. Hierarchical multivariable logistic regression models were developed to determine the association of race and ethnicity on the primary outcomes. Inverse odds-weighted mediation analyses were used to estimate the degree to which complicated disease, insurance status, urbanicity, and residential socioeconomic status– mediated disparate outcomes. ResultsA total of 67,303 patients were included. Compared with Non-Hispanic White children, Non-Hispanic Black (NHB) (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.23-1.59) and Hispanic/Latinx (HL) children (OR 1.55, 95% CI 1.44-1.67) had higher odds of ED visits. Only NHB children had higher odds of readmission (OR 1.43, 95% CI 1.30-1.57). On a multivariable analysis, NHB (adjusted OR 1.19, 95% CI 1.04-1.36) and HL (adjusted OR 1.19, 95% CI 1.09-1.31) children had higher odds of ED visits. Insurance, disease severity, socioeconomic status, and urbanicity mediated 61.6% (95% CI 29.7-100%) and 66.3% (95% CI 46.9-89.3%) of disparities for NHB and HL children, respectively. ConclusionsChildren of racial and ethnic minorities are more likely to visit the ED after treatment for acute appendicitis, but HL patients did not have a corresponding increase in readmission. These differences were mediated mainly by insurance status and urban residence. A lack of appropriate postdischarge education and follow-up may drive disparities in healthcare utilization after pediatric appendicitis.

Post-discharge follow-up attendance after pediatric dermatology consultation in the emergency department: A retrospective analysis.

The emergency department (ED) is a frequent source of care for pediatric patients with dermatologic conditions, possibly owing to limited access to routine and urgent outpatient dermatology appointments. The demographics, clinical characteristics, follow-up scheduling practices, and attendance rates of 50 pediatric and 142 adult patients evaluated by the dermatology consult service in the ED were reviewed. High rates of follow-up attendance were observed in the pediatric and adult populations, with the majority receiving an appointment within 2 weeks. The dermatology consult service may play an important role in facilitating post-discharge access to outpatient care.

Willingness to engage in post-discharge follow-up service conducted via video telemedicine: Cross-sectional study

BackgroundLeading influencing factors for telemedicine implementation remain unclear, affecting the focus of intervention strategies. Despite recent effectiveness evidence of video telemedicine visits, limited evidence exists regarding patients’ willingness to use video follow-up. Moreover, patients’ acceptance is crucial for implementing such services. ObjectiveWe conducted a large-sample survey to analyze patient willingness and perceptions of post-discharge video follow-up and assessed the factors influencing their willingness during the COVID-19 outbreak. MethodIn February and March 2022, we conducted a face-to-face questionnaire survey involving inpatients in a tertiary care hospital in Longhua District, Shenzhen, China. We assessed demographics, health-related determinants, access to technology and literacy, preferences, willingness, and opinions toward video telemedicine follow-up. We implemented random forest and logistic regression analyses to obtain reliable results. ResultsIn total, 1,017 inpatients completed the survey. Overall, as an initial choice, 44.9 % preferred telephone consultation for post-discharge follow-up, which was followed by video telemedicine (17.1 %), WeChat voice calls (11.6 %), SMS text messages (10.7 %), WeChat graphic messages (10.5 %), and in-person visits (4.5 %). Moreover, 54.9 % were willing to experience video visits. The results highlight the perceived benefits outweighing the risks (OR 2.64, 95 % CI 1.76, 3.95), patients’ trust in the physician (OR 2.41, 95 % CI 1.45, 3.99), access to a private space (OR 2.18, 95 % CI 1.01, 2.96), medium geographical distance (compared to long distance, OR 0.72, 95 % CI 0.54, 0.98), moderate disease (compared to mild disease, OR 0.75, 95 % CI 0.57, 0.99), followed by the comfort with video technology (OR 1.73, 95 % CI 1.76, 3.95), broadband internet accessibility (OR 1.56, 95 % CI 1.07, 2.27), privacy concerns (OR 0.62, 95 % CI 0.43, 0.89), and prior telemedicine video experience (OR 1.77, 95 % CI 1.15, 2.72), as factors influencing the willingness to use video follow-up. ConclusionsA low percentage of patients chose video visits as their initial decisions; nevertheless, most had a positive attitude toward video follow-up visits. The willingness to choose video telemedicine post-discharge follow-up was influenced by geographical distance, disease severity, basic telemedicine requirements, physician–patient relationship, and perceptions of video communication.

Multidimensional evaluation of a 12-month intensive outpatient program for the treatment of substance use disorder. Experience in Argentina

The purpose of this study was to asess the efficacy of an intensive outpatient treatment (IOT) for substance use disorder (SUD) using a multidimensional approach. All the patients consecutively admitted to a private institution between May 2019 and May 2020 were invited to participate in the study. The program consisted in a 12-month set of psychosocial, medical and recreative interventions requiring an attendance of at least 9 hours per week. Efficacy was evaluated at admission and every three months by the Addiction Severity Index (ASI). Quality of life was evaluated at admission and at the end of the treatment by the WHOQOL-Bref questionnaire. A comparison of parameters obtained at admission between the group that completed and the one that abandonned the treatment was also performed to detect potential predictors of early dropout. Six months after the end of the treatment, the participants were contacted in order to repeat an evaluation through the ASI and the WHOQOL-Bref scales. 41 participants (73% male, age 42.8 ± 16 years) were included. 14 participants dropped out at a median time of 88 days. Among those who completed the treatment improvements were observed in different clinical dimensions: in alcohol and drug consumption (3 months), in medical problems (6 months), in family/social relationships (9 months), in psychological scores (12 months) and in the four dimensions of WHOQOL-Bref. No changes were observed in legal problems and in the employment status. Only legal problems and family/social relationships at admission were significantly different among patients who completed versus those who dropped-out. Six months after discharge, no differences in WHOQOL-Bref scores were observed in the 15 participants who could be located and accepted the assessment. A little but statistically significant worsening was observed in the psychological problems dimension of the ASI in post-discharge follow-up. The rest of the ASI dimensions remained unchanged 6 months after concluding the treatment. This is one of the few studies performed in a latinamerican setting assessing the efficacy of a long-term IOT for SUD. It confirms previous works from developed countries, showing the potential benefits of IOTs implementation in our region.

Evaluating smoking cessation service at an emergency department clinical observation unit.

To evaluate the effectiveness of a pilot smoking cessation service in an emergency department (ED) clinical observation unit. A descriptive case series review was undertaken of smoking cessation service patients in the short-stay unit of an acute hospital in Singapore from July 1, 2018, to December 31, 2019. Upon admission, ED nurses screen all patients regarding their current smoking status and implement the 5 A's framework, which involves the steps of Ask-Advise-Assess-Assist-Arrange. Patients in the "contemplation" and "preparation" stages were offered the following components: (1) a bedside counseling session by a pharmacist and (2) a follow-up appointment at an outpatient smoking cessation clinic. Postdischarge follow-up telephone calls at 1, 6, and 12 months were carried out as part of the study data collection to obtain abstinence information. Forty-seven patients were included in the study; the majority were male (n = 41; 87.2%). The median numbers of cigarettes smoked per day at baseline, 1 month, 6 months, and 12 months were 14, 5, 3, and 5, respectively. The overall point-prevalence abstinence rates over the same follow-up time points were 26.5%, 38.7%, and 31.3%, respectively. The proportions of patients lost to follow-up at 1 month, 6 months, and 12 months were 27.7%, 34.0%, and 31.9%, respectively. Given the small sample and high number of uncontactable patients, more research is needed to assess whether the trend toward increasing point-prevalence abstinence rate over time and the trend toward decreasing median number of cigarettes smoked are observed in a larger sample.

The Impact of Kangaroo Mother Care on the Outcome of Premature Babies at the Regional Hospital Buea

Background: Prematurity and its complications are the leading causes of neonatal death. Kangaroo Mother Care (KMC) is one of the neonatal interventions to prevent these main complications, improve the outcome of preterm babies and reduce neonatal mortality due to prematurity. This study was conducted to assess the impact of KMC on the morbidity and mortality of premature babies in a semi-urban setting in Cameroon. Method: This study was a hospital-based retrospective cohort study carried out at the Buea Regional Hospital from February to April 2021. The files of neonate patients born before 37 weeks of completed pregnancy and who were hemodynamically stable were extracted and used. Participating babies selected were sorted into two groups: those who were cared for conventionally and those who were cared for through KMC. Some variables were obtained and compared between the 2 cohorts including: prevalence of hospitalisation, complications, duration of hospitalisation, mortality rate, rate of post discharge follow-up, rate of breastfeeding and increase in anthropometric parameters (head circumference, length and weight). Results: One hundred and twenty four premature babies were retained. Forty four of these were cared for conventionally and 80 cared for through KMC. Admissions significantly increased with KMC p&lt;0.001). The main complications before and after KMC institution were and remained: infection, jaundice, respiratory distress and anaemia. There was a reduction in the frequency of some morbidities with KMC (infection, Necrotic Enterocolitis, hypoglycaemia and feeding difficulties), though the decrease was not statistically significant (p= 0.227, 0.285, 0.353 and 0.123 respectively). The frequency of respiratory distress, apnoea and hypothermia increased with KMC, but the changes were not significant (p= 0.551, 1.000 and 0.131 respectively). There was no significant change in duration of hospitalization between the cohorts (p= 0.637). Mortality rate reduced with KMC, though not significantly (p= 0.786). KMC significantly promoted the practice of exclusive breastfeeding both in hospital and at home (p&lt;0.001). Post-discharge follow-up significantly improved after KMC was instituted (p&lt;0.001). Head circumference and length increased, while weight reduced at discharge with KMC, but the changes were not statistically significant (p= 0.348, 0.118 and 0.438 respectively). Conclusion: KMC significantly increased admissions in this study. Mortality rate, infection and some other morbidities reduced, anthropometric parameters were better at discharge and post-discharge follow up improved for babies cared for through KMC. Implementation of KMC therefore has a positive effect on the outcome of preterm babies and should be intensified in resource-poor settings. Keywords: Kangaroo Mother Care; Neonates; Growth; Outcome; Cameroon