Reduce Hospital Admissions Research Articles

Effectiveness of Interventions to Disease Management Programs of Patients with Heart Failure: A Systematic Review and Meta-Analysis.

Heart failure (HF) prevalence is rising due to population aging and increasing risk factor incidence, thereby posing a significant global public health challenge. Disease management programs (DMPs) play a crucial role in managing HF and optimizing postevent health outcomes. Through a systematic review and meta-analysis, this study aimed to evaluate the effectiveness of DMPs following an HF event. Five electronic databases-Embase, PubMed, Web of Science, Scopus, and CINAHL-were searched for relevant studies published before December 2023. Studies with randomized controlled trials evaluating DMPs versus placebo for patients after an HF event were selected. Twelve articles were included in the meta-analysis, with a total of 3844 patients. The intervention group showed clinically significant improvement in exercise capacity [mean difference (95% confidence interval), 53.33 (43.40-67.26); P < 0.00001]; physical activity [-5.76 (-8.86 to -2.66); P = 0.0003]; emotional well-being [-2.32 (-4.39 to -0.25); P = 0.03]; and quality of life [-9.13 (-16.79 to -1.48); P = 0.02) compared with the control group. Furthermore, the control group showed significantly higher hospital admissions (P = 0.0002); readmissions (P = 0.00001); and mortality due to HF causes (P = 0.003) than the intervention group. DMPs have a positive effect on patients who have experienced an HF event by improving exercise capacity, physical activity, emotional well-being, and quality of life and reducing hospital admissions, readmissions, and mortality due to HF causes.

How to deliver person-centred care for people living with heart failure: a multi stakeholder interview study with patients, caregivers and healthcare professionals in Thailand

ContextHeart failure has high, growing global prevalence, morbidity and mortality, and is a leading cause of death with serious health-related suffering in low- and middle-income countries. Person-centred care (PCC) is a critical component of high-quality healthcare and is particularly vital in the context of a serious illness such as heart failure. However, there are limited data exploring PCC in this population in low- and middle-income settings.AimThe aim of this study was to explore how clinical services could respond to the PCC needs of individuals living with heart failure in Thailand, with potential for adaptation in other settings. The specific objectives were (i) to understand the experiences and needs of persons living with heart failure, their caregivers and HCPs; (ii) to explore specific practical actions that can help deliver PCC for heart failure patients in this setting.MethodsCross-sectional qualitative study. In depth, semi-structured interviews were conducted in Thailand with heart failure patients (n = 14), their caregivers (n = 10) and healthcare professionals (n = 12). Framework analysis was conducted with deductive coding to populate an a priori coding frame based on Santana et al’s PCC model (2018) and Giusti et al’s systematic review (2020), with further inductive coding of novel findings to expand the frame. The study is reported in accordance with the consolidated criteria for reporting qualitative research guidelines (COREQ).ResultsThe findings reveal specific practice actions that deliver PCC for persons living with heart failure in Thailand, such as (i) compassionate communication by healthcare professionals; (ii) effective teamwork amongst multidisciplinary healthcare professionals; (iii) proactive responses to physical, psychosocial, relational and information needs of patients and caregivers; (iv) engaging patients and families in symptom management; (v) providing opportunities for patients to be cared for in the community; and (vi) responding to the social determinants of health, illness and healthcare access.ConclusionPerson-centred healthcare systems must aim to address the social determinants of illness and place focus on community- and home-based care. Heart failure patients and caregivers must be supported to self-manage, including how to recognise symptoms and take appropriate action. Delivering PCC in such a way has the potential to improve outcomes for patients, enhance patients’ sense of agency and experiences of care, improve health equity, and reduce hospital admissions, relieving pressure on the hospital system and reducing overall costs of care.

Key Dissemination Learnings from an Innovative, Value-Based Emergency Department Prevention Program

The Caboolture and Redcliffe regions of North Brisbane have experienced rapid population growth in recent years, with high levels of emergency department (ED) use, an ageing population, and a high proportion of complex health and psychosocial needs. An innovative intervention was co-designed to reduce unnecessary emergency department (ED) presentations by those with chronic complex conditions in the selected regions. Local general practices (GPs) were approached to participate in the program, now titled the ‘Care Collective,’ and provided with a funding package to build the capacity of the practice to employ an existing practice nurse or utilise a contracted nurse to upskill in a coordination role. The nurses, titled Complex Care Coordinators (CCCs), connect eligible clients with existing services in the community, aiming to improve patient quality of life, health literacy, and ability to self-manage their condition; in turn reducing unnecessary ED presentations and hospital admissions. The program has been funded by the Department of Health and Aged Care Primary Pilots Program.

Telemonitoring for Chronic Heart Failure: Narrative Review of the 20-Year Journey From Concept to Standard Care in Germany.

Chronic heart failure (CHF) is a major cause of morbidity and mortality worldwide, placing a significant burden on health care systems. The concept of telemedicine for CHF was first introduced in the late 1990s, and since 2010, studies have demonstrated its potential to improve patient outcomes and reduce health care costs. Over the following decade, technological advancements and changes in health care policy led to the development of more sophisticated telemedicine solutions for CHF, including remote patient management through invasive or noninvasive telemonitoring devices, mobile apps, and virtual consultations. Years of public funding in Germany have generated evidence that remote patient management improves outcomes for patients with CHF, such as quality of life, and reduces hospital admissions. Based on these data, the Federal Joint Committee (Gemeinsamer Bundesausschuss; G-BA) decided, independently of the current European Society of Cardiology recommendations, to incorporate telemedicine as a standard digital intervention for high-risk patients with reduced left ventricular ejection fraction in Germany in 2020. This review aims to illustrate the journey from the initial concept through pioneering studies that led to telemedicine's integration into standard care, and to share current experiences that have positioned Germany as a leader in cardiovascular telemedicine. We review and discuss existing literature and evidence on the development and implementation of telemonitoring for CHF in Germany over the past 20 years. Relevant studies, reports, and guidelines were identified through a comprehensive search of electronic databases, including PubMed, Google Scholar, and specialized journals focused on CHF telemonitoring. Pioneering studies, such as the TIM-HF2 (Telemedical Interventional Management in Heart Failure II) and IN-TIME (Influence of Home Monitoring on Mortality and Morbidity in Heart Failure Patients with Impaired Left Ventricular Function) trials, demonstrated the effectiveness of remote patient management applications for patients with CHF in Germany and their applicability to current practices involving both invasive and noninvasive methods. Collaborations between researchers and technology developers overcame barriers, leading to sustainable improvements in patient care. Ongoing research on artificial intelligence applications for prioritizing and interpreting individual health data will continue to transform digital health care. The establishment of telemedical care for patients with HF across Europe is likely to benefit from experiences in Germany, where significant improvements have been achieved in the care of patients with HF.

The habitus and field of district nursing: a discussion around its professional status and symbolic capital.

This paper examines the significant historical and political influences on district nursing and its representation in terms of employability and education today. Using Bourdieu's theory of habitus and field, the author looks at how district nursing has been positioned in terms of a profession since its establishment. District nursing's profile and value within the NHS has declined in recent years, resulting in reduced district nurse education opportunities and funding from government. Bourdieu's habitus (how something has come to be) and field (an identified social space) can be used as a tool to understand and examine the field of district nursing and its relationship with other areas. The paper explores the history of the profession of district nursing, the definition of professional capital, political moves in cost savings, education and the influence of media on determining public perception, and how this may influence the play for professional and symbolic capital. It also discusses the politics of internal, external and wider fields of power at play when considering the decline in the number of district nurses. The author recommends making district nurse education a priority to improve quality of patient care in the community, reduce hospital admissions and expedite patient discharge.

Palliative Homecare in Chronic Liver Disease: A Cohort Analysis of Factors and Outcomes Associated with Home Palliative Care in Patients with End-Stage Liver Disease.

Objective: The prevalence and mortality of chronic liver disease has risen significantly. In end-stage liver disease (ESLD), the survival of patients is approximately 2 years. Despite the poor prognosis and high symptom burden, integration of palliative care in ESLD is reduced, and the majority of patients continue to die in inpatient care. We aim to assess predictors and outcomes of home palliative care, as well as factors associated with death at home in patients with ESLD. Methods: Retrospective cohort study of patients with ESLD, followed by a palliative care team between 2017 and 2022. Information regarding patient demographics, ESLD etiology, decompensations, and interventions was collected. Two-sided tests were used to identify factors associated with home palliative care. Results: We analyzed 75 patients: 44% had home palliative care and 33% died at home. ESLD patients with home palliative care were older (72.52 vs 64.45; p = 0.002), had a longer palliative care intervention time (149.97 ± 196.23 vs 43.69 ± 100.60 days; p = 0.007), higher rates of ascites or hepatic encephalopathy (χ2 = 11.024; p = 0.029), and hepatocarcinoma (90.9% vs 64.3%; p = 0.007). Patients with home palliative care had a reduction in-hospital admissions (2.61 vs 1.06; p = 0.000) and a greater probability of death at home (66.7% vs 33.3%; p = 0.000). Patients who died at home (33.3%) were older (72.20 vs 64.40; p = 0.000) and had longer palliative care intervention time (178.80 ± 211.78 vs 46.28 ± 99.67 days; p = 0.006). Conclusion: Home palliative care in ESLD differs based on demographics and disease complications, with a positive impact of homecare translated into a reduction in hospital admissions and an increased probability of death at home.

Gestational Diabetes Management and Outcomes in South Jordan: Metformin Alone vs. Metformin-Insulin Therapy, A Retrospective Cohort Study

Background: Gestational diabetes mellitus (GDM) in Jordan displays a considerable variable prevalence, with reported rates ranging from 1.2% to 13.5%. To address this, our institution established a dedicated GDM clinic. The primary goal was to develop an efficient management system that reduces hospital admissions and improves outpatient care for pregnant women with diabetes. The current study aims to assess the cost-benefit ratio of the clinic, determine the incidence of GDM at our hospital, identify its associated risk factors, assess pregnancy outcomes, and analyze the treatment regimens applied. Methods: From March to August 2023, data from newly diagnosed women with GDM attending outpatient clinics and the GDM clinic at Al Karak Governmental Hospital were retrospectively analyzed. Extraction of information on hospital admissions, baseline maternal characteristics, and perinatal outcomes from medical records was performed. The hospital’s accounting department provided daily cost details for the patient’s stay. We then used these details to calculate the average costs over a four-day period. Descriptive analysis was performed for the maternal sociodemographics, obstetric characteristics, and perinatal outcomes. The association between categorical variables was analyzed using Fisher’s exact test. We conducted a Mantel-Haenszel (MH) analysis to evaluate the associations between selected perinatal outcomes (large for gestational age (LGA), polyhydramnios, pregnancy-induced hypertension (PIH), and neonatal intensive care unit (NICU) admission rate) and two treatment regimens (metformin vs. metformin and insulin), while controlling for the gestational age at diagnosis. SPSS version 25 was used to complete the statistical analysis. Results: During the six-month study period, 75 women were diagnosed with GDM, yielding an incidence rate of 4.97%. Hospitalization for blood sugar management decreased from 81 admissions in the previous year to 16 during the study period. A mean age of 32.6 years (±5.47) was observed among the participants, and 46% were considered obese. Two-thirds of multiparous women had a first-degree relative with diabetes, and 45% reported prior GDM. At diagnosis, 60% were less than 24 weeks pregnant. Treatment modalities included metformin alone (25.3%) and combined metformin-insulin therapy (65.3%). LGA was the most prevalent antenatal complication (30.6%). After controlling for gestational age at diagnosis, no statistically significant differences were found between treatment groups for LGA, polyhydramnios, and pregnancy-induced hypertension (MH p values: 0.505, 0.971, and 0.737, respectively). However, the combined therapy group showed a tendency towards increased odds of polyhydramnios (odd ratio (OR) 1.431, 95% confidence interval (CI) 0.285–7.173) and PIH (OR 2.818, 95% CI 0.255–31.097), but decreased odds of LGA (OR 0.476, 95% CI 0.111–2.050). Compared to the metformin-only group, the combined therapy group had significantly higher rates of NICU admissions (87% vs. 13%, p value = 0.001). 66.7% of these admissions were for hypoglycemia screening. Conclusions: This study evaluated a clinic dedicated to managing GDM in a region with a high prevalence of diabetes. The clinic improved care and created a valuable research database. Our findings revealed no significant outcome differences between insulin-treated patients and those on metformin, though the former group had higher NICU admission rates due to logistical factors. As a result of this centralized approach, we may be able to develop population-specific protocols, enhance maternal and neonatal care, and advance the management of GDM in our community and the development of new research.

Abstract 4134772: Optimizing Heart Failure with Preserved Ejection Fraction Management: Quality Review of SGTL2 Inhibitor Use

Heart failure with preserved ejection fraction (HFpEF) remains a diagnostic challenge despite a 50% incidence of HF admissions. H2FPEF tool is a validated scoring system that estimates HFpEF probability with a sensitivity of 69% and positive predictive value of 85%. Despite clinical research interest and therapeutic advances in HFpEF, implementation of therapies remain inconsistent. Currently ACC/AHA guidelines classify sodium-glucose cotransporter 2 inhibitors (SGLT2i) use a 2A recommendation with benefits for reducing hospital admissions. We assess the utilization of current guidelines. An observational retrospective analysis was performed of patients &gt;18 years with a left ventricular ejection fraction of &gt;50% seen in cardiology clinic with an ICD.10 code of diastolic heart failure from January 2022 to 2024 at a large tertiary hospital. Electronic records were reviewed for patient demographics, documentation of heart failure diagnosis, medication list and echocardiogram parameters. Primary outcome was HF related hospitalization. The study screened 79 patients, 51% females and 49% males. 20.2% of the patients were on SGLT2i, a quarter of which were female. Of those on SGLT2i, 56% were on diuretics, 81% had H2FpEF score &gt; 5, 56% had diabetes, and 19% had a HF hospitalization. SGLT2i was stopped in 1 patient due to cost. Of the (63) 79.8% of patients not on SGLT2I, 65% were on diuretics, 90% had H2FPEF score &gt; 5, 23% had diabetes and 32% had a HF hospitalization. 43% were males, with an average age of 71 for males and 62 for females. Ten patients had documented reasons for not being on SGLT2i including CKD, dialysis, yeast infection and denied insurance coverage. Unadjusted effect measures for HF hospitalization (HR 0.59, RRR 40.9%, OR 0.496; p 0.134). As guidelines are readily investigated and updated by expert consensus groups, evaluating practice patterns is key. Unlike other cardiac medications, SGLT2is are primarily initiated by cardiologists and recognizing barriers can identify generalizability of current guidelines. Our data looked at both objective and clinical endpoints for HFPEF diagnosis. Interestingly, women were less often started on SGLT2i and coverage was not a frequent cause for not using SGLT2i. Our quality metric analysis shows a potential protective effect of HF readmission with SGLT2i use in a highly symptomatic cohort, and suggests future directives need to focus on broadening educational reach among cardiologists.

Effects of a Virtual Trauma Clinic on admissions and length of stay for minor to moderate trauma.

To investigate the feasibility of a Virtual Trauma Clinic (VTC) for patients with minor to moderate trauma, and evaluate patient satisfaction and outcomes. One hundred VTC patients were matched 1:1 with historical patients from the hospital trauma registry who received conventional care. Matching was based on age ± 5 years, sex, mechanism of injury, Injury Severity Score ± 2, trauma team activation and day of week of presentation. VTC patients were sent surveys on experience and outcome measures. VTC was associated with reduced average hospital length of stay for admitted patients by 1.81 days (95% CI = -2.82, -0.79; P = 0.001) and reduced hospital admissions (odds ratio 0.26; 95% CI = 0.14, 0.48; P < 0.001). There was an avoidance of 199 inpatient bed days in total, with no trauma-related readmissions within 30 days post-hospital discharge. 92% of respondents (n = 22) rated the care they received from VTC as excellent or good. Patient-reported outcome surveys showed overall improvement in functional domains but evidence of ongoing disability, with persistent issues of pain and psychological distress at 1 month post-injury. Patients with minor to moderate trauma have ongoing care needs with high rates of pain, psychological distress and disability remaining prevalent long after discharge. VTC provided an innovative strategy for hospital avoidance with high levels of patient satisfaction and no adverse effects on safety. The overall quality of care for these patients was enhanced through the provision of standardised, patient-centred and multidisciplinary follow-up.

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 &amp;lt; 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 &amp;lt; 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 &amp;lt;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.

Capsule Endoscopy for the Risk Stratification and Management of Acute Upper Gastrointestinal Bleeding in Emergency Departments: A Systematic Review on Triage, Risk Stratification, and Management.

Gastrointestinal bleeding is a common occurrence in emergency departments. The standard of care for it is an esophagogastroduodenoscopy within 24 hours to diagnose and potentially treat the bleeding. Several tools and pre-endoscopic risk assessment scores are used to help evaluate and manage upper gastrointestinal bleeding. Additionally, capsule endoscopy providesanon-invasive method to visualize thegastrointestinal tract and identify lesions. The aim of this review was to explore the role of capsule endoscopy in thetriage, stratification, and management of upper gastrointestinal bleeding patients in the emergency department. Four databases, PubMed, Scopus, Embase, and the Cochrane Library, were searched using keywords related to capsule endoscopy and gastrointestinal bleeding in the emergency department. Studies were included if they assessed the use of capsule endoscopy in emergency settings for managing upper gastrointestinal bleeding. After screening titles, abstracts, and full texts and reviewing bibliographies for relevant articles, data on study design, participant demographics, capsule endoscopy procedure description, and outcomes were collected into a pre-designed spreadsheet. The review focused on the triage, risk stratification, management impact, and safety of capsule endoscopy. The literature search identified 712 records, with 37 studies screened for full-text review, resulting in nine studies included in the review. These studies involved 634 patients and primarily compared capsule endoscopy with standard care in emergency settings. Capsule endoscopy demonstrated potential advantages, including improved identification of high-risk lesions and reduced hospital admissions. Capsule endoscopy effectively detected bleeding and reduced the need for invasive procedures compared to standard practices. Capsule endoscopy also had lower costs relative to traditional triaging methods. The use of capsule endoscopy in the risk stratification and management of upper gastrointestinal bleeding in emergency settings is promising. Its high diagnostic accuracy can enhance patient outcomes by enabling timely and precise diagnosis, reducing the need for invasive procedures. Future research should focus on larger randomized trials to validate capsule endoscopy's efficacy and explore its cost-effectiveness.

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.

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.

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...

Impact of Chronic Organ Disorder Staging on Hospitalization Risk in Elderly Patients With Multimorbidity: A Retrospective Cohort Study.

Introduction Multimorbidity, defined as the coexistence of two or more chronic conditions, is increasingly prevalent in the aging population and is linked to adverse health outcomes, including hospitalization. Chronic organ disorder (COD) is a proposed framework in Japan to assess multimorbidity by categorizing organ dysfunction stages. This study investigates the association between COD stages and hospitalization rates in elderly patients with multimorbidity. Method A retrospective cohort study was conducted at the Internal Medicine Department of Unnan Municipal Hospital. Patients aged 18 and older with multimorbidity, defined as having two or more chronic diseases, who visited the clinic from April to September 2022 were included. COD stages were classified from A to E, representing increasing severity. Logistic regression analysis was used to evaluate hospitalization-related factors, including age, BMI, serum albumin, and COD stages. Results Among 568 patients, 66 (11.6%) were hospitalized. Hospitalized patients were older (75.5 vs. 58.8 years, p < 0.001), had lower BMI (20.65 vs. 22.21 kg/m², p = 0.003), and lower serum albumin levels (3.70 vs. 3.96 g/dL, p < 0.001). Advanced COD (Stage B or above) was associated with an increased risk of hospitalization (OR: 1.86, 95% CI: 1.01-3.45, p = 0.048). Age ≥75 years (OR: 2.93, 95% CI: 1.55-5.54, p < 0.001) and low BMI were also significant predictors. Conclusion This study demonstrates that advanced COD stages, age, and low BMI are significant predictors of hospitalization in patients with multimorbidity. Comprehensive COD assessment aids in identifying high-risk patients and potentially guides preventive interventions to reduce hospital admissions.