Reduce Hospital Admissions Research Articles

Management of inoperable malignant bowel obstruction using the 4-step BOUNCED diet.

Malignant bowel obstruction (MBO) presents with multiple symptoms. The 4-step BOUNCED diet educates patients to self-manage oral intake according to symptoms. It includes clear fluids, thin liquids, purée and soft, sloppy foods, which are low in fibre. This mixed methods single-arm feasibility study aimed to establish if the diet could reduce MBO symptoms in patients with inoperable colorectal and gynaecological malignancies. The secondary objectives were to investigate if it was easily followed, improved quality of life (QOL) and reduced hospital admissions. Patients able to tolerate an oral diet with one or more symptoms (pain, bloating, early satiety, nausea and vomiting) were eligible. Following informed consent, an oncology dietitian took a diet history and determined which step of the diet they needed to follow using a detailed patient information leaflet. Patients remained on the trial for 28 days. Symptom and QOL data were collected on Days 1 and 28 using the Memorial Symptom Assessment Scale and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) questionnaires. Thirty patients (24 female, 6 male) aged 18-85 years consented from March 2021 to November 2022. Twenty-six participants completed the trial and 25 found the diet very easy or easy to understand. There was a significant reduction in pain from 96% on Day 1 to 63% on Day 28 (p = 0.004). The mean increase of EORTC global health status/QOL was 23.5 points, 95% CI (12.4-32.5) (p ≤ 0.001). There was a significant difference between number of admissions (p = 0.018) and bed days (p = 0.004) in the 28 days prior to consent compared to the trial period. A modified consistency low-fibre diet is easily followed, may reduce symptoms of MBO, admissions to hospital and improve QOL.

The use of a point of care high sensitivity troponin in the investigation of patients presenting to the Emergency Department with undifferentiated chest pain

Abstract Background In 2012 in a hospital, New Zealand, a chest pain pathway was instituted for the use in patients presenting to the Emergency Department (ED) with undifferentiated chest pain. This reduced hospital admissions and ED length of stay (LOS) without adversely affecting outcomes. The pathway consists of risk stratification combined with ECG and troponin testing. The pathway suggests, but does not enforce, that low risk patients can be discharged after a single troponin, intermediate risk patients are for serial troponins (which can be done in ED or the next day in the community), with further testing if appropriate, and high risk patients are reviewed by Cardiology or General medicine. In August 2023, Siemens point of care high sensitivity troponin I (POC-hsTnI) was introduced for the use in ED, although Beckman laboratory troponin I (Lab–hsTnI) is still available. A POC test reduces result turnaround times but until recently there has been a lack of POC assays fulfilling criteria for "high sensitivity". Purpose To ascertain whether the availability of a POC-hsTnI in the ED is a viable option for use in the chest pain pathway Methods A 1 month "snap shot" of all consecutive patients presenting to the ED with chest pain was undertaken and the patients followed for adverse events using electronic notes review. October 2023 was selected for the post POC-hsTnI period and compared with April 2022. Results There were 688 patients presenting to ED with undifferentiated chest pain during October 2023 with a type 1 acute myocardial infarction (AMI) rate of 80 (11.6%), median age 58 (41-72), female 335 (48.7%). POC-hsTnI was used in isolation in 377 (54.8%), in conjunction with Lab-hsTnI in 218 (31.7%) and Lab-hsTnI was used alone in 93 (13.5%). The median turnaround time for POC-hsTnI was 11 minutes (10-11) compared with Lab-hsTnI 87 minutes (61-129). The POC-hsTnI was less sensitive for AMI than the Lab-hsTnI on presentation using the upper reference limit, 72.1% (60.6-81.6) versus 91.5% (83.0-96.4). However, when used with risk stratification, there were no excess adverse events (cardiac death or AMI) at 4 months in patients discharged with a diagnosis of non-cardiac chest pain – 7 (1.4%) (n=495) versus 5 (1.2%), (n=424) in 2022. Median LOS in the ED was 4.4 hours (2.9-6.2) versus 4.0h (3.0-5.9) in 2022. However, a higher proportion of patients had a second cTn: 414 (60.2%) versus 309 (48.4%) and a lower proportion had their second troponin the next day in the community, 28 (6.7%) versus 56 (18.1%). Conclusion The use of a POC-hsTnI is a practical solution to reduce turnaround times for troponin results and has the potential to reduce LOS or allow serial troponins to be measured in a timely manner during their ED visit, obviating the need for a next day community troponin. Whilst POC-hsTnI has a lower early sensitivity for AMI, the use of POC-hsTnI as part of a pathway does not adversely affect outcomes.

Efficacy and safety of intravenous iron therapy in heart failure patients with iron deficiency: a systematic review and meta-analysis of randomized controlled trials

Abstract Background Heart failure is a diverse life-threatening condition with complex biology and demanding therapeutic goals. Even when anemic patients are excluded, up to 59% of heart failure patients have low ferritin levels, making them especially vulnerable to iron deficiency. Purpose To assess the complete data derived from Randomized controlled trials concerning the benefits and safety of IV ferric carboxymaltose therapy among patients with heart failure with iron deficiency. Methods A systematic review and meta-analysis of randomized controlled trials obtained from PubMed, WOS, SCOPUS, EMBASE, and Cochrane up to August 31, 2023. We used RevMan V. 5.4 to pool dichotomous data using a risk ratio (RR) with a 95% confidence interval (CI). Results We included 14 randomized controlled trials with a total of 6,626 patients. The IV iron group was favored over the control group in reducing hospital admissions for heart failure (first event) (RR= 0.83, 95% CI 0.71 to 0.97; p = 0.02) and (total events) (RR= 0.81, 95% CI 0.74 to 0.89; p < 0.0001). Also, the iron group had a 21% lower risk in terms of cardiovascular death and hospital admission for HF (number of events, rate per 100 patients in a year) (RR= 0.79, 95% CI 0.74 to 0.85; p < 0.00001). Concerning the adverse events, both ferric carboxymaltose and ferric derisomaltose showed a beneficial effect in reducing the cardiac disorder (RR= 0.81, 95% CI 0.76 to 0.87; p <0.0001), and (RR= 0.82, 95% CI 0.71 to 0.95; p = 0.009), respectively. Conclusion IV iron infusion in patients with heart failure has a favorable safety profile. It reduces total hospitalizations for heart failure and cardiovascular mortality, with no effect on all-cause mortality, cardiovascular mortality alone, or first-time hospitalization for heart failure.

Nurse Practitioners' Experiences of Transitioning to and Working in the Pioneering Nursing Role: An Interview Study.

Nurse practitioners (NPs) play a crucial role in healthcare by providing person-centred and high-quality care. Their contributions encompass enhanced accessibility to healthcare and reduced hospital admissions and cost-effectiveness. They usually hold a master's degree in nursing, incorporating expanded clinical skills to manage patients in different settings and address both nursing and medical needs. Despite the global development of the role, its implementation varies, presenting challenges related to role clarity, regulation and acceptance by other healthcare professionals. To explore how nurses who are or have been employed as NPs describe their experiences of transitioning to and working in the NP role in Sweden. A qualitative interview study. This study explores the experiences of 15 NPs in Sweden, using a snowball sampling strategy and semi-structured interviews. The data were collected through interviews in April and May 2022 and analysed with inductive content analysis. The present study explores the experiences of NPs as they transition from experienced nurses to NPs, emphasising motivations, educational challenges, acceptance and autonomy. Transitioning into the NP role initially brought isolation that evolved into acceptance. They recognised their strength in integrating medical and nursing competencies for holistic care. Leadership was pivotal, with managerial support crucial for the successful implementation of the role. Autonomy-related challenges, such as prescription rights and dependency on physicians, underscored the need for a protected professional title and national guidelines. This study enriches the evolution of the NP role in Sweden, offering vital insights into the ongoing national-level dialogues on NP role development in Sweden. The paper's relevance extends globally by providing valuable perspectives on NPs practicalities and fostering international understanding and advancement. Standards for reporting qualitative research. Not applicable.

Biosensor applications in the monitoring of elderly patients

Nurse-based patient monitoring is prone to errors due to manual measurements and documentation, leading to potential inaccuracies in care. The use of biosensors offers a promising solution by enabling real-time and continuous monitoring of patient health. Categorizing patient care reports as critical or non-critical using mobile recording systems based on biosensor data can help prevent errors and improve care. The use of biosensors can significantly reduce morbidity and mortality, especially after emergencies and accidents. These devices improve the quality of care and increase the satisfaction of older people, their families and healthcare professionals. Wearable biosensors make it easier for older people to monitor their health, which can help reduce hospital admissions. Chronic diseases such as cardiovascular disease, cancer, diabetes, dementia and stroke pose challenges to healthcare delivery and interpretation of results. Integrating biosensors into health monitoring and measurement is an innovative approach to managing these chronic conditions more effectively. To improve self-management of chronic diseases in older people, it is essential to educate healthcare professionals and promote research in this area. As a result, the use of biosensors to monitor the daily activities and health parameters of elderly patients is expanding, highlighting the importance of multidisciplinary research in biotechnology, chemistry, engineering and nursing.

SARS-CoV-2 Vaccination in Patients with Cancer and COVID-19 in Mexico

Objectives: Vaccination is the best preventive measure for SARS-CoV-2 infection; however, efficacy is lower in cancer patients. During the pandemic period, Mexico was characterized by the use of seven different COVID-19 vaccine platforms, and oncologic patients were not prioritized for vaccination. We report the outcomes of COVID-19 in cancer patients after the beginning of the national vaccine campaign in Mexico. Methods: All patients with cancer and COVID-19 diagnosed at Instituto Nacional de Cancerología from 14 February 2021 to 28 February 2022 were included. Primary outcomes were the proportion of individuals who required hospital admission and/or invasive mechanical ventilation, according to the vaccination status; 30-day mortality; the period of infection; and other cancer-related variables. Results: A total of 691 patients were included; 524 (76%) had solid tumors (STs), and 167 (24%) had hematologic malignancies (HMs). Patients infected in the first two periods, had lower rates of vaccination and higher rates of mortality and hospitalization compared to those infected in the Omicron period. In the multivariate analysis, vaccination status was independently associated with hospitalization in patients with STs (aOR 0.38, 95%CI 0.19–0.75, p = 0.005), but it was not associated with invasive mechanical ventilation and 30-day mortality. In those with HMs, vaccination status was not associated with any outcome; in this group, only recent chemotherapy and time of infection were associated with invasive ventilation. Conclusions: Vaccination significantly reduced hospital admissions in patients with STs. Infections occurring during the Omicron period were associated with improved outcomes in both ST and HM patients. Despite having a lesser impact in immunosuppressed patients, vaccination is an essential strategy, and access to vaccination campaigns in patients with cancer needs to be prioritized.

Reduced Hospital Admission, Emergency Department Visit, and Urgent Surgeries and its Correlation with Non-COVID-19 Mortality

Reduced Hospital Admission, Emergency Department Visit, and Urgent Surgeries and its Correlation with Non-COVID-19 Mortality

A New Hospital-At-Home Model for Integrated Geriatric Care: Data from a Preliminary Italian Experience

ObjectiveHospital-at-home (HaH) has emerged as an alternative to conventional in-hospital care in older adults, possibly reducing hospital admissions and related complications. This study aimed to describe the characteristics and outcomes of patients referred to “Gruppo di Intervento Rapido Ospedale-Territorio” (GIROT), a HaH service based on comprehensive geriatric assessment, developed in Florence, Italy, during the postpandemic period. DesignRetrospective longitudinal study. Setting and ParticipantsGIROT provided home-based care to patients with acute or exacerbated chronic diseases and a high risk of hospital-related complications (ie, patients with moderate-to-severe disability and/or dementia), referred from primary care, emergency departments, or in-hospital units. MethodsAll-cause mortality and hospitalization rates were assessed at 1, 3, and 6 months, and predictors of 6-month mortality were investigated. ResultsAmong 391 patients (mean age, 88.4 years; 62.4% female) referred from emergency departments (58.6%), primary care (27.9%), and acute medical units (13.6%), the main diagnoses were respiratory failure (28.4%), acute heart failure (25.3%), and delirium (13.6%). Patients referred from primary care were older and showed a higher prevalence of severe disability and hypomobility. After 1, 3, and 6 months, mortality rates were 34.5%, 45.6%, and 53.8%, and hospitalization rates 7.2%, 21.5%, and 37.9%, respectively. Predictors of 6-month mortality included age [odds ratio (OR), 1.039], severe disability (OR, 3.446), impossible/assisted walking (OR, 4.450) and referral from primary care (OR, 2.066). High global satisfaction with the service was reported. Conclusions and ImplicationsThe GIROT model may help expanding acute health care capacity for older adults at high risk of hospital-related complications. Customized care plans are needed in patients with severe disability/hypomobility, considering also simultaneous palliative care.

Evaluating the effectiveness of a home treatment team for older adults and adults with dementia in a mental health crisis: A retrospective analysis

The demographic shift towards an aging population presents challenges in healthcare, notably in addressing frailty and dementia. Hospitalization risks, including out-of-area (OOA) admissions, are well-documented. This evaluation focused on the Intensive Support Team (IST), designed to reduce hospitalisations for older adults, usually over 75 years old, and adults with dementia facing mental health crises. The study assessed the effectiveness of IST within the Specialist Dementia and Frailty Service (SDFS) in West Essex. Using a retrospective comparative design, IST admission data from 2018 (pre-IST) and 2022 (post-IST) were analysed, covering 246 patients’ records. Objectives included evaluating changes in admission rates for patients under or eligible for SDFS and comparing with other community teams, as well as examining IST’s impact on hospital stay length. Chi-square analysis showed a significant reduction in SDFS admissions post-IST, though no significant change was found for other admissions. One-way ANOVA revealed no significant difference in admission length. The results support IST’s effectiveness in reducing hospital admissions, aligning with NHS long-term goals and informing policy and clinical decisions.

The Role of Subcutaneous Furosemide in Heart Failure Management: A Systematic Review.

Acute decompensated heart failure (ADHF) patients with symptomatic congestion often require in-hospital admission for intravenous (IV) diuretic, impacting both patient well-being and healthcare expenses. Subcutaneous (SC) furosemide has a potential to facilitate outpatient management of ADHF patients. Thus, this study aims to assess the efficacy and safety of SC furosemide utilization, offering a potential alternative to traditional IV administration. A systematic search was conducted until April 14 2024 across scientific databases. This review included studies comparing SC furosemide with oral and IV formulations in adult HF patients. This study analyzed 687 patients from 20 studies. The results demonstrate that SC furosemide can effectively manage symptomatic congestion in HF patients and results in significant cost reductions, symptom relief, and improved quality of life. Although further investigation into mortality rates is needed, SC furosemide demonstrates efficacy comparable to IV furosemide in diuresis and weight loss, with similar bioavailability and natriuretic effects. Adverse events are generally minor, predominantly related to skin irritation. Innovative strategies, such as developing isotonic alkaline solutions and improved infusion devices, are being explored to address these challenges. SC furosemide offers a promising alternative for managing ADHF, particularly in symptomatic HF patients with volume overload. The integration of SC furosemide into routine clinical practice and future guidelines, could optimize the management of HF, reducing hospital admission and improving patient outcomes.

Systematic screening for multimorbidities in patients with inflammatory rheumatic diseases enhanced preventive medication use and reduced hospitalisations: an exposed-non-exposed study

RationalStudies are needed to determine if multimorbidity screening and management reduce the rate of multimorbidity accumulation in patients with chronic inflammatory rheumatic diseases (IRD).ObjectivesThis study evaluates the impact of systematic...

Pooled analysis of the MANTICO2 and MONET randomized controlled trials comparing drug efficacy for early treatment of COVID-19 during Omicron waves

BackgroundThe clinical effectiveness of early therapies for mild-to-moderate COVID-19, comparing antivirals and monoclonal antibodies (mAbs) during the Omicron era, has not been conclusively assessed through a post-approval comparative trial. We present a pooled analysis of two randomized clinical trials conducted during Omicron waves. Methods The MANTICO2/MONET trial is a pooled analysis of two multicentric, independent, phase-4, three-arm, superiority, randomized, open-label trials. Nonhospitalized patients with early mild-to-moderate COVID-19 (≤5 days after symptoms’ onset) and at least one risk factor for disease progression were randomized 1:1:1 to receive 500mg of intravenous sotrovimab (SOT) or 600mg of intramuscular tixagevimab/cilgavimab (TGM/CGM) or oral 5-days course of nirmatrelvir/ritonavir (NMV/r) 300/100mg BID. Primary outcome was COVID-19-related hospitalization or death within 29 days after randomization. Fisher’s exact test for pooled data and incidence of failure was reported as overall and by arm with respective 95% CI.Pairwise comparisons across the arms were conducted using unadjusted exact logistic regression. An analysis by means of a doubly robust marginal model using augmented inverse probability weighting (AIPW) was also conducted to estimate the potential outcomes (Pom) in each treatment group and their difference by the average treatment effect (ATE). Analysis of symptom persistence within 30 days after randomization was performed using a 2-level hierarchical mixed-effects logistic model with a random intercept at the patient’s level. Point estimates and 95% confidence intervals were adjusted for age and sex and calculated using ANOVA-like methods for the mixedeffects logistic model. These trials are registred with the European Clinical Trials Database, EudraCT2021-002612-31 (MANTICO2) and EudraCT2021-004188-28 (MONET) and ClinicalTrials.gov, NCT05321394 (MANTICO2) Findings Between March 2022 and February 2023, 991 patients (SOT=332, TGM/CGM =327, NMV/r=332) were enrolled in 15 Italian centersThe overall mean age was 66 years; 482 participants (48.80%) were male and 856 vaccinated with at least a primary course ( 86%). Among the 8/991 hospitalizations observed, one resulted in death. The overall estimate of failure was 0.81% (95%CI; 0.35-1.58%). The odds ratio (OR) for the primary outcome in the NMV/r arm compared to the TGM/CGM and SOT arms was 8.41 (95% CI 1.21 to infinity; p=0.015) and 2.42 (95% CI 0.19 to infinity; p=0.499), respectively. No significant difference was observed between SOT and TGM/CGM (OR 0.32; 95% CI 0.032-1.83; p=0.174). Results were similar when we applied the marginal weighted model accounting for potential residual confounding bias. There was no evidence for a difference in the prevalence of symptoms between treatment groups, except for cough, which was higher in the SOT group compared to the other two groups at the 21-day follow-up (P=0.039) and a higher prevalence of nausea at the 7-day follow-up in the NMV/r group compared to the mAbs group (p=0.036). Interpretation NMV/r was superior to TGM/CGM in reducing hospital admission or death in clinical vulnerable patients with SARS-CoV-2 infection treated within 5 days of symptoms’ onset. No significant difference in symptom prevalence over time across the arms was found. Funding: The trials were funded by the Italian Agency of Drugs (AIFA) in 2021.

Implementing telemedicine with 5G technologies in a nursing home for reducing emergency admissions– study protocol of a mixed-methods study

BackgroundBy transmitting various types of data, telemedical care enables the provision of care where physicians and patients are physically separated. In nursing homes, telemedicine has the potential to reduce hospital admissions in nonemergency situations. In this study, telemedicine devices were implemented with the new 5G mobile communications standard in selected wards of a large nursing home in Northwest Germany. The main aim of this study is to investigate which individual and organizational factors are associated with the use of telemedicine devices and how users perceive the feasibility and implementation of such devices. Moreover, it is investigated whether the telemedical devices help to reduce the number of emergency admissions.MethodsTelemedicine devices are implemented over an 18-month period using a private 5G network, and all users receive training. This study uses qualitative and quantitative methods: To assess the individual and organizational factors associated with the use of telemedicine devices, survey data from employees before and after the implementation of these devices are compared. To assess the perception of the implementation process as well as the feasibility and usability of the telemedical devices, the nursing staff, physicians, medical assistants and residents are interviewed individually. Moreover, every telemedicine consultation is evaluated with a short survey. To assess whether the number of emergency admissions decreased, data from one year before implementation and one year after implementation are compared. The data are provided by the integrated dispatch centre and emergency medical services (EMS) protocols. The interview data are analysed via structured qualitative content analysis according to Kuckartz. Survey data are analysed using multivariable regression analysis.DiscussionLearnings from the implementation process will be used to inform future projects implementing telemedicine in care organizations, making the final telemedicine implementation and care concept available to more nursing homes and hospitals. Moreover, the study results can be used to provide use cases for appropriate and targeted application of telemedicine in nursing homes and to define the role of 5G technologies in these use cases. If the intervention is proven successful, the results will be used to promote 5G network rollout.Trial registrationGerman Clinical Trials Register – trial registration number: DRKS00030598.

EP45 - Improving Management of Patients undergoing Inguinal Hernia Repair Who Experience Post-Operative Urinary Retention

Abstract Aims Post-operative urinary retention (POUR) is a common complication following inguinal hernia repair. Left untreated POUR can result in significant patient discomfort, acute kidney injury, detrusor muscle damage and infection. It was observed that the detection and management of POUR in our trust following planned day case inguinal hernia repair was varied, often resulting in unplanned admission. We therefore carried out a review of how our trust is managing these patients. Methods A retrospective analysis of all patients undergoing planned day case inguinal hernia repair in a single institution between March 2023 and August 2023 was performed. Patients having open, laparoscopic, or robotic repair were included. Data was collected on demographics, documentation of POUR, time to diagnosis, bladder scan volume, catheterisation, overnight stay and follow up for all patients. Results 124 patients underwent inguinal hernia repair. 13 patients reported experiencing POUR (10.4%). 9 patients experienced POUR during their initial admission, of which 8 had unplanned overnight admissions. 5 patients were not managed with catheterisation despite having significant volume of urine detected on bladder scan (>700ml). Time to diagnosis varied with POUR not being detected for 24 hours for one patient. 4 patients went into retention after discharge and re-presented via the emergency department. Conclusion Significant variation in the detection and management of patients with POUR was noted in this cohort. Introduction of a POUR pathway in day-surgery describing both diagnosis and management has therefore been created to try and address this, to improve outcomes and reduce hospital admission.

Exposure to green spaces and schizophrenia: a systematic review.

The mental health benefits of exposure to green spaces are well known. This systematic review summarizes the evidence of green space exposure for people with schizophrenia spectrum disorders (SSDs), focusing on incidence and mental health outcomes, including mental health symptoms and health service use. The study was pre-registered (PROSPERO ID: CRD42023431954), and conducted according to PRISMA guidelines. Seven databases, reference lists, and gray literature sources were searched. Methodological quality was assessed using The Quality Assessment Tool for Quantitative Studies. 126 studies were screened, and 12 studies were eligible for inclusion. Seven studies found that exposure to green space was associated with a reduced risk of schizophrenia (lowest to highest green space exposure: HRs = 0.62-0.37; IRRs = 1.52-1.18), with five studies reporting a dose-response relationship. Of these studies, four examined childhood exposure and the remainder examined adult exposure. Regarding health service use, proximity to green space was not significantly associated with length of hospital admission, though greater green space exposure was associated with reduced hospital admission rates. Three studies found reduced symptoms of anxiety (d = -0.70-2.42), depression (d = -0.97-1.70) and psychosis (d = -0.94) with greater green space exposure. Exposure to green space reduces the risk of schizophrenia, and there is emerging evidence of the potential benefits of green space for reducing symptoms and health service use among people with SSDs. Future research using experimental and longitudinal designs will provide more robust evidence of the benefits of green space for people with SSDs.

Favipiravir for COVID-19 in adults in the community in PRINCIPLE, an open-label, randomised, controlled, adaptive platform trial of short- and longer-term outcomes

BackgroundEvidence for the effect of favipiravir treatment of acute COVID-19 on recovery, hospital admissions and longer-term outcomes in community settings is limited. MethodsIn this multicentre. open-label, multi-arm, adaptive platform randomised controlled trial participants aged ≥18 years in the community with a positive test for SARS-CoV-2 and symptoms lasting ≤14 days were randomised to: usual care; usual care plus favipiravir tablets (loading dose of 3600mg in divided doses on day one, then 800mg twice a day for four days); or, usual care plus other interventions. Co-primary endpoints were time to first self-reported recovery and hospitalisation/death related to COVID-19, within 28 days, analysed using Bayesian models. Recovery at six months was the primary longer-term outcome. Trial registration: ISRCTN86534580. FindingsThe primary analysis model included 8811 SARS-CoV-2 positive mostly COVID vaccinated participants, randomised to favipiravir (n=1829), usual care (n=3256), and other treatments (n=3726). Time to self-reported recovery was shorter in the favipiravir group than usual care (estimated hazard ratio 1·23 [95% credible interval 1·14 to 1·33]), a reduction of 2·98 days [1·99 to 3·94] from 16 days in median time to self-reported recovery for favipiravir versus usual care alone. COVID-19 related hospitalisations/deaths were similar (estimated odds ratio 0·99 [0·61 to 1·61]; estimated difference 0% [-0·9% to 0·6%]). 14 serious adverse events occurred in the favipiravir group and 4 in usual care. By six months, the proportion feeling fully recovered was 74·9% for favipiravir versus 71·3% for usual care (RR = 1·05, [1·02 to 1·08]). InterpretationIn this open-label trial in a largely vaccinated population with COVID-19 in the community, favipiravir did not reduce hospital admissions, but shortened time to recovery and had a marginal positive impact on long term outcomes.

An emergency department transitional care team prevents unnecessary hospitalization of older adults: a mixed methods study.

Older adults with acute functional decline may visit emergency departments (EDs) for medical support despite a lack of strict medical urgency. The introduction of transitional care teams (TCT) at the ED has shown promise in reducing avoidable admittances. However, the optimal composition and implementation of TCTs are still poorly defined. We evaluated the effect of TCTs consisting of an elderly care physician (ECP) and transfer nurse versus a transfer nurse only on reducing hospital admissions, as well as the experience of patients and caregivers regarding quality of care. We assessed older adults (≥ 65 years) at the ED with acute functional decline but no medical indication for admission. Data were collected on type and post-ED care, and re-visits were evaluated over a 30-day follow-up period. Semi-structured interviews with stakeholders were based on the Consolidated-Framework-for-Implementation-Research, while patient and caregiver experiences were collected through open-ended interviews. Among older adults (N = 821) evaluated by the TCT, ECP and transfer nurse prevented unnecessary hospitalization at the same rate (81.2%) versus a transfer nurse alone (79.5%). ED re-visits were 15.6% (ECP and transfer nurse) versus 13.5%. The interviews highlighted the added value of an ECP, which consisted of better staff awareness, knowledge transfer and networking with external organizations. The TCT intervention in general was broadly supported, but adaptability was regarded as an important prerequisite. Regardless of composition, a TCT can prevent unnecessary hospitalization of older adults without increasing ED re-visiting rates, while the addition of an ECP has a favourable impact on patient and professional experiences.

A Primary Health Care Program and COVID-19. Impact in Hospital Admissions and Mortality

BackgroundMost patients with mild or moderate COVID infection did not require hospital admission, but depending on their personal history, they needed medical supervision. In monitoring these patients in primary care, the design of specific surveillance programs was of great help. Between February 2021 and March 2022, EDCO program was designed in Tenerife, Spain, to telemonitor patients with COVID infection who had at least one vulnerability factor to reduce hospital admissions and mortality.ObjectiveThe aim of this study is to describe the clinical course of patients included in the EDCO program and to analyze which factors were associated with a higher probability of hospital admission and mortality.DesignRetrospective cohort study.PatientsWe included 3848 patients with a COVID-19 infection age over 60 years old or age over 18 years and at least one vulnerability factor previously reported in medical history.Main MeasuresPrimary outcome was to assess risk of admission or mortality.Key Results278 (7.2%) patients required hospital admission. Relative risks (RR) of hospital admission were oxygen saturation ≤ 92% (RR: 90.91 (58.82–142.86)), respiratory rate ≥ 22 breaths per minute (RR: 20.41 (1.19–34.48), obesity (RR: 1.53 (1.12–2.10), chronic kidney disease (RR:2.31 (1.23–4.35), ≥ 60 years of age (RR: 1.44 (1.04–1.99). Mortality rate was 0.7% (27 patients). Relative risks of mortality were respiratory rate ≥ 22 breaths per minute (RR: 24.85 (11.15–55.38), patients with three or more vulnerability factors (RR: 4.10 (1.62–10.38), oxygen saturation ≤ 92% (RR: 4.69 (1.70–15.15), chronic respiratory disease (RR: 3.32 (1.43–7.69) and active malignancy (RR: 4.00 (1.42–11.23).ConclusionsVulnerable patients followed by a primary care programme had admission rates of 7.2% and mortality rates of 0.7%. Supervision of vulnerable patients by a Primary Care team was effective in the follow-up of these patients with complete resolution of symptoms in 91.7% of the cases.

Effectiveness of an interdisciplinary home care approach for older adults with chronic conditions: A systematic review and meta-analysis.

The effectiveness of interdisciplinary home healthcare service consisting of at least two or more healthcare providers, such as a nurse, physician and physiotherapist, for community-dwelling older adults remains unclear. This systematic review assesses the effects of interdisciplinary home care on quality of life (QOL) and health outcomes in older adults with chronic conditions using validated tools. Databases were searched using CINAHL Plus with Full Text, PubMed, EMBASE, CENTRAL, PsycINFO, and OpenGrey from inception to January 25, 2021. Eligibility criteria included (i) an interdisciplinary home care approach, (ii) participants aged 65 years and older with chronic conditions, (iii) randomized controlled trials (RCTs), and (iv) original literature in English. The study reviewer's dyad independently screened the literature and assessed the study quality using the Cochrane's Risk of Bias 2 tool. The analysis employed qualitative and quantitative integration and Grading of Recommendations Assessment, Development, and Evaluation. This study included 13 RCTs with 4709 participants. Four RCTs indicated that interdisciplinary home healthcare services reduced hospital admissions during the initial 6 months after the start of home care interventions (risk ratio [RR] = 0.73; 95% confidence interval [CI] = 0.61-0.88; p < 0.001; I2 = 0%). However, evidence certainty was moderate; QOL and mortality showed low certainty; and institutionalization and adherence showed moderate certainty of evidence. This study suggests that the interdisciplinary home care approach reduces hospital admissions but lacks effects on other outcomes. More robust studies are required to evaluate this evidence. Geriatr Gerontol Int 2024; ••: ••-••.

A better quality in the relationship between patients with heart failure and nurses reduces hospital admissions and adverse clinical events

Abstract Background An estimated 64.3 million people live with heart failure (HF) worldwide and most are older adults. HF patients often use emergency services, and unplanned hospitalizations represent 20-25% of all hospital admissions in those over 65 years of age. During these frequent hospitalizations, patients with HF may experience adverse clinical events, such as falls, pressure ulcers, and infections. Furthermore, during these hospitalizations, patients with HF can develop a good mutuality(i.e., good quality in the relationship)with nurses, characterized by empathy, trust, reciprocity, equality, shared goals, shared decision making, and sharing of care. It is unknown whether mutuality is associated with hospital admissions, and adverse clinical events. Purpose The aim of this study was to investigate whether nurse-patient mutuality is associated with reduced hospital admission(i.e., use of emergency services and unplanned hospitalizations) and adverse clinical events(i.e., falls, pressure ulcers, and infections). Method A multicenter cross-sectional study was conducted in Italy. Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness Scale, which includes three dimensions: "Developing and going beyond"(score ranges 3-15),"Being a point of reference"(score ranges 8-40)and "Deciding and sharing care"(score ranges 9-45). Higher scores mean better mutuality. Adverse clinical events were obtained from medical records. Data were analyzed with descriptive statistics and logistic regression. Covariates in the tested models were age, sex, education, living conditions, number of diseases, and number of medications. Results A sample of 167 patients with HF participated in the study (mean age 66.6, SD ±13.9; 58.1 % male). The mutuality average scores were 12.8(±2.4), 35.4(±5.0) and 32.0(±8.7) for "Developing and going beyond", "Being a pointof reference" and "Deciding and sharing care",respectively. Logistic regression showed that higher "Developing and going beyond" scores were associated with lower odds of pressure ulcers(OR=.49, 95%CI[.27-.87])and infections(OR=.75, 95%CI[.59-.96]); higher "Being a point of reference" scores were associated with lower odds of pressure ulcers(OR=.56, 95%CI[.37-.84]); higher "Deciding and sharing care" scores were associated with lower odds of infections(OR=.86, 95%CI[.80-.92]), of uses of emergency services(OR=.92, 95%CI[.87-.97]), of unplanned hospitalizations(OR=.94, 95%CI[.89-.99]),and of falls(OR=.90, 95%CI[.84-.97]). Among the covariates, patients living alone were 3.01(95%CI [1.06-.8.54])times as likely to have emergency access than those living with a family. Conclusions Our study showed that nurse-patient mutuality has an important role in predicting either hospital admissions or adverse clinical events. These results, if supported by further studies, may be useful to guide future interventions for patients with HF in order to reduce their hospitalizations and improve their clinical outcomes.