Routine Hospital Research Articles

AdvantAGE: Implementation and Evaluation of an Interprofessional Transitional Care Model for Frail Older Adults-Protocol of an Effectiveness-Implementation Hybrid Study.

To implement and evaluate an Advanced Practice Nurse-led transitional care model (AdvantAGE) to reduce rehospitalisation rates in frail older adults discharged from a Swiss geriatric hospital. The study adopts an effectiveness-implementation hybrid design (Type 1) to simultaneously evaluate the effectiveness of the care model and explore the implementation process. The primary outcome, the 90-day rehospitalisation rate, will be evaluated using a matched-cohort design with a prospective intervention group and a retrospective control group. Secondary outcomes include the number of emergency department visits, health-related quality of life and intervention costs. The care model was developed through comprehensive contextual analysis and pilot testing in an iterative approach. It comprises five core elements: continuous support, care coordination, comprehensive health management at home, medication and self-management and advance care planning. Data collection includes both quantitative and qualitative methods, utilising routine hospital data, structured and semi-structured interviews and observations. Qualitative data will provide insights into implementation outcomes, potential barriers and facilitators. Additionally, a process evaluation will offer an in-depth understanding of individual intervention effects and reasons for rehospitalisation. The AdvantAGE project, grounded in implementation science methodology, aims to significantly improve transitional care outcomes for frail older adults. The results are expected to provide essential recommendations for scaling up the model to other settings. The study addresses the issue of frequent rehospitalisations in older adults, which carry risks of functional and cognitive decline. By implementing a comprehensive transitional care model, the study aims to improve continuity of care, reduce readmissions and enable frail older adults to remain in the community longer. The project highlights the importance of contextually adapted intervention and implementation strategies to bridge the gap between research and real-world healthcare practice. The project employs a participatory approach, engaging representatives from the hospital and primary care settings, the cantonal health department and older people and their caregivers. This study has been registered at clinicaltrials.gov on 5 January 2024 (Identifier: NCT06190288).

At mid gestation, markers of placental function rather than maternal cardiac function are stronger determinants of birthweight.

The role of maternal cardiac and hemodynamic assessment during normal and complicated pregnancies has gained attention during the last few years. Some researchers suggested that the manifestation of complications in pregnancy suffering from impaired placentation is mainly driven by pre-existing cardiac changes, identifiable at an early stage by echocardiographic and hemodynamic assessment. It is therefore of great importance to determine the link between placental perfusion and maternal cardiac function and hemodynamics. Also, the impact of maternal cardiac function on birth weight has not been thoroughly studied. To elucidate the possible association of maternal cardiovascular indices with placental perfusion at mid-gestation and birthweight. Prospective study on women with singleton pregnancies attending Kings' College Hospital, London, UK for a routine hospital visit at 19-24 weeks' gestation. We recorded maternal characteristics and medical history, measured mean arterial pressure (MAP), heart rate, uterine artery pulsatility index (UtA-PI), umbilical artery PI, middle cerebral artery PI, and serum placental growth factor (PlGF). We also performed maternal echocardiogram to assess cardiac output and peripheral vascular resistance as well as indices of diastolic and systolic cardiac function. Multivariable regression modeling was used. Our cohort included 4006 women. Higher UtA-PI values were associated with lower MAP, heart rate, and left ventricular systolic function, after adjustment for maternal characteristics and subsequent development of hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM). In a multivariable approach that explained 17.9% of the variance of the birthweight we found that some cardiovascular indices provided small but significant contribution to the model after accounting for maternal factors, and development of HDP and GDM, UtA-PI, and PlGF. The findings of our study indicate a weak but significant association between maternal cardiovascular indices with placental perfusion at mid-gestation and birthweight. Our data would not support routine maternal cardiovascular assessment for predicting birthweight.

Association of maternal body mass index with hemodynamic and vascular alterations at 35-37 weeks' gestation.

Globally, one in four pregnant women is classified as overweight or obese, based on their prepregnancy body mass index (BMI). Obese pregnant women are at increased risk of adverse pregnancy outcomes and long-term cardiovascular disease that occurs earlier in life. This study aimed to assess maternal hemodynamic and vascular parameters at 35-37 weeks' gestation, to understand the alterations that may occur in association with increased maternal BMI and gestational weight gain, and to evaluate obesity-related pregnancy outcomes. This was a prospective observational study of 11 731 women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation at King's College Hospital, London, UK, between December 2021 and June 2024. Women were categorized based on their BMI at 11-13 weeks' gestation, as normal weight (BMI, 18.5-24.9 kg/m2), overweight (BMI, 25.0-29.9 kg/m2) or obese (BMI, ≥ 30 kg/m2). We recorded details regarding maternal demographic characteristics and medical history, used Doppler ultrasound to assess the uterine artery pulsatility index (UtA-PI) (as a marker for uteroplacental perfusion) and ophthalmic artery peak systolic velocity (PSV) ratio (as a marker for small vessel peripheral circulation), and measured carotid-to-femoral pulse-wave velocity, augmentation index (as direct and indirect markers of aortic stiffness, respectively), cardiac output, total peripheral resistance (TPR), and central systolic and diastolic blood pressure. Multivariable analysis was performed to examine the relationship of BMI and gestational weight gain with hemodynamic and vascular measures, adjusting for maternal demographics, medical history, pregnancy characteristics and pregnancy outcomes (including pre-eclampsia and gestational diabetes mellitus). Overweight and obese women were more often of black ethnicity, and had higher central systolic and diastolic blood pressure, cardiac output, aortic stiffness and UtA-PI, compared with normal-weight women. There was no significant difference between overweight or obese women and normal-weight women with regard to TPR and ophthalmic artery PSV ratio. On multivariable analysis, increasing BMI at 11-13 weeks and gestational weight gain between 11-13 weeks and 35-37 weeks were independently associated with increases in all cardiovascular indices (including ophthalmic artery PSV ratio), apart from TPR. Women with a high BMI in early pregnancy vs normal-weight women, and those with higher gestational weight gain, had worse maternal hemodynamic and vascular indices at 35-37 weeks' gestation, independent of baseline and pregnancy characteristics. Our findings support the notion that optimization of prepregnancy weight and gestational weight gain may improve maternal hemodynamics and vascular function during pregnancy, and therefore may improve pregnancy outcomes. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Machine learning to predict stroke risk from routine hospital data: A systematic review

Machine learning to predict stroke risk from routine hospital data: A systematic review

An Overview of Patient-reported Outcomes for Men with Prostate Cancer: Results from the PIONEER Consortium.

Patient-reported outcome measures (PROMs) are increasingly being used to capture the patients' perspective of their functional status and quality of life (QoL). Big data can help us better understand patient-reported outcomes (PROs). Using prospectively collected data from the Prostate Cancer Diagnosis and Treatment Enhancement Through the Power of Big Data in Europe (PIONEER) consortium, we aimed to describe the functional status and QoL in men with prostate cancer (PCa) treated with active surveillance (AS), radical prostatectomy (RP), and radiotherapy (RT), and to demonstrate the applicability of PROM data on a large scale and at a European level. We identified data sources that collected QoL data using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, EORTC QLQ-PR25, or Expanded Prostate Cancer Index Composite (EPIC)-26/50 questionnaires. Aggregated summary scores for urinary, bowel, and sexual dysfunction, global health status, and QoL were shared for each data source. We identified eight data sources originating from various settings: routine hospital data, embedded research PRO collection, survey data collected by a patient organization, multi-institutional prospective cohort study, and registry data. PRO data were available for 709 men on AS, 20 508 on RP, and 3417 on RT, with a median time between diagnosis and PROM assessment ranging from 1 to 8.7yr. Most men were diagnosed with Gleason ≤7 disease, and T1 or T2 PCa. We observed that sexual dysfunction was the most affected PRO and found large differences between data sources. Our results support the feasibility of PRO assessment using big data in Europe. Implementation of PROMs in clinical practice and the use of standardized methods could improve value-based health care provision. In this study, we combined several data sources that reported urinary, bowel, and sexual dysfunction, global health status, and quality of life. We identified eight data sources and show that sexual function is the most affected domain after treatment.

ESBL-producing Enterobacteriaceae, an Unnoticed Pandemic with Challenges in Clinical Practice, a mini-review.

Antimicrobial resistance in gram-negative bacilli is an ecological problem with a major impact on public health. Extended-spectrum β-lactamases (ESBLs) are enzymes that inactivate broad-spectrum antibiotics, penicillins, third and fourth generation cephalosporins. There are many factors associated with the global spread of ESBLs, such as the use of over-the-counter antibiotics, the food industry, travel abroad, and the lack of implementation of control strategies in hospitals and at the community level. Fecal carriers of ESBLs are increasingly commonly encountered in routine hospital settings as many hospitals have implemented rectal screening for ESBLs, however, the utility of this clinical practice and the routine isolation of patients carrying these bacteria has controversial benefits. There are challenges in selecting suitable patients for empirical therapy with carbapenems for the treatment of presumed severe ESBLs infections. Inappropriate empirical therapy is associated with high mortality in bloodstream infections. Carbapenems are the standard of care for severe invasive ESBL-E infections outside the urinary tract, however, overuse of carbapenems may lead to the emergence of carbapenem-resistant Enterobacterales. This mini review is intended to contribute to understanding about ESBLs as a global ecological problem, causing a considerable impact on health care services and posing enormous challenges in everyday antimicrobial therapy.

ESBL-producing Enterobacteriaceae, an Unnoticed Pandemic with Challenges in Clinical Practice, a mini-review.

Antimicrobial resistance in gram-negative bacilli is an ecological problem with a major impact on public health. Extended-spectrum β-lactamases (ESBLs) are enzymes that inactivate broad-spectrum antibiotics, penicillins, third and fourth generation cephalosporins. There are many factors associated with the global spread of ESBLs, such as the use of over-the-counter antibiotics, the food industry, travel abroad, and the lack of implementation of control strategies in hospitals and at the community level. Fecal carriers of ESBLs are increasingly commonly encountered in routine hospital settings as many hospitals have implemented rectal screening for ESBLs, however, the utility of this clinical practice and the routine isolation of patients carrying these bacteria has controversial benefits. There are challenges in selecting suitable patients for empirical therapy with carbapenems for the treatment of presumed severe ESBLs infections. Inappropriate empirical therapy is associated with high mortality in bloodstream infections. Carbapenems are the standard of care for severe invasive ESBL-E infections outside the urinary tract, however, overuse of carbapenems may lead to the emergence of carbapenem-resistant Enterobacterales. This mini review is intended to contribute to understanding about ESBLs as a global ecological problem, causing a considerable impact on health care services and posing enormous challenges in everyday antimicrobial therapy.

Management strategy and experience of vasa previa in perinatal centers: A nationwide survey in Japan.

To clarify the current situation and outcomes of vasa previa (VP) in Japan. A questionnaire survey on VP was conducted at all 408 perinatal centers in Japan. The content of the survey included (1) the management strategy for pregnant women who were diagnosed with VP and (2) the number and outcomes of VP cases managed between January 2020 and December 2022. Questionnaires were collected from 220 (53.9%: 220/408) perinatal centers. (1) A total of 78.8% (164/208) of facilities implemented routine hospitalization. Routine hospitalization was initiated at 32 (22-36) [median (range)] weeks of gestation. The timing of planned cesarean section (CS) was at 36 (33.5-39) weeks of gestation in 198 facilities. (2) Of the 220 facilities that responded, 109 (49.5%: 109/220) accommodated patients with VP during the observation period. The total number of VP cases was 351, with a frequency of one case (0-33) per single perinatal center for 3 years. Emergency CS was required in 89 cases (25.4%: 89/351). There were no fetal or neonatal deaths in this study. The number of undiagnosed patients with VP prenatally was seven (2.0%: 7/351). Umbilical vessel rupture occurred in two cases (0.6%: 2/351). Current management strategies in Japanese perinatal centers that responded to this survey appear to yield good perinatal outcomes in VP. Additional studies and comparisons are needed to elucidate the necessity of routine hospitalization, the optimal duration of hospitalization, and the timing of planned CS.

HPR210 Will We Have Access to Healthcare? Escalating Burden of Chronic Disease Hospitalizations: Evidence From Routine Hospital Data

HPR210 Will We Have Access to Healthcare? Escalating Burden of Chronic Disease Hospitalizations: Evidence From Routine Hospital Data

Abstract 4138578: NICE-Support program effectively improves symptom and psychological distress in patients with heart failure

Background: Patients with heart failure may suffer from symptom distress, affecting their overall quality of life and psychological well-being including depression. Limited researches focused on the effects of intervention on symptoms and psychological distress for patients with heart failure. Research Hypothesis: Nutritional education and exercise intervention can significantly improve symptoms and psychological distress in patients with heart failure. Aims: To investigate the effectiveness of the Nutrition Instruction Combined Exercise and Support program (NICE-Support) on symptom and psychological distress in patients with heart failure. Methods: This randomized controlled trial recruited 240 patients with heart failure from two medical centers in Taiwan by convenience sampling. Participants were divided into two subgroups based on participation in the "Post-Acute Care Integration Program (PAC)." Each group was randomly assigned to the experimental group and control group, including PAC, PAC+NICE, N-PAC, and N-PAC+NICE groups. The experimental group received a 12-week NICE-Support intervention, encompassing nursing instruction, nutritional counseling, exercise, and support. The control group followed routine hospital care. Data were collected through a structured questionnaire, including basic information, the Heart Failure Symptom Distress Scale, Hospital Anxiety and Depression Scale at baseline, 4, 12, and 24 weeks after enrollment. Data were analyzed using SPSS 24, including descriptive, t-tests, one-way ANOVA, Pearson correlation coefficients, chi-square tests, and generalized estimating equations. Results: The overall symptom distress score was 45.02 (SD = 13.50). Anxiety and depression were reported in 23.8% and 30.9% patients, with the mean anxiety and depression score of 5.01 (SD = 4.50) and 5.98 (SD = 4.16), respectively. Compared with the N-PAC control group, the PAC+NICE group and N-PAC+NICE group exhibited significant greater improvements in symptom distress at 4, 12, and 24 weeks post-intervention, while the N-PAC+NICE group showed statistically significant greater improvement in anxiety at 12 and 24 weeks. Conclusion: The NICE-Support program effectively improves symptom and psychological distress in patients with heart failure and could implement in patients with heart failure.

Rule-based clinician-developed programmes can facilitate haemodialysis clinical workflows.

There are routine hospital workflows that are not addressed by certain institutional electronic medical records, including the detection of patients requiring haemodialysis who are admitted under non-nephrology services. In this study, the feasibility and performance of a clinician-developed automated haemodialysis patient finder was evaluated. The programme ran with zero downtime for 6 months and had zero false negatives or false positives. This work demonstrates the potential benefits that may be gained when clinicians can meaningfully alter electronic clinical workflows.

Utilization of Psychiatric Hospital Services Following Intensive Home Treatment

Home treatment (HT) has been associated with fewer inpatient treatment (IT) readmission days but lacks evidence on reducing combined psychiatric hospital service use (IT, HT, day clinic). To assess the association of intensive home treatment (IHT) compared with IT regarding readmission rate, social outcomes, and clinical outcomes. This quasi-experimental, nonrandomized trial was conducted from 2020 to 2022 in 10 psychiatric hospitals in Germany. Propensity score (PS) matching was used to compare both treatment models at the 12-month follow-up using standardized instruments and routine hospital data. All patients were screened until the target sample size was reached, based on these criteria: stable residence with privacy for sessions, no child welfare risk, primary diagnosis within International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes F0X to F6X, residence in the catchment area, no commitment order, no acute suicidality or severe aggression requiring hospitalization, capacity to consent, not participating in other interventional studies, sufficient German language skills, no substantial cognitive deficits or intellectual impairment, and no more than 7 days in IHT or IT before recruitment. Statistical analysis was performed from February to November 2023. IHT provided daily acute psychiatric treatment at home, while IT was psychiatric inpatient treatment as usual. The mean treatment duration of the index treatment was 37.2 days for IHT and 28.2 days for IT. The inpatient readmission rate was the primary outcome. Secondary outcomes were combined readmission rate, total inpatient days, job integration, quality of life, psychosocial functioning, symptom severity, and recovery. Of 1396 individuals, 200 patients receiving IHT and 200 patients receiving IT were included (264 female [65%]; mean [SD] age, 45.45 [15.83] years [range, 18-88 years]). Baseline sociodemographic and psychometric characteristics did not differ significantly between the groups. At 12-month follow-up, patients in the IHT group had lower inpatient readmission rate (IHT vs IT: 31.12% vs 49.74% IT; mean difference, 18% [95% CI, 9%-28%; P < .001), combined readmission rate (mean difference, 13% [95% CI, 4%-24%; P < .001), and fewer inpatient days (mean difference, 6.82 days; P < .001) than the IT group. This nonrandomized clinical trial found that patients receiving IHT had a lower likelihood of utilizing hospital-based psychiatric services and spent fewer inpatient days, suggesting that IHT is a viable alternative to IT. ClinicalTrials.gov Identifier: NCT04745507.

Effect of Social Skill Training on Social Function in Patients with Schizophrenia

Objective: To explore the effect of Social Skills Training (SST) on the social function of inpatients with schizophrenia. Methods: A total of 40 patients with schizophrenia (20 in the intervention group and 20 in the control group) were selected from a psychiatric hospital in Shanghai for 10 times (once a week) of social skills training. The control group was treated with routine hospitalization (drug therapy and routine hospitalization nursing) for 10 weeks. Social Disability Screening Schedule before and after intervention for patients enrolled in the intervention group (Social Disability Screening Schedule, SDSS and Scale of Social Function in Psychosis Inpatients, SSPI). Conclusion: The results of social skills training on SDSS and SSPI were different between the two groups, and there was no statistical value (P &gt; 0.05). Observation of patients in this group, when undergoing social skills training, SSPI score was significantly better than the control group (P &lt; 0.01) and SDSS score was significantly lower than the control group (P &lt; 0.01), the differences were statistically significant. Social skills training and social work group intervention can improve psychiatric symptoms and further enhance social function in hospitalized patients with schizophrenia.

An analytical observational study for diagnostic accuracy of volume, conductivity & scatter (VCS) indices of neutrophils for diagnosis of sepsis in an emergency hospital setting.

Background & objectives The newer technique using an innovative volume conductivity scatter (VCS) technology is emerging as a surrogate for sepsis diagnosis. The VCS technology offers a more objective method to measure cell volume (V), characterize conductivity (C) and light scatter (S) directly from more than 8,000 white blood cells (WBCs). However, diagnostic performance of VCS parameters in sepsis has not been extensively tested in routine hospital emergency settings. Therefore, the present study aimed to investigate the diagnostic and prognostic performance of VCS markers of neutrophils in our local hospital emergency setting. Methods It was an observational analytical study with 41 cases of sepsis and 43 healthy controls aged above 18 yr. Individuals with acute coronary syndrome and individuals with already diagnosed Human Immunodeficiency Virus (HIV) infection were excluded from the study. Results The mean neutrophil volume (MNV) values were not significantly different between cases and controls (P 0.138) whereas mean neutrophil conductance (MNC) and mean neutrophil scatter (MNS) measurements were significantly higher among cases as compared to controls (both P-values <0.001). According to Receiver Operating Characteristics (ROCs) curve analysis, MNV in our study failed to show statistically significant discriminatory ability in sepsis (AUC 0.54) whereas MNC (AUC 0.98) and MNS (AUC 0.95) showed marked discriminatory ability in diagnosing sepsis in this study cohort. Interpretation & conclusions Among VCS parameters, MNV failed as a standalone biomarker of sepsis in routine emergency setting whereas MNC and MNS had statistically significant diagnostic and discriminatory accuracies among hospitalized affected individuals with sepsis.

The Decontamination of N95 Masks as an Occupational Safety Strategy

Objective: This study aimed to monitor the use of a short-wave ultraviolet (UV-C) decontamination device for N95 masks at the João de Barros Barreto University Hospital, Belém, Pará, Brazil. The research investigated the reuse of masks, storage methods, and the perception of healthcare professionals regarding the decontamination protocol using UV-C after each work shift. Theoretical Framework: The research is based on theories related to biosafety and occupational health, focusing on the importance of decontamination processes in hospital settings to enhance the protection of healthcare workers and reduce infection risks. Method: A cross-sectional study was conducted with 295 nursing professionals, including nurses, technicians, and assistants. Data were collected through a questionnaire addressing the reuse of N95 masks, storage between uses, and opinions on the use of the UV-C device for decontamination. Results and Discussion: All participants (n=295) agreed that UV-C decontamination improves biosafety by reducing the handling of potentially contaminated masks. The acceptance of the device was unanimous, confirming its feasibility both in high-demand scenarios, such as the Covid-19 pandemic, and in routine hospital practices. Research Implications: This study demonstrates that implementing UV-C decontamination systems is a practical and effective solution for hospitals, with the potential to increase occupational safety and reduce infectious waste generation. Originality/Value: The study contributes to the literature by highlighting the feasibility and benefits of reusing N95 masks with UV-C decontamination, promoting greater safety in hospital environments.

Utility of Jaundice Surveillance and Bilirubin Screening in Identifying Neonates Who Qualify for Phototherapy ≤24 Hours after Birth

To assess the utility of jaundice surveillance and routine 24hour bilirubin screening in identifying neonates who qualify for phototherapy (PT) at≤24hours after birth. In this retrospective, single-center observational study, records of neonates ≥350/7weeks gestation born to O+, antibody negative mothers (n=6098) were screened to identify who received PT at≤24hours after birth. The hour specific TSB at which neonates qualified for PT, blood type, direct antiglobulin test (DAT), and whether treatment was triggered by jaundice detection at <24hours or the 24-hour bilirubin screen were determined. 59 neonates (1.0%) qualified for PT≤24hours after birth; 10 (17%) were identified by jaundice detection at<24hours, whereas 49 (83%) were identified on 24-hour bilirubin screening. Forty-eight of the 59 (81%) were ABO incompatible and DAT+; 11 were DAT negative, one of whom had glucose-6-phosphate dehydrogenase deficiency. Among the ≤24hour PT group, 17 had a PT qualifying TSB within 3mg/dL of exchange transfusion (ET); 14 of whom were only identified first on 24-hour bilirubin screening. Six exceeded ET thresholds, 4 of whom were identified on 24-hour bilirubin screening. Neonates who qualified for PT at ≤24hours were identified mostly by 24-hour bilirubin screening, a fraction of whom had a TSB that approached or exceeded ET thresholds. Our findings support routine birth hospitalization bilirubin screening and suggest screening no later than 24hours after birth may be beneficial.

Maternal vascular indices and hemodynamic parameters at 36 weeks' gestation in gestational and pre-existing diabetes mellitus.

To compare maternal vascular indices and hemodynamic parameters at 35-37 weeks' gestation in pregnancies complicated by gestational diabetes mellitus (GDM), those with pre-existing diabetes mellitus (DM) and those without GDM or pre-existing DM. This was a prospective observational study in women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. The visit included recording of maternal demographic characteristics and medical history, and measurement of vascular indices and hemodynamic parameters using a non-invasive operator-independent device. These included carotid-to-femoral pulse-wave velocity, augmentation index, cardiac output, stroke volume, central systolic and diastolic blood pressure, total peripheral resistance and heart rate. The values in the GDM and pre-existing DM groups were compared to those in the unaffected group. We examined 6746 women, of whom 396 were excluded because they had chronic hypertension or developed pre-eclampsia or gestational hypertension. The study population of 6350 pregnancies contained 99 (1.6%) with pre-existing Type-I or Type-II DM and 617 (9.7%) that developed GDM, including 261 (42.3%) that were treated with diet alone, 239 (38.7%) treated with metformin alone and 117 (19.0%) treated with insulin with or without metformin. Among women with GDM and those with pre-existing DM, compared to those without GDM or pre-existing DM, there was a higher median cardiac output and heart rate, central systolic and diastolic blood pressure and pulse-wave velocity, but there was no significant difference in stroke volume or total peripheral resistance. There were no significant differences within the GDM group according to treatment type, except for higher heart rate in women treated with metformin alone compared to the group treated with diet alone. Women with GDM and those with pre-existing DM have evidence of early vascular disease in the third trimester, and this may contribute to their increased long-term cardiovascular risk. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Opioid use disorder's impact on asthma hospitalizations: A propensity-matched nationwide study

BackgroundPatients with asthma and opioid use disorder (OUD) experience higher rates of acute exacerbation, but the effects of OUD on asthma hospitalizations have been poorly described. ObjectiveTo explore how concurrent OUD may affect the clinical outcomes of adult patients hospitalized for asthma. MethodsUsing the National Inpatient Sample, adult patients admitted for asthma with concomitant OUD were identified and compared with those without OUD. Cohorts were matched in a 1:1 ratio using propensity score matching, with mortality as primary outcome of interest. ResultsA total of 491,990 patients were hospitalized for asthma, and 3.49% had a concomitant diagnosis of OUD. Patients with asthma and OUD were younger, with a mean age of 41 years (SD ± 12.2) vs 51 years (SD ± 17.2) in those without OUD. After matching, both cohorts had 17,125 patients. There was no significant difference regarding in-hospital mortality (odds ratio [OR] 0.92, 95% CI 0.51-1.63, P = .77) between the cohorts. Patients with asthma with OUD had significantly higher rates of mechanical ventilation (OR 1.52, 95% CI 1.23-1.87, P < .001), noninvasive mechanical ventilation (OR 1.37, 95% CI 1.15-1.62, P < .001), and mean length of stay (3.18 vs 2.92 days, P < .001) compared with patients with asthma without OUD. Patients with OUD had no difference in mean total hospitalization costs ($33,514 vs $31,529, P = .054) compared with patients without OUD. Compared with a routine hospital discharge, patients with OUD were more likely to leave against medical advice (relative risk [RR] 2.67, 95% CI 2.28-3.13, P < .001), be discharged to a long-term facility (RR 1.40, 95% CI 1.01-1.95, P = .045), and be discharged with home health care (RR 1.56, 95% CI 1.22-1.99, P < .001) than patients without OUD. ConclusionConcomitant OUD has no impact on mortality in asthma hospitalizations, but patients with asthma with OUD have worse secondary outcomes compared with those without OUD.

Palliative care resources utilized in patients with liver cancer with cirrhosis: Trend in National Inpatient Sample (NIS) study (2016–2020).

59 Background: Liver cancer is the fourth cause of cancer death in the world. Hepatocellular carcinoma represents around 90% of all liver cancer, with an increase in incidence and a worsening survival rate over the years. Liver cirrhosis is the major risk factor for liver cancer development. Early involvement in palliative care/hospice care focusing on quality of life, is associated with improved physical and psychological symptoms and improvement in caregiver stress and bereavement. We examined as primary outcome the utilization and trend of palliative care (PC) among hospitalized patients with liver cancer and cirrhosis using the NIS. Methods: This is a retrospective study using NIS data from 2016 to 2021. We included patients aged 18 years or older who were admitted with a diagnosis of malignancy of the liver and the intrahepatic bile duct and who also had a diagnosis of fibrosis and cirrhosis of the liver. Patients who had a PC encounter during hospitalization were identified. The cohort was divided between patients with PC encounters and those without PC encounters. Cohorts were matched in a 1:1 ratio with no replacement using propensity scores. Total charges during hospitalization, length of stay (LOS), mortality, and disposition were measured as outcomes. Results: A total of 53,475 admissions with a diagnosis of liver malignancy and liver cirrhosis were identified. Of those, 20.8% had an encounter with a PC. The mean age of those with a PC encounter was 65.1 years (SD±7.86), while the mean age for those without was 64.5 years (SD±7.35). Sex and race were similar between both cohorts. Patients with PC encounters had a higher mean Elixhauser index (6.43 vs 5.58, p &lt; 0.001) than those without a PC encounter. Patients with PC encounters had lower total hospital charges ($70,988 vs $94,518, p &lt; 0.001), longer LOS (6.83 vs. 5.82 days, p &lt; 0.001), and higher odds of mortality (aOR 7.20, CI 5.56- 9.32, p &lt; 0.001) compared to those without a PC encounter. Patients with a PC encounter were more frequently discharged to a long-term facility (23.9% vs. 12.6%) or with home health care (36.1% vs. 18.4%) and less often had a routine hospital discharge (13.5% vs. 60.1%), compared to those without a PC encounter. Conclusions: This study highlights the impact of PC on patients hospitalized with liver malignancy and cirrhosis. Despite being underutilized, with only 20.8% of patients receiving PC, those who do experienced lower hospital charges, longer hospital stays, and higher in- hospital mortality. These findings suggest that PC focuses on symptom management and quality of life rather than extending life expectancy. Patients receiving PC are more frequently discharged to long-term care or home health care, indicating a shift towards supportive care. The results advocate for the broader and earlier integration of palliative care in treating liver cancer and cirrhosis to improve patient outcomes and support.

Impact of the Hospital Frailty Risk Score on Outcomes following Primary Total Elbow Arthroplasty

The Hospital Frailty Risk Score (HFRS) has demonstrated strong correlation with adverse outcomes in various joint replacement surgeries, yet its applicability in total elbow arthroplasty (TEA) remains unexplored. The purpose of this study is to assess the association between HFRS and postoperative complications following elective primary TEA. The Nationwide Readmissions Database was queried to identify patients undergoing primary TEA from 2016 to 2020. The HFRS was used to compare medical, surgical, and clinical outcomes of frail vs. non-frail patients. Mean and relative costs, total hospital length of stay (LOS), and discharge disposition for frail and non-frail patients were also compared. We identified 2,049 primary TEA in frail patients and 3,693 in non-frail patients. Frail patients had increased complication rates including acute respiratory failure (13.6% vs. 1.1%; p < 0.001), urinary tract infections (12.3% vs. 0.0%; p < 0.001), transfusions (3.9% vs. 1.1%; p < 0.001), pneumonia (1.1% vs. 0.2%; p < 0.001), acute respiratory distress syndrome (3.2% vs 0.6%; p < 0.001), sepsis (0.7% vs. 0.1%; p < 0.001), and hardware failure (1.2% vs 0.1%; p < 0.001). Frail patients also experienced higher rates of readmission (37% vs. 25%; p < 0.001) and death (1.7% vs. 0.2%; p < 0.001), while being less likely to undergo revision (6.5% vs. 17%; p < 0.001). Frail patients incurred higher healthcare costs ($28,497 vs. $23,377; p < 0.001) and longer LOS (5.3 days vs. 2.6 days; p < 0.001), with reduced likelihood of routine hospital stays (36% vs. 71%; p < 0.001) and increased utilization of short-term hospitalization (p < 0.001), care facilities (p < 0.001), and home health care services (p < 0.001). HFRS is a validated indicator of frailty and is strongly associated with increased rates of complications in patients undergoing elective primary TEA. These findings should be considered by orthopedic surgeons when assessing surgical candidacy and discussing treatment options in this at-risk patient population.