Time Of Discharge Research Articles

A Fully Connected Neural Network (FCNN) Model to Simulate Karst Spring Flowrates in the Umbria Region (Central Italy)

In the last decades, climate change has led to increasingly frequent drought events within the Mediterranean area, creating an urgent need of a more sustainable management of groundwater resources exploited for drinking and agricultural purposes. One of the most challenging issues is to provide reliable simulations and forecasts of karst spring discharges, whose reduced information, as well as the hydrological processes involving their feeding aquifers, is often a big issue for water service managers and researchers. In order to plan a sustainable water resource exploitation that could face future shortages, the groundwater availability should be assessed by continuously monitoring spring discharge during the hydrological year, using collected data to better understand the past behaviour and, possibly, forecast the future one in case of severe droughts. The aim of this paper is to understand the factors that govern different spring discharge patterns according to rainfall inputs and to present a model, based on artificial neural network (ANN) data training and cross-correlation analyses, to evaluate the discharge of some karst spring in the Umbria region (Central Italy). The model used is a fully connected neural network (FCNN) and has been used both for filling gaps in the spring discharge time series and for simulating the response of six springs to rainfall seasonal patterns from a 20-year continuous daily record, collected and provided by the Regional Environmental Protection Agency (ARPA) of the Umbria region.

Impact of critical illness on continuation of anticancer treatment and prognosis of patients with aggressive hematological malignancies

BackgroundMaintaining the dose-intensity of cancer treatment is an important prognostic factor of aggressive hematological malignancies. The objective of this study was to assess the long-term outcomes of intensive care unit (ICU) survivors with acute myeloid leukemia (AML) or aggressive B-cell non-Hodgkin lymphoma (B-NHL) with emphasis on the resumption of the intended optimal regimen of cancer treatment.Patients and methodsWe conducted a retrospective (2013–2021) single-center observational study where we included patients with AML and B-NHL discharged alive from the ICU after an unplanned admission. The primary endpoint was the change in the intended optimal cancer treatment following ICU discharge. Secondary endpoints were 1-year progression-free survival and overall survival rates. Determinants associated with modifications in cancer treatment were assessed through multivariate logistic regression.ResultsOver the study period, 366 patients with AML or B-NHL were admitted to the ICU, of whom 170 survivors with AML (n = 92) and B-NHL (n = 78) formed the cohort of interest. The hematological malignancy was recently diagnosed in 68% of patients. The admission Sequential Organ Failure Assessment (SOFA) score was 5 (interquartile range 4–8). During the ICU stay, 30 patients (17.6%) required invasive mechanical ventilation, 29 (17.0%) vasopressor support, and 16 (9.4%) renal replacement therapy. The one-year survival rate following ICU discharge was 59.5%. Further modifications in hematologic treatment regimens were required in 72 patients (42%). In multivariate analysis, age > 65 years (odds ratio (OR) 3.54 [95%-confidence interval 1.67–7.50], p < 0.001), ICU-discharge hyperbilirubinemia > 20 µmol/L (OR 3.01 [1.10–8.15], p = 0.031), and therapeutic limitations (OR 16.5 [1.83–149.7], p = 0.012) were independently associated with modifications in cancer treatment. Post-ICU modifications of cancer treatment had significant impact on in-hospital, 1-year overall survival and progression-free survival.ConclusionThe intended cancer treatment could be resumed in 58% of ICU survivors with aggressive hematological malignancies. At the time of ICU discharge, advanced age, persistent liver dysfunction and decisions to limit further life-support therapies were independent determinants of cancer treatment modifications. These modifications were associated with worsened one-year outcomes.

Functional Disability at 3 Months in Patients with Residual Limb Swelling after Snakebite Envenoming.

Limited data indicate that snakebite survivors have persistent musculoskeletal disability. We assessed the pain and functional disability at hospital discharge and after 3 months in 47 patients treated for snakebite envenoming and with at least a specified amount of local swelling at the time of hospital discharge, using the numerical pain rating scale and the Patient-Specific Functional Scale (PSFS). Russell's viper was the most common biting snake species identified. At hospital discharge, the median pain score was 2 (0-3); 9 (19%) patients reported mild persisting pain at 3 months. The median PSFS score at hospital discharge was 3.7 (3.3-4.0), which improved to 8.3 (6.3-9.0) on follow-up (P <0.001); 32 (68%) patients had a PSFS score of 8.9 or below on follow-up. We conclude that snakebite envenoming could be associated with persisting functional disability at 3 months even in the absence of local complications such as skin necrosis and compartment syndrome.

Two-Way Coupling of the National Water Model (NWM) and Semi-Implicit Cross-Scale Hydroscience Integrated System Model (SCHISM) for Enhanced Coastal Discharge Predictions

This study addresses the limitations of and the common challenges faced by one-dimensional river-routing methods in hydrological models, including the National Water Model (NWM), in accurately representing coastal regions. We developed a two-way coupling between the NWM and the Semi-implicit Cross-scale Hydroscience Integrated System Model (SCHISM). The approach demonstrated improvements in modeling coastal river dynamics, particularly during extreme events like Hurricane Matthew. The coupled model successfully captured tidal influences, storm surge effects, and complex river–river interactions that the standalone NWM missed. The approach revealed more accurate representations of peak discharge timing and magnitude as well as water storage and release in coastal floodplains. However, we also identified challenges in reconciling variable representations between hydrological and hydraulic models. This work not only enhances the understanding of coastal–riverine interactions but also provides valuable insights for the development of next-generation hydrological models. The improved modeling capabilities have implications for flood forecasting, coastal management, and climate change adaptation in vulnerable coastal areas.

A hybrid data-driven approach for state of health estimation in lithium-ion batteries

ABSTRACT The assessment of the state of health (SOH) in lithium-ion batteries is essential for ensuring safe operation and implementing scientific management practices. This paper proposes a novel hybrid data-driven approach for accurately estimating the SOH of lithium-ion cells. Initially, the sparrow search algorithm (SSA) was implemented to optimize the structural configuration of a hybrid long-short-term memory neural network and convolutional neural network model. Second, four health indicators, namely, constant current charging time (CCCT), constant current charging capacity (CCCC), discharging time (DT), and discharging capacity (DC), were identified as inputs to the estimation model by Pearson correlation analysis. The CALCE battery dataset is utilized for conducting experiments, yielding remarkably low average values of root mean square error (RMSE) and mean absolute error (MAE), standing at merely 0.6737% and 0.5286%, respectively. And comparing with GRU, TCN, CNN, LSTM, and PSO optimization models, the proposed method has higher SOH estimation accuracy, which is more than 11% better than that. The robustness of three additional kinds of batteries is tested to validate their performance under varying current rates and temperatures. The results demonstrate that the accurate estimation of SOH, and the estimated values’ relative errors for each cycle of the three different types of batteries are all basically within 1%, with their maximum average RMSE are only 0.4840%, 0.3609%, and 0.5681%, respectively, and their maximum average MAE are only 0.3900%, 0.2828%, and 0.4149%, respectively.

SP2.6 - Improvements in patient discharge efficiency and safety: the impact of a dedicated Clinical Pharmacist in an Emergency General Surgery team

Abstract Introduction Efficiency in management of acute surgical admissions is related to safe clinical practice combined with good patient flow, optimising use of limited capacity. Preventable morbidity and discharge delays may significantly compromise outcomes for Emergency General Surgery (EGS) teams managing increasing numbers of admissions. Aim To investigate the effectiveness of a prescribing pharmacist employed within an EGS team in a DGH, with specific focus on patient discharge times by facilitating discharge prescription efficiency, including venous thromboembolism (VTE) prophylaxis. Methods Data was collected for two separate 1-month time periods in 2021 (Period A), before the appointment of a pharmacist and in 2023 (Period B), after pharmacist appointment. Data was analysed for (i) differences in times related to ‘to take home’ (TTH) medication prescription and (ii) prescribing of post-operative extended enoxaparin prophylaxis (EEP) following discharge. Results Mean time for prescription of TTH medications during working hours in Period A was 100 minutes (n=133, range 0-433 minutes) compared with 67 minutes (n=120, range 0-416 minutes) in Period B. Pharmacist prescribing accounted for 51.6% of TTH prescriptions with a mean prescription time of 18.6 minutes (range 0-389 minutes). During Period A, 36% of patients (n=48) who had a VTE assessment mandating EEP received this on discharge compared to 100% in Period B (n=31). Conclusions This data highlights an improvement in prescribing of TTH medications since appointment of a dedicated EGS pharmacist. The consequences of such improvements include more rapid patient flow, better patient experience and heightened patient safety by prevention of post-operative VTE through EEP.

The effect of transcutaneous auricular vagus nerve stimulation on cardiovascular function in subarachnoid hemorrhage patients: a safety study.

Subarachnoid hemorrhage (SAH) is characterized by intense central inflammation, leading to substantial post-hemorrhagic complications such as vasospasm and delayed cerebral ischemia. Given the anti-inflammatory effect of transcutaneous auricular vagus nerve stimulation (taVNS) and its ability to promote brain plasticity, taVNS has emerged as a promising therapeutic option for SAH patients. However, the effects of taVNS on cardiovascular dynamics in critically ill patients, like those with SAH, have not yet been investigated. Given the association between cardiac complications and elevated risk of poor clinical outcomes after SAH, it is essential to characterize the cardiovascular effects of taVNS to ensure this approach is safe in this fragile population. Therefore, we assessed the impact of both acute taVNS and repetitive taVNS on cardiovascular function in this study. In this randomized clinical trial, 24 SAH patients were assigned to either a taVNS treatment or a Sham treatment group. During their stay in the intensive care unit, we monitored patient electrocardiogram (ECG) readings and vital signs. We compared long-term changes in heart rate, heart rate variability, QT interval, and blood pressure between the two groups. Additionally, we assessed the effects of acute taVNS by comparing cardiovascular metrics before, during, and after the intervention. We also explored acute cardiovascular biomarkers in patients exhibiting clinical improvement. We found that repetitive taVNS did not significantly alter heart rate, QT interval, blood pressure, or intracranial pressure. However, taVNS increased overall heart rate variability and parasympathetic activity compared to the sham treatment. The increase in parasympathetic activity was most pronounced from 2-4 days after initial treatment (Cohen's d = 0.50). Acutely, taVNS increased heart rate, blood pressure, and peripheral perfusion index without affecting the corrected QT interval, intracranial pressure, or heart rate variability. The acute post-treatment elevation in heart rate was more pronounced in patients who experienced a decrease of more than one point in their Modified Rankin Score at the time of discharge. Our study found that taVNS treatment did not induce adverse cardiovascular effects, such as bradycardia or QT prolongation, supporting its development as a safe immunomodulatory treatment approach for SAH patients. The observed acute increase in heart rate after taVNS treatment may serve as a biomarker for SAH patients who could derive greater benefit from this treatment. NCT04557618.

Oral donor site evaluation in the early and late postoperative periods for augmentation and replacement urethroplasty

Introduction. The use of oral mucosa in augmentation and replacement urethroplasty is the gold standard for several reasons. Most commonly, the mucous membrane of the cheek, the underside of the tongue or lip is employed. Assessing postoperative complications in the donor area is crucial as it impacts patients' quality of life.Objective. To evaluate early and late postoperative changes in the donor area after oral graft extraction for urethroplastyMaterials &amp; methods. A retrospective analysis of the results of surgical treatment using oral mucosa from 2017 to 2022 was carried out. The study included 65 patients. The intensity of pain syndrome in the graft sampling area was assessed by patients on a visual analog scale (VAS). The donor area was sutured only in the case of tongue and lip mucosa sampling.Results. The mucous membrane of the oral cavity was harvested from different sites in 65 patients. Specifically, it was taken from the inside of the cheek in 49 patients (75.38%), from both inner sides of the cheeks in 13 (20.0%), the lower lip in two (3.07%) and the lower surface of the tongue in one (1.54%) patient, respectively. On the first day after surgery, the median pain level according to VAS was 4 points (range: 2 – 7), at the time of discharge — 3 points (1 – 6). After 120 days, a follow-up examination showed a regression of pain symptoms: the median was 0 points (0–1). In the late postoperative period, incomplete opening of the mouth was recorded in two patients (3.07%), cosmetic defect in the donor area in two (3.07%), discomfort during meals in six (9.23%), impaired sensitivity in the donor area in two (3.07%), exacerbation of chronic stomatitis and hypersalivation in two (3.07%) patients, respectively.Conclusion. The incidence of complications in the donor area is low, but for some patients this can result in a reduced quality of life. Using proper technique when extracting oral mucosa grafts reduces pain and the likelihood of early- and late-stage postoperative complications in this area.

Application of sensory and motor training in AIDET communication mode in patients after knee arthroplasty.

Patients with knee arthroplasty often have problems such as slow recovery of knee function, which may cause negative emotions and affect their postoperative rehabilitation. The application of sensory and motor training in the Acknowledge, Introduce, Duration, Evaluation, Thank You (AIDET) communication mode in patients after knee arthroplasty can provide reference for the selection of postoperative rehabilitation training measures. To explore the sensory and motor training effects in AIDET communication mode on knee function recovery and resilience of patients after knee arthroplasty. One hundred patients who underwent knee arthroplasty at our hospital between January 2022 and January 2024 were randomly divided into two groups. The control group (n = 50) received routine rehabilitation training. In the observation group (n = 50), the AIDET communication mode was used to perform sensory and motor training, in addition to routine rehabilitation training. The rehabilitation training was administered for 8 weeks. After surgery, knee function, balance ability, walking ability, proprioception, and resilience were compared between the two groups. The New York Hospital for Special Surgery knee scores of the observation group at the time of discharge and 8 weeks after intervention were (65.23 ± 6.84, 84.53 ± 5.27), which was higher than those of the control group (61.03 ± 7.15, 74.92 ± 6.52) (P < 0.05). The balance ability of the observation group at the time of discharge and 8 weeks after the intervention was higher than that of the control group, the time of time up to go test was shorter than that of the control group, and proprioceptive function was higher than that of the control group (P < 0.05). The resilience level in the observation group after the intervention was higher than that in the control group (P < 0.05). Sensory and motor training in AIDET communication mode promotes knee function recovery of patients after knee arthroplasty, improves their limb walking ability and balance function, and increases their resilience level.

Clinical application of a modified wiltse approach in middle and lower thoracic vertebrae: a case-control study of thoracic fracture patients

BackgroundThe Wiltse approach has been extensively employed in thoracolumbar surgeries due to its minimal muscle damage. However, in the middle and lower thoracic spine, the conventional Wiltse approach necessitates the severance of the latissimus dorsi and trapezius muscles, potentially leading to muscular injury. Consequently, we propose a modified Wiltse approach for the middle and lower thoracic vertebrae, which may further mitigate muscular damage.MethodsFrom May 2018 to April 2022, 60 patients with spinal fractures in the middle and lower thoracic vertebrae (T5-12) were enrolled in this study. Thirty patients underwent surgery using the modified Wiltse approach (Group A), while the remaining 30 patients received traditional posterior surgery (Group B). The observation indices included operation time, intraoperative blood loss, incision length, number of C-arm exposures, postoperative drainage, postoperative ambulation time, discharge time, as well as preoperative and postoperative Cobb’s angle, percentage of anterior vertebral body height (PAVBH), visual analog scale (VAS) Score, and Oswestry disability index (ODI).ResultsCompared to the traditional posterior approach, the modified Wiltse approach demonstrated significant advantages in operation time, intraoperative blood loss, length of incision, postoperative ambulation time, postoperative drainage, and discharge time, as well as postoperative VAS and ODI scores. No significant differences were observed between the two groups in terms of number of C-arm exposures, postoperative Cobb’s angle, or postoperative PAVBH.ConclusionWe propose a modification of the Wiltse approach for the middle and lower thoracic vertebral regions, which may further minimize muscular damage and facilitate the recovery of patients who have undergone surgery in the middle and lower thoracic vertebrae.

Outpatient parenteral antimicrobial therapy for patients with Enterococcus faecalis endocarditis using continuous infusion IV benzylpenicillin plus IV ceftriaxone.

Many patients with Enterococcus faecalis endocarditis are clinically stable and able to leave hospital before completing antibiotic treatment, but data are lacking regarding some outpatient treatment options. To assess the outcomes for adults with E. faecalis endocarditis receiving outpatient parenteral antimicrobial therapy (OPAT) with continuous infusion IV benzylpenicillin plus bolus/continuous infusion IV ceftriaxone. We retrospectively reviewed adults who received at least 2 weeks duration of OPAT for E. faecalis endocarditis with the above treatment regimen in the Auckland and Christchurch regions between July 2019 and September 2022. Forty-four patients met inclusion criteria. Fifteen were female (34%). The median age was 80 (IQR 71.5 to 84) years. Twenty-two (50%) had prosthetic valve (PV), 15 (34%) native valve (NV), 3 (7%) NV and/or cardiac implantable electronic device (CIED) infection, 3 (7%) PV and/or CIED infection, and 1 (2%) repaired valve endocarditis. Patients received a median of 16.5 days inpatient and 28 days OPAT antibiotic treatment. The 12 month outcome was cure (n = 25; 57%), antibiotic suppression (n = 9; 20%), relapse (n = 2; 5%; both possible) or death (n = 8; 18%). Compared with a historical cohort treated with OPAT continuous infusion IV benzylpenicillin plus bolus IV gentamicin, there was no difference in the relapse rate. This study adds to the accumulating evidence supporting the treatment of E. faecalis endocarditis with OPAT continuous infusion IV benzylpenicillin plus bolus/continuous infusion IV ceftriaxone. This is an option for patients requiring further antibiotic treatment at the time of hospital discharge.

Changes in motor unit behaviour across repeated bouts of eccentric exercise.

Unaccustomed eccentric exercise (EE) is protective against muscle damage following a subsequent bout of similar exercise. One hypothesis suggests the existence of an alteration in motor unit (MU) behaviour during the second bout, which might contribute to the adaptive response. Accordingly, the present study investigated MU changes during repeated bouts of EE. During two bouts of exercise where maximal lengthening dorsiflexion (10 repetitions × 10 sets) was performed 3weeks apart, maximal voluntary isometric torque (MVIC) and MU behaviour (quantified using high-density electromyography; HDsEMG) were measured at baseline, during (after set 5), and post-EE. The HDsEMG signals were decomposed into individual MU discharge timings, and a subset were tracked across each time point. MVIC was reduced similarly in both bouts post-EE (Δ27 vs. 23%, P=0.144), with a comparable amount of total work performed (∼1,300 J; P=0.905). In total, 1,754 MUs were identified and the decline in MVIC was accompanied by a stepwise increase in discharge rate (∼13%; P<0.001). A decrease in relative recruitment was found immediately after EE in Bout 1versus baseline (∼16%; P<0.01), along with reductions in derecruitment thresholds immediately after EE in Bout 2. The coefficient of variation of inter-spike intervals was lower in Bout 2 (∼15%; P<0.001). Our data provide new information regarding a change in MU behaviour during the performance of a repeated bout of EE. Importantly, such changes in MU behaviour might contribute, at least in part, to the repeated bout phenomenon.

Comparative clinical and laboratory evaluation of the effectiveness of a nanodispersed silica-based drug with antimicrobial properties for the local treatment of purulent inflammatory diseases of the maxillofacial area

Background. The problem of purulent inflammatory diseases of the maxillofacial area remains one of the most pressing problems of modern dentistry and maxillofacial surgery. The aim of the study is to conduct a comparative evaluation of the effectiveness of a drug based on nanodispersed silica (NDS) with antimicrobial properties for the local treatment of purulent inflammatory diseases of the maxillofacial area. Materials and methods. A comparative assessment of the postoperative period was performed in 71 patients with maxillofacial phlegmon, who were divided into two representative groups: comparison (39 patients), in whose local treatment of purulent wounds was carried out by conventional methods, and the main group (32 patients), where the local treatment was carried out using a drug based on NDC. The level of endogenous intoxication was determined by the level of C-reactive protein (CRP), by the level of blood metabolites of average mass (MAM) and leukocyte intoxication index (LII) in the blood serum. The data obtained were statistically processed and compared. Results. During the study of the dynamics of СRР was found that starting from 3 days in the main group there was a tendency to its faster decrease and normalization before discharge, while in patients of the comparison group it was significantly higher (p &lt; 0.05)., The level of MAM in patients of the comparison group remained significantly (p &lt; 0.05) elevated throughout the treatment in the postoperative period, while in the main group it was on the verge of normal before discharge. Comparison group of patients had significantly higher LII during treatment and at the time of discharge from hospital (p &lt; 0.05) than the main group. Conclusions: The treatment of maxillofacial phlegmon by the developed method provided a more favorable course of the postoperative period than in the comparison group, as evidenced by a significantly (p &lt; 0.05) faster normalization of endogenous intoxication blood parameters.

Improving the medication literacy at the time of discharge from hospital (the LiMeTiD study)

Unintended discrepancy in medications at the time of discharge from the hospital is associated with an increased incidence of adverse drug events, including readmission to hospital. Medication literacy is an essential part of health literacy and can reduce medication discrepancies. This prospective observational cohort study aimed to measure the medication literacy of patients at the time of discharge from the hospital when managed with usual care and after the introduction of a medication literacy improvement instrument. This study involved a baseline cohort receiving usual care and a post-intervention cohort aged 50–80 years with high health literacy. The 7 Things I Should Know About My Medications at the Time of Discharge from Hospital instrument, in short, The 7 Domains MedLit Instrument, was designed by the researchers in addition to three medication literacy measurement questionnaires. Medication literacy was measured at 30 h post-discharge. The impact on readmission to hospital was assessed at 30 days post-discharge. The 7 Domains MedLit Instrument was found to significantly increase the number of patients reporting increased counselling by a clinician at the time of discharge from the hospital (clinician, 59.3 % vs. 100.0 %, X2 (1, n = 49) = 11.10, p < 0.01, physician, 28.6 % vs. 76.2, X2 (1, n = 49) = 10.9, p < 0.01, pharmacist 25.0 % vs. 71.4 %, X2 (1, n = 49) = 10.4, p < 0.01)). Significantly, more patients had increased knowledge on drug interactions or adverse drug reactions after using the instrument (26.1 % vs. 61.9 %, P = 0.032 and 30.4 % vs. 66.7 %, P = 0.033, respectively). The 7 Domains MedLit Instrument and the schooling years significantly correlated with the knowledge of drug interactions and adverse drug reactions. Less post-intervention participants visited an emergency department within 30 days post-discharge. The 7 Domains MedLit Instrument significantly improved the patients’ medication literacy at the time of discharge from hospital.

Polymorphism of antioxidant defense genes as a predictor of unfavorable neurological outcomes in preterm children

Currently, oxidative stress is considered as one of the most important factors in the pathogenesis of many pathological processes occurring in the newborn baby. Purpose. To establish the relationship of the polymorphism of genes, encoding antioxidant enzymes (glutamyl cysteine ligase, manganine superoxide dismutase) with unfavorable neurological outcomes in preterm children at various age periods. Material and methods. A prospective cohort continuous study included 151 preterm children, with a gestational age of 26–32 weeks and body weight of 590–1990 grams. Cord blood was sampled in children to determine allelic polymorphisms of 4 genetic markers: the SOD2 gene rs4880 (с.47C&gt;Т, р.Ala16Val), the SOD2 gene rs1141718 (с.58T&gt;C, р.Thr58Ile), the SOD2 gene rs11575993 (с.60С&gt;Т, р.Leu58Phe), GCLC gene rs17883901 (с.–129 С&gt;Т). The division of children into groups was carried out based on the assessment of neurological outcomes at the following control points: 1 control point — at the time of discharge from hospital, 2 control point — corrected age of 1 year of life, 3 control point — 4 years of life. Results. The cohort of children with unfavorable neurological outcomes was found to increase from 36.4 % at the time of hospital discharge to 70 % by the age of 4 years. Children who joined the cohort of children with unfavorable neurological outcomes at corrected age of 1 year of life were carriers of 47 CT of the gene of the mitochondrial superoxide dismutase (SOD2) rs4880, and those, attached by 4 years of age, were carriers of heterozygous 129 CT genotype of the gene of the catalytic subunit of glutamate cysteine ligase (GCLC) rs17883901 and 47 CT mitochondrial superoxide dismutase (SOD2) rs4880. Children with a favorable neurological outcome at corrected age of 1 year of life were more often diagnosed with homozygous 47 CC genotype of SOD2 rs4880 and 60 CC SOD2 rs11575993, and at the age of 4 years of life — with homozygous 129 CC genotype of GCLC rs17883901 gene and 47 TTSOD2 rs4880. Conclusion. The study of single nucleotide exchange in the antioxidant enzyme genes will establish the risk group of children exposed to free-radical injuries of CNS and begin neuroprotective therapy with the inclusion of antioxidant treatment.

Postoperative Outcomes of the Awake Colorectal Surgery with Neuraxial Anaesthesia.

To determine the outcome of awake surgery with combined spinal epidural in geriatric colon cancer patients with advanced comorbidity. Quasi-experimental study. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, Ankara Bilkent City Hospital, Ankara, Turkiye, from April 2022 to 2023. Twenty-four American Society of Anaesthesiologists (ASA) I-II patients, aged 25-65 years and scheduled for colon cancer surgery were included in this research. All patients were observed preoperatively, at the operation room and at the postoperative surgery service. Spinal anaesthesia was planned for Group I and general anaesthesia for Group II. Ketofol (1:1) was administered to the combined spinal-epidural group, with a Ramsay sedation score of 3 after the spinal block. Epidural analgesia was planned for all patients. Patients' age, gender, weight, comorbidities, ASA risk scores, intraoperative haemodynamic parameters, bleeding amounts, colloid, crystalloid, and blood products were collected. There was no significant difference between the demographic characteristics of both anaesthesia groups (p >0.05). The amount of bleeding was statistically lower in Group I than in the general anaesthesia group (p = 0.004). Oral intake, drain withdrawal, mobilisation, discharge times, and costs were similar in all groups (p >0.05). The regional anaesthesia applications facilitate compliance with routine mobilisation, discharge procedures and prevent complications in abdominal surgery and its positive perioperative effects in patients with poor respiratory parameters, poor general condition, and high comorbidity in advanced age. Regional anaesthesia, Spinal-epidural, Mobilisation, Pain, Colon cancer.

The Effect of Supplemental Feeding Tube Device on Time to Transition to Exclusive Breastfeeding and Discharge: A Randomized Controlled Trial with Preterm Infants.

Aim: This study investigated the effect of supplemental feeding tube device (SFTD) method on time to transition to exclusive breastfeeding and discharge time in preterm infants. Methods: This randomized controlled trial was conducted in the neonatal intensive care unit of a public hospital in Turkey (Clinical Trial Number: NCT05815706). The sample consisted of 65 preterm infants randomized into a control (n = 32) and an experimental (n = 33) group. The experimental group participants were SFTD-fed until they switched to exclusive breastfeeding. The control group participants were fed according to the routine procedure. Data were collected using a questionnaire, a Preterm Infant Monitoring Form, and the LATCH Breastfeeding Assessment Tool. The data were analyzed using numbers, percentage distributions, means, standard deviations, Pearson's chi-square test, and independent samples t-test. The study was approved by an Ethics Committee. Permission was obtained from the hospital. Informed consent was obtained from all parents. Results: The experimental group (123.64 ± 63.25 hours) demonstrated an earlier transition to exclusive breastfeeding compared with the control group (187.50 ± 95.30 hours) (p < 0.05). The experimental group (361.45 ± 110.46 hours) had significantly shorter hospital stays than the control group (479.25 ± 163.17 hours). The experimental group (35.33 ± 1.14 weeks) had a significantly younger gestational age at discharge than the control group (35.97 ± 1.03 weeks). Conclusion: The SFTD is an alternate supportive feeding method that helps preterm infants switch to exclusive breastfeeding sooner, have shorter hospital stays, and have a younger gestational age at discharge than their bottle-fed counterparts.

Readmissions in Sepsis Survivors: Discharge Setting Risks.

Sepsis is a complex condition with high morbidity and mortality. Prompt treatment can improve survival, but for survivors the risk of deterioration and readmission remains high. Little is known about the association between discharge setting and readmission among sepsis survivors. To examine 30-day hospital readmission rates in adult sepsis survivors by the type of setting to which patients were discharged. The Medical Information Mart for Intensive Care database was used to identify adult sepsis survivors and evaluate 30-day readmission by discharge setting. A χ2 contingency analysis was used with each factor and presence/absence of readmission. The Kruskal-Wallis test was used to compare readmissions across discharge settings. From our sample (N = 7107; mean age 66.5 years; 46.2% women), 23.6% (n = 1674) were readmitted within 30 days and of those readmitted, 30% were readmitted between 1 and 3 times. Discharge setting (P < .001) and age (P = .02) were significantly associated with readmission, but sex, ethnicity, and insurance type were not. High numbers of readmissions were seen in patients discharged to skilled nursing facilities (29.6%), home health care (26.9%), and home (15.0%). Similar high comorbidity burden and acuteness of illness were seen in patients discharged to these settings. Sepsis survivors discharged to skilled nursing facilities, home health care, and home are at high risk for 30-day readmission. The rates of readmission from home health care and home settings were alarming. Often patients are discharged to inappropriate settings, placing them at risk for residual sepsis and readmission. Future research should focus on appropriate timing of hospital discharge and transition to the most appropriate discharge setting.

Prescription Patterns in Management of Heart Failure and Its Association With Readmissions: A Retrospective Analysis

BackgroundThe American Heart Association/American College of Cardiology/Heart Failure Society of America recently added sodium-glucose cotransporter-2 inhibitors in addition to renin–angiotensin–aldosterone system inhibitors, beta-blockers, and mineralocorticoid receptor antagonists to form the 4 pillars of guideline-directed medical therapy (GDMT) for the management of heart failure with reduced ejection fraction (HFrEF). Despite strong evidence suggesting improved outcomes with inpatient initiation of GDMT at target doses, significant lag has been noted in prescription practices. We sought to study GDMT prescription rates in patients with HFrEF at the time of hospital discharge and evaluate its association with various patient characteristics and all-cause readmission rates. Methods and ResultsWe used a modified version of Heart Failure Collaboratory (HFC) score to characterize patients into 2 groups (those with an HFC score of <3 and an HFC score of ≥3) and to examine various socioeconomic and biomedical factors affecting GDMT prescription practices. Out of the eligible patients, the prescription rates for beta-blockers was 77.9%, renin–angiotensin–aldosterone system inhibitor was 70.3%, and mineralocorticoid receptor antagonists was 41%. Furthermore, prescription rates for sacubitril/valsartan was 27.7% and sodium-glucose cotransporter-2 inhibitors was 17%. Only 1% of patients had an HFC score of 9 (drugs from all 4 classes at target doses). Patients of black ethnicity, those admitted on teaching service and those with HFrEF as the primary cause of admission were more likely to have an HFC of ≥3 at discharge. An HFC of ≥3 was associated with lower rates of 1-month all-cause readmissions. ConclusionsConsistent with the prior research, our data show significant gaps in prescription of GDMT in HFrEF. Further implementation research should be done to improve GDMT prescription during inpatient stay.

Changes in snow‐dominated streamflow quantity and timing following an extensive wildfire in British Columbia

AbstractThe length and frequency of extreme fire weather has increased across the globe in recent decades, with potential deleterious consequences to streamflow quantity, timing and quality. Changes in the hydrologic regime following wildfire can have substantial downstream consequences, affecting communities and ecosystems through flooding, erosion, loss of habitat and degraded water quality. While there are many studies that address post‐wildfire hydrology across the globe, there are few studies in the snow‐dominated regions. The 2017 Elephant Hill wildfire in south‐central BC burned across or adjacent to four watersheds with long‐term streamflow gauges providing a rare opportunity to evaluate hydrologic change. Several approaches were used to identify patterns of change following the wildfire, all of which suggest increased post‐fire flows. The before‐after‐control‐impact design showed significant increases in annual, spring and summer water yield from the small (49 km2) Arrowstone Creek watershed (30%, 21% and 86%, respectively). Significant increases in spring water yield were observed in the larger (5318 km2) Bonaparte River watershed (48%). Annual and summer water yield increased in the Bonaparte River (31% and 58%, respectively) but these changes were not statistically significant. In both the Bonaparte River and Arrowstone Creek, the onset of spring freshet (26 days earlier in both) was significantly advanced, however, the timing of maximum snowmelt discharge was significantly advanced (27 days earlier) only in Arrowstone Creek. Smaller changes were also observed in the reference watersheds; however, these were not statistically significant. The difference in results between the small and large watershed, as well as the effects of weather and watershed attributes, highlight the need for continued research into the relationships between wildfire and hydrologic regime across diverse landscapes.