Subacute Care Research Articles

The Technology Acceptance of Video Consultations for Type 2 Diabetes Care in General Practice: Cross-sectional Survey of Danish General Practitioners.

BackgroundDuring the COVID-19 pandemic, video consultations became a common method of delivering care in general practice. To date, research has mostly studied acute or subacute care, thereby leaving a knowledge gap regarding the potential of using video consultations to manage chronic diseases.ObjectiveThis study aimed to examine general practitioners’ technology acceptance of video consultations for the purpose of managing type 2 diabetes in general practice.MethodsA web-based survey based on the technology acceptance model measuring 4 dimensions—perceived usefulness, perceived ease of use, attitude, and behavioral intention to use—was sent to all general practices (N=1678) in Denmark to elicit user perspectives. The data were analyzed using structural equation modeling.ResultsThe survey sample comprised 425 general practitioners who were representative of the population. Structural equation modeling showed that 4 of the 5 hypotheses in the final research model were statistically significant (P<.001). Perceived ease of use had a positive influence on perceived usefulness and attitude. Attitude was positively influenced by perceived usefulness. Attitude had a positive influence on behavioral intention to use, although perceived usefulness did not. Goodness-of-fit indices showed acceptable fits for the structural equation modeling estimation.ConclusionsPerceived usefulness was the primary driver of general practitioners’ positive attitude toward video consultations for type 2 diabetes care. The study suggests that to improve attitude and technology use, decision-makers should focus on improving usefulness, that is, how it can improve treatment and make it more effective and easier.

Health Care and Behavioral Service Use by Medicaid-Enrolled Adults After Release From Incarceration.

This study explored the characteristics and health care utilization of adults released from state prisons and enrolled in Medicaid in Indiana, which has policies to facilitate timely enrollment. Medicaid claims and Department of Corrections data were used to examine demographic and incarceration characteristics and health care utilization patterns of adults (N=15,929) released from state prisons and enrolled in Medicaid within 120 days of release, between 2015 and 2018. More than 80% of participants had at least one health encounter within 120 days of initiating coverage, and nearly 50% used the emergency department. Those enrolled in Medicaid within 30 days of release were more likely to have behavioral health needs and to utilize subacute behavioral health care than those who enrolled later. Understanding these patterns of health care utilization is essential to operationalizing procedures and interventions to support the health care needs of adults involved in the criminal legal system.

STUDY OF SEXUAL FUNCTIONING, SEXUAL CONCERNS, AND SEXUAL SATISFACTION IN MALE STROKE SURVIVORS

Objective: The aim of this study was to study the sexual functioning, sexual concerns, and sexual satisfaction in males stroke survivors. The aim of this study was to determine the male sexual functions (1) libido/desire, (2) coital frequency, (3) sexual arousal, (4) erectile function using international index of erectile function (IIEF) score, (5) ejaculation using premature ejaculation diagnostic tool (PEDT) score, and (6) sexual satisfaction in male stroke survivors. Methods: It was a cross-sectional questionnaire study in the Neurological Rehabilitation department of a tertiary care Institute in 33 adult male stroke survivors in the age more than 21 years with at least 3 months of community dwelling post-discharge. The sexual functions recorded were (1) libido/ desire, (2) coital frequency, (3) sexual arousal, (4) erectile function using IIEF score, (5) ejaculation using PEDT score, and (6) sexual satisfaction. Results: Thirty-three eligible male stroke survivors in the age range from 25–54 years (mean 42.5 years) with post-stroke duration of 3–45 months (mean = 16.6 months) were included in the study. Of them, 14 had experienced stroke within 12 months and 19 had experienced stroke &gt;12 months ago. Thirteen participants were sexually inactive and reported no coitus due to a loss of erection. The sexually active stroke survivors reported a moderate recovery of libido (60%), coital frequency (60%), erectile function (63%), orgasm (32%), and sexual satisfaction (25%), while others had poor recovery. Erectile dysfunction was present in 16 cases, an-ejaculation in 18 cases, and premature ejaculation in nine cases. Hypertension and depression with a history of smoking posed a higher risk of erectile dysfunctions. Conclusion: Exploration of sexual dysfunctions and sexual counseling by clinicians should be part of the comprehensive stroke rehabilitation program in sub-acute care.

Use of a Sacral Foam Dressing to Prevent Pressure Injury in At-Risk Subacute Hospitalized Older Adults: A Pilot Randomized Controlled Trial.

The purpose of this pilot study was to inform a future trial aimed at comparing the effectiveness of a prophylactic sacral dressing plus standard care to standard care only to reduce sacral pressure injuries (PIs) in at-risk older adults admitted to a subacute hospital setting. A pilot study with a pragmatic, open-label, randomized controlled trial design. One hundred thirty participants were randomized (intervention n = 66, 50.8%; control n = 64, 49.2%). Protocol violations occurred in 48 participants (intervention n = 33, 68.8%; control n = 15, 31.3%). The study setting was a subacute hospital inpatient care unit located in Queensland, Australia. Participants were randomly allocated 1:1 to the intervention (prophylactic dressing plus standard care) or control group (standard care). Standard care included regular PI risk and skin assessments, and selection and implementation of preventive interventions (eg, support surfaces and increased repositioning) from a PI prevention care plan. The sacral dressing was applied for intervention participants immediately following recruitment. Ward and research staff collected data and assessed skin integrity daily; participants were followed up until onset of a PI or up to 28 days without PI occurrence. In addition, retrospective chart reviews were undertaken to verify PI occurrences. Patient comfort and dressing utility were also evaluated. Two (3.0%) participants in the intervention group and 1 (1.6%) in the control group developed a sacral PI. The difference was not statistically significant. Only 1 PI was recorded prospectively, while 2 PIs were identified via retrospective chart review. Participants rated dressing comfort highly, particularly during the first 2 weeks, and nurses rated utility highly. Based on the intention-to-treat results, a sample size of 1799 per arm would be required in a definitive trial. A definitive trial is feasible and warranted. However, the large sample size required in a definitive trial indicates the need for multiple sites.

Surface EMG in Subacute and Chronic Care after Traumatic Spinal Cord Injuries

Background: Traumatic spinal cord injury (SCI) is a devastating condition commonly originating from motor vehicle accidents or falls. Trauma care after SCI is challenging; after decompression surgery and spine stabilization, the first step is to assess the location and severity of the traumatic lesion. For this, clinical outcome measures are used to quantify the residual sensation and volitional control of muscles below the level of injury. These clinical assessments are important for decision-making, including the prediction of the recovery potential of individuals after the SCI. In clinical care, this quantification is usually performed using sensation and motor scores, a semi-quantitative measurement, alongside the binary classification of the sacral sparing (yes/no). Objective: In this perspective article, I review the use of surface EMG (sEMG) as a quantitative outcome measurement in subacute and chronic trauma care after SCI. Methods: Here, I revisit the main findings of two comprehensive scoping reviews recently published by our team on this topic. I offer a perspective on the combined findings of these scoping reviews, which integrate the changes in sEMG with SCI and the use of sEMG in neurorehabilitation after SCI. Results: sEMG provides a complimentary assessment to quantify the residual control of muscles with great sensitivity and detail compared to the traditional clinical assessments. Our scoping reviews unveiled the ability of the sEMG assessment to detect discomplete lesions (muscles with absent motor scores but present sEMG). Moreover, sEMG is able to measure the spontaneous activity of motor units at rest, and during passive maneuvers, the evoked responses with sensory or motor stimulation, and the integrity of the spinal cord and descending tracts with motor evoked potentials. This greatly complements the diagnostics of the SCI in the subacute phase of trauma care and deepens our understanding of neurorehabilitation strategies during the chronic phase of the traumatic injury. Conclusions: sEMG offers important insights into the neurophysiological factors underlying sensorimotor impairment and recovery after SCIs. Although several qualitative or semi-quantitative outcome measures determine the level of injury and the natural recovery after SCIs, using quantitative measures such as sEMG is promising. Nonetheless, there are still several barriers limiting the use of sEMG in the clinical environment and a need to advance high-density sEMG technology.

Oncology hospital at home in rural communities: The Huntsman at Home rural experience.

1535 Background: Oncology hospital at home programs have shown promise in decreasing unplanned health care utilization while improving quality of life. While most hospital at home programs serve local urban areas, we extended our oncology hospital at home program, Huntsman at Home, to provide equitable distribution of program services for cancer patients living in rural communities at a distance from our cancer center. Methods: Utilizing a community engagement approach we redesigned our urban Huntsman at Home program for 3 rural communities in Southeastern Utah, a 2 to 5 hour one-way drive from Huntsman Cancer Institute. We systematically collected patient data and program modifications required for rural community delivery during the program’s first 6 months. Care was delivered by on-ground and telehealth nurse practitioner visits and on-ground registered nurse and physical therapy visits. Cardiovascular remote monitoring was utilized during acute care episodes. Results: A total of 47 cancer patients (31 men; 16 women; mean age 69 years) were admitted to the rural program during the first 6 months. Seven patients had 9 acute illness episodes of care. The average length of acute episode care was 6.1 days for treatment of infection, respiratory distress/ hypoxia, cardiac instability (hypotension, tachycardia), and dehydration/electrolyte imbalance and uncontrolled vomiting. Forty patients received subacute management aimed to prevent acute episodes and escalation to the emergency department (ED) or hospitalization. Subacute patients were in the program an average of 15.8 days. There were 4 appropriate escalations (2 hospitalizations, 1 ED visit returned to home and 1 ED visit with hospitalization) for symptoms related to disease progression requiring imaging and hospital-based procedures and one for diagnosis of a post-surgical PE. We found geographic and social determinates of health impacted rural patients’ cancer burden, most notably transportation barriers (44.7%). Secondarily, we found food insecurity impacted nutritional status in 14.9% of patients. A significant number of patients experienced financial toxicity (29.8%) related to lost wages, co-pays and/or out of pocket expenses for care. Lack of health literacy impacted 48.9% of patients effectively navigating their health care and self-management at home. Robust communication and coordination between the hospital at home clinical team, local primary care providers, the rural hospital, community resources and the patients’ cancer center oncology team were keys to improving care pathways. Conclusions: Rural oncology hospital at home is feasible and addresses geographic disparities in equitable access to acute and subacute cancer care in local communities. It requires adaptation to rural needs and culture, coordinated escalation procedures and a focus on addressing geographic and social determinates of health that impact cancer burden.

STUDY OF SEXUAL FUNCTIONING, SEXUAL CONCERNS AND SEXUAL SATISFACTION IN MALE STROKE SURVIVORS.

Context: Post stroke sexual dysfunction in adult survivors frequently goes under-considered in medical practice. Sexual dysfunction following stroke is thought to result from multiple factors like organic and/or psychosocial and physical. Aim: To study the sexual functioning, sexual concerns and sexual satisfaction in males stroke survivors. Methods: It was a cross sectional questionnaire based study in the Neurological Rehabilitation department of a tertiary care Institute in 33 adult male stroke survivors in the age more than 21 years with at least 3 months of community dwelling post discharge. The sexual functions recorded were (1) libido/desire, (2) coital frequency, (3) sexual arousal (4) erectile function using IIEF score (5) ejaculation using PEDT score and (6) sexual satisfaction Results: Thirty three eligiblemale stroke survivors in the age range from 25-54 years (mean 42.5 years) with post-stroke duration of 3-45 months (mean 16.6 months) were included in the study. Of them, 14 had experienced stroke within 12 months and 19 had experienced stroke &gt; 12 months ago. Thirteen participants were sexually inactive and reported no coitus because of a loss of erection. The sexually active stroke survivors reported a moderate recovery of libido (60%), coital frequency (60%), erectile function (63%), orgasm (32%) and sexual satisfaction (25%) while others had poor recovery. Erectile dysfunction was present in 16 cases, an-ejaculation in 18 cases and premature ejaculation in 9 cases. Hypertension and depression with a history of smoking posed a higher risk of erectile dysfunctions. Conclusion: Exploration of sexual dysfunctions and sexual counselling by clinicians should be part of the comprehensive stroke rehabilitation program in sub-acute care.

Correlation of ICU Nurses' Cognitive Level with Their Attitude and Behavior toward the Prevention of Ventilator-Associated Pneumonia.

Objective To analyze the correlation of ICU nurses' cognitive level with their attitude and behavior toward the prevention of ventilator-associated pneumonia (VAP). Methods A total of 90 ICU nurses working in the adult internal medicine ICU, adult surgery ICU, subacute respiratory care ward, etc. from January 2018 to June 2019 were chosen as the subjects to carry out questionnaire survey with the cognition scale, and the correlation analysis on their cognitive level, attitude, and behavior toward the prevention of VAP was conducted. Results The linear fitting analysis finding showed that the cognitive level presented a positive correlation with the attitude score and behavior score (R2 = 0.668, 0.734). Conclusion Improving ICU nurses' cognitive level, attitude, and behavior toward preventing VAP is conducive to the upgrade of their quality of nursing services. In addition, the ICU nurses' cognitive level is positively correlated with their attitude and behavior.

Improving In-Hospital Care For Older Adults: A Mixed Methods Study Protocol to Evaluate a System-Wide Sub-Acute Care Intervention in Canada.

Introduction:Acute care hospitals often inadequately prepare older adults to transition back to the community. Interventions that seek to improve this transition process are usually evaluated using healthcare use outcomes (e.g., hospital re-visit rates) only, and do not gather provider and patient perspectives about strategies to better integrate care. This protocol describes how we will use complementary research approaches to evaluate an in-hospital sub-acute care (SAC) intervention, designed to better prepare and transition older adults home.Methods:In three sequential research phases, we will assess (1) SAC transition pathways and effectiveness using administrative data, (2) provider fidelity to SAC core practices using chart audits, and (3) SAC implementation outcomes (e.g., facilitators and barriers to success, strategies to better integrate care) using provider and patient interviews.Results:Findings from each phase will be combined to determine SAC effectiveness and efficiency; to assess intervention components and implementation processes that ‘work’ or require modification; and to identify provider and patient suggestions for improving care integration, both while patients are hospitalized and to some extent after they transition back home.Discussion:This protocol helps to establish a blueprint for comprehensively evaluating interventions conducted in complex care settings using complementary research approaches and data sources.

A preliminary simulation-based qualitative study of healthcare students\u2019 experiences of interprofessional primary care scenarios

BackgroundIntroducing interprofessional education (IPE) in healthcare curricula can prepare students for healthcare practices that have become increasingly complex. The use of simulation is promoted to support IPE. This study explores healthcare students’ experiences of participating in common, sub-acute patient scenarios that routinely occur in clinical practice in primary care. More specifically, it looks at how sub-acute patient scenarios from primary care can help develop interprofessional collaborative competence.MethodsMedical students (N = 10), master’s students in advanced geriatric nursing (N = 8) and bachelor’s students in nursing (N = 9) participated in the simulations. The students were in their last or second-to-last year of education. We conducted five semi-structured focus group interviews with the participants’ directly after the simulation training to elicit experiences related to the scenarios, the simulation and interprofessional collaboration. The transcripts were analysed using systematic text condensation. To supplement the focus group interviews, the students also completed the interprofessional collaborative competency attainment survey (ICCAS), which measures the students’ self-assessed interprofessional competence.ResultsThree main themes emerged from the analysis of the focus group interviews: realism, uncertainty and reflection. The students emphasised the importance of authentic and recognisable scenarios. They said the vague and unspecific patient symptoms created uncertainty in the situation, making it difficult to understand the patient’s diagnosis. Despite that uncertainty, they described the experience as positive. Further, the students expressed that the simulation increased their confidence in interprofessional collaboration and prepared them for future work. The results from the ICCAS questionnaire showed that the students reported a subjective positive change in their interprofessional competence after participating in the scenarios.ConclusionsThis study showed that simulation-based IPE with sub-acute primary care scenarios contributes to develop interprofessional collaborative competence in healthcare education. Sub-acute scenarios can supplement the more common approaches with acute care scenarios and aid in developing the collaborative competence required to work in healthcare teams.

Geriatric rehabilitation during COVID-19: a lesson learned

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new strain of coronavirus that causes coronavirus disease 2019 (COVID-19) infection and is responsible for a deadly pandemic. The elderly population have a high risk to be infected by COVID-19 and tend to have worse outcomes compared to adult population. Elderly patients also have higher comorbidity than the whole population. Therefore, management of COVID-19 in the elderly needs special attention in terms of regarding drug doses, drug interactions, and side effects of the drugs given. Approach from Physical Medicine and Rehabilitation (PM&amp;R) in elderly population known as Geriatric Rehabilitation is required for COVID-19 because PM&amp;R will go through all phases of treatment during the acute, sub-acute, and long-term care phases. The targets are relieving symptoms, assisting in the mechanical ventilation weaning process, preventing decondition of the airway and other organ systems, and managing psychosocial aspects, especially in the vulnerable and high-risk elderly population. The geriatric rehabilitation approach to COVID-19 patients resulted in improved functional prognosis, optimized role of function, and improved Quality of Life.

359 The Cost of Illness of an Aneurysm Rupture: A Prospective Study to Quantity the Unseen Cost of Aneurysmal Subarachnoid Hemorrhage

INTRODUCTION: Subarachnoid hemorrhage (SAH) is a devastating neurological event affecting 1/10,000 adults globally with a mortality of more than 30%. SAH is financially straining for both the patient and caretaker due to its high morbidity, prolonged hospital stay, intensive treatments, and involved recovery. In this prospective study, we aim to quantify the total direct and indirect costs of SAH throughout the acute and subacute care periods. METHODS: Patients and their self-reported primary caregivers were prospectively followed for up to a year after the ictus hemorrhagic event, and queried monthly about expenses related to the recovery process. Additional clinical and cost information was obtained from the hospital finance department and directly from patient/caregiver follow-up interviews. RESULTS: Thirty-three patients were enrolled in this prospective study including 28 females (85%) and 5 males (15%) with a median (quartile range) age of 58 (47-66). Thirty-nine designated caregivers were also enrolled. The median ICU and hospital length of stay were 14 (11-19) and 19 (15-23) days, respectively. The median total cost for these patients was $135,568 ($38,082 - $644,688) and the median direct cost was $73,161 ($55,138 - $91,596) with a median expected patient payment of $114,453 ($70,772 -$204,855). The median percentage of direct costs attributed to the ICU was 40% (32-45). Patients with Medicare had smaller ranges of costs. Additionally indirect hospital costs reported were for travel related costs (hotels, ride shares, metro cards), toiletries, home modifications and medications ranging from $0 to $1000 a day. CONCLUSION: SAH is consistently a devastating neurological event affecting active members of society and their social networks. Its complicated course and recovery process can leave patients confined to a hospital for extended periods of time. As providers, we must investigate avenues to mitigate the costs and burdens patients and their support networks face.

Impact of Spousal Death on Healthcare Costs and Use Among Medicare Beneficiaries: NHATS 2011-2017.

Spousal death is associated with elevated mortality in the surviving partner; less is known about how healthcare costs and use change following spousal death. To examine the causal impact of spousal death on Medicare costs and use over time. Longitudinal cohort study with an event study design. National Health and Aging Trends Study (NHATS) with linked Medicare claims. Respondents from 2011-2017 who reported spousal death the prior year, limited to those with traditional Medicare (n=491 with 9,766 respondent-quarters). Total Medicare costs; binary indicators for acute hospitalization; emergency department; sub-acute care (including skilled nursing, rehabilitation, and long-term care); and number of outpatient management visits on a quarterly basis 3 years before and after spousal death. During the first year post-death, quarterly Medicare costs for the surviving spouse were $1,092 higher than pre-death; probability of hospitalization, emergency department, and sub-acute care were 3.3%, 2.8%, and 2.2% higher, respectively; and there were 0.3 more outpatient visits (p<.01 for all). Several outcomes continued to be elevated during the second year, including costs ($1,174 higher per quarter), hospitalization (3.2% higher), and sub-acute care (2.9% higher; p<.01 for all). By the third year, costs returned to pre-death level but hospitalization and sub-acute care (2.9% and 3.1% higher per quarter; p<.05 for both) remained elevated. Cost increases in the first and second years post-death were larger if the deceased spouse was a caregiver ($1,588 and $1,853 per quarter) or female (i.e., among bereaved males; $1,457 and $1,632 per quarter; p<.05 for all). Spousal death increased total Medicare costs and use of all healthcare categories among the surviving partner; elevations in hospitalization and sub-acute care persisted through the third year. Clinicians and payors may want to target surviving partners as a high-risk population.

Economic Effects of Occupational Therapy Services for Adults in Acute and Subacute Care Settings: A Systematic Review.

Research supports the clinical effectiveness of hospital-based occupational therapy to improve functional outcomes, but no synthesis of economic evaluations of occupational therapy services provided in these settings has been published. To determine the economic value of occupational therapy services in acute and subacute care settings. MEDLINE, CINAHL, CENTRAL, EconLit, Embase, National Health Services Economic Evaluation Database, PsycINFO, ProQuest (Health and Medicine and Social Science subsets only), OTseeker, and gray literature. Study Selection and Data Collection: Eligible studies used trial-based or modeled economic analyses and included an adult population (ages ≥18 yr) and occupational therapy assessments or interventions provided in acute and subacute care. Two authors independently assessed abstracts and then full text. Articles were then appraised using the Evers Consensus on Health Economic Criteria. The authors identified 13,176 unique abstracts and assessed 190 full-text articles for eligibility. Ten studies were included in the systematic review; they varied in their primary objectives, methodology, costs, and outcomes. Studies examined the cost-benefit, cost-effectiveness, cost-utility, or cost minimization of a range of occupational therapy services. Five studies suggested that occupational therapy services offer value for money (lower cost, higher benefit); 4 suggested that they offer higher cost and benefits. One study that investigated upper limb rehabilitation did not indicate value for money. The findings suggest that occupational therapy for adults poststroke and post-traumatic brain injury, acute discharge planning, and pre- and post-hip replacement is cost-effective, but further research is needed to substantiate these findings. What This Article Adds: The findings provide preliminary evidence of the economic effectiveness of occupational therapy in acute and subacute care.

Emergency department interventions that could be conducted in subacute care settings for patients with nonemergent conditions transported by paramedics: a modified Delphi study.

Background:As the number of patients with nonemergent conditions who are transported by paramedics continues to increase in Ontario, redirecting specific patients to subacute settings may be more beneficial and suitable for both patients and emergency departments. We aimed to evaluate whether emergency department interventions conducted on patients with nonemergent conditions who are transported by paramedics could be conducted in subacute health centres.Methods:We conducted a RAND/UCLA modified Delphi study in Ontario between Oct. 13 and Dec. 19, 2020. We used purposive sampling to recruit practising emergency and primary care physicians for an expert panel. We abstracted interventions given to adult patients with nonemergent conditions (18 yr of age or older) who were transported by paramedics to an emergency department from the National Ambulatory Care Reporting System (NACRS) database (Jan. 1, 2014, to Mar. 31, 2018). Participants in the expert panel rated the suitability of the 150 most frequently recorded emergency department interventions from the NACRS database, for completion in subacute health care centres. We set consensus at 70% agreement.Results:We invited 25 physician experts, 21 of whom consented to participate; 20 physicians completed round 1, and 18 physicians completed both rounds. After 2 rounds, consensus was reached on 146 (97.3%) interventions; 103 interventions (68.7%) were suitable for subacute centres, 43 (28.7%) for only the emergency department and 4 (2.6%) did not receive consensus. For subacute centres, all 103 interventions were rated for urgent care centres; walk-in medical centres were applicable for 46 (30.6%) interventions and clinics led by nurse practitioners for 47 (31.3%) interventions.Interpretation:Most interventions provided to patients with nonemergent conditions transported by paramedics to emergency departments were identified as suitable for urgent care clinics, with one-third being suitable for either walk-in medical centres or clinics led by nurse practitioners. This study has potential to inform a patient classification model for paramedic-initiated redirection of patients from emergency departments, although further contextualization is required for this to be implemented in clinical practice.Study registration:ID ISRCTN22901977.

Factors Related to Successful Ventilator Weaning in Respiratory Care Center Patients: A Retrospective Chart Review Study

The subacute respiratory care unit is an important relay station where respirator-dependent patients may access subsequent chronic respiratory care. Although there is relatively little information in the literature regarding respirator disconnections in subacute respiratory care units, assisting patients to disconnect successfully from respirators is a primary challenge for care teams. The purpose of this study was to understand respirator disconnections and the factors affecting these events in subacute respiratory care units to improve the effectiveness of ventilator weaning and reduce the burden on families and medical care providers. This was a retrospective chart review study. Patients admitted to the subacute respiratory care unit for respiratory training during the study period from January 2016 to December 2019 were recruited as subjects and the data were collected from the Chang Gung Medical Research Database`s health insurance secondary data using a self-made transcription form. The ventilator weaning success rate of the subjects in this study was 78.5%. A bivariate analysis revealed that consciousness status; disease severity; rapid shallow breathing index; days of hospitalization in a respiratory care center; days of ventilator use; blood urea nitrogen, white blood cell, hemoglobin, and blood albumin levels; and mean caloric intake were each significantly associated with successful ventilator withdrawal. The predictors of ventilator weaning in respiratory care center patients were identified as disease severity, rapid shallow breathing index, days of ventilator use, white blood cell level, and hemoglobin level. Respirator-dependent patients should be evaluated and monitored as early as possible. Moreover, a ventilator weaning plan should be included as a regular testing and monitoring item. Also, a respirator removal program should be provided on a case-by-case basis. Individualized ventilator weaning programs may reduce the burden on families and medical care providers.

Identifying patient characteristics associated with potentially redirectable paramedic transported emergency department visits in Ontario, Canada: a population-based cohort study

ObjectiveParamedic redirection from emergency department (ED) to subacute centres may be more beneficial for some patients, though little is known about which patients are potentially appropriate. We examined whether patient...

The Occupational Experience Helps to Express the Clients’ Occupational Needs in Goal Setting: A Retrospective Study in Subacute Care Setting

This study investigates whether reflection on occupational experience during assessment and intervention would help clients express their occupational needs in goal setting. Sixty-two participants who were not able to express their occupational needs in the initial assessment process were either allocated to the occupational experience group who undertook occupation-based assessment and intervention, or the physical training group who engaged in physical training only. The ratio of participants who expressed their occupational needs in each group was 67% (30/45) and 12% (2/17) respectively. Reflection on occupational experience during assessment and intervention to help clients express their occupational needs would have significant implications for practice, as it may encourage clients to reflect on their performance more easily.

Optimization of the medication-use process for fentanyl patches at a small community hospital.

To describe a community hospital pharmacy department's novel approach to addressing safe use of fentanyl patches in acute and subacute care patients. Beginning in 2017, improvement opportunities were identified within the medication-use process for fentanyl patches at Cleveland Clinic Euclid Hospital. Prescribing was addressed through development of a procedure requiring an opioid status verification by a pharmacist for all fentanyl patch orders. This procedure includes determination of indication, review of prior opioid use, and documentation within the medical record. At baseline in 2017, 11 of 45 fentanyl patches were initiated for acute pain. In the first year of the procedure, 1 of 13 orders was initiated for acute pain, and in the second year 2 of 24 orders for fentanyl patches were initiated for acute pain. With each review, the pharmacy department identified additional safety and clinical education opportunities. Subsequently, inventory and dispensing practices for patches were assessed. The hospital's inventory was decreased and dispensing practices were altered to mitigate accessibility of the patches. This resulted in a decrease of 73.65% in the on-hand quantity from 2018 to 2020. The overall morphine milligram equivalents (MME) per 24 hours of this dosage form available in the hospital were reduced from 56,073.6 MME in 2018 to 13,557.6 MME in 2020 (75.82% decrease). Evaluation of the fentanyl patch medication-use process and pharmacy-driven interventions resulted in an increase in appropriate utilization of fentanyl patches and a decrease in accessible MME of this potent dosage form.

Barriers and enablers to implementing hospital-acquired urinary tract infection prevention strategies: A qualitative study using the Theoretical Domains Framework

Introduction: To date, little is known about the factors affecting implementation of hospital-acquired urinary tract infection (UTI) prevention strategies in the high-risk subacute care setting. This study aimed to identify the perceived barriers and enablers of clinicians to implementing hospital-acquired UTI prevention strategies in an Australian subacute hospital.