Transfer Decisions Research Articles

Use of artificial intelligence embryo selection based on static images to predict first-trimester pregnancy loss

Research questionCan an artificial intelligence (AI) embryo selection assistant predict the incidence of first trimester spontaneous abortion (SA) using static images of IVF embryos? DesignIn a blind, retrospective study, a cohort of 172 blastocysts from IVF cases with single embryo transfer and a positive biochemical pregnancy test was retrospectively ranked by the AI morphometric algorithm ERICA™. Making use of static embryo images from a light microscope, each blastocyst was assigned one of four possible groups (Optimal, Good, Fair, Poor), and linear regression was used to correlate the results with the presence or absence of a normal fetal heart rate (FHR) as an indicator of ongoing pregnancy or SA, respectively. Additional analyses included modelling for recipient age and chromosomal status established by preimplantation genetic testing (PGT-A). ResultsEmbryos grouped as Optimal/Good had a lower incidence of SA (16.1%) compared to embryos classified as Fair/Poor (25%, P=0.005, Odds ratio (OR)=0.46). The incidence of SA in chromosomally normal embryos (determined by PGTA) was 13.3% for Optimal/Good embryos and 20.0% for Fair/Poor embryos, although this difference was not statistically significant (P=0.531). There was a significant association between embryo rank and recipient age (P=0.018) in that the incidence of SA was unexpectedly lower in older recipients (21.3% in ≤35, 17.9% in 36-38, 16.4% in ≥39, P=0.0181, OR=0.354). Overall, these results support a correlation between risk of SA and embryo rank as determined by AI; the classification accuracy was calculated to be 67.4%. ConclusionsThis preliminary study suggests that AI (ERICA™), which was designed as a ranking system to assist with embryo transfer decisions and ploidy prediction, might also be useful in providing information for couples on the risk of SA. Future work will include larger sample size and karyotyping of miscarried pregnancy tissue.

Telephone versus video consultations: A systematic review of comparative effectiveness studies and guidance for choosing the most appropriate modality.

This systematic review compared clinical, service and cost effectiveness of telephone consultations (TC) to video consultations (VC). We searched Embase, CINAHL and MEDLINE for empirical studies that compared TC to VC using clinical, service or economic outcome measures. Clinician or patient preference and satisfaction studies were excluded. Findings were synthesised descriptively. A total of 79 articles were included. The most effective modality was found to be VC in 40 studies (50%) and TC in 3 (4%). VC and TC were found to be equivalent in 28 of the included articles (35%). VC were superior or equivalent to TC for all clinical outcomes. When compared to TC, VC were likely to have better patient engagement and retention, to improve transfer decisions, and reduce downstream sub-acute care utilisation. The impact of telehealth modality on consultation time, completion rates, failure-to-attend rates and acute care utilisation was mixed. VC were consistently found to be more cost effective despite having a higher incremental cost than TC. Our systematic review demonstrates equal or better, but not inferior clinical and cost outcomes for consultations delivered by VC when compared to TC. VC appear to be more clinically effective when visual information is required, when verbal communication with the patient is impaired and when patient engagement and retention is linked to clinical outcomes. We have provided conditions where VC should be used in preference to TC. These can be used by clinicians to guide the choice of telehealth modality. Cost effectiveness is also important to consider when choosing modality.

Optimizing patient transitions to skilled nursing facilities

Hospital inpatient care costs is the largest component of health care expenditures in the US. At the same time, the number of non-hospital rehabilitative settings, such as Skilled Nursing Facilities (SNFs), has increased. Lower costs and increased availability have made SNFs and other non-hospital rehabilitation settings a promising care alternative to hospitalization. To maximize their benefits, transitions to SNFs require special attention, since poorly coordinated transitions can lead to worse outcomes and higher costs via unnecessary hospital readmissions. This study presents a framework to improve care transitions based on the premise that certain SNFs may provide better care for some patients. We estimate 30-day readmission rates by SNF and patient types using observational data from a tertiary teaching hospital and nearby SNFs. We then analyze and solve a stochastic model optimizing patient transfer decisions to minimize 30-day readmissions. Our model accounts for patient discharge patterns and SNF capacity availability. We provide conditions for when an easy-to-use myopic policy, which assigns discharged patients to the SNF with the lowest readmission rate that is available, is optimal. We also show when an optimal policy has a threshold-like structure. Using estimated readmission rates, we compare the performance of the myopic policy and a proposed policy that depends on the discharge process, readmission rates, and future SNF availability. We evaluate when the myopic policy may be beneficial to use and when the proposed transfer heuristic provides a better alternative. Otherwise, we contend that using a stochastic optimization model for guiding transfer decisions may help reduce readmissions.

Two-stage recoverable robust optimization for an integrated location–allocation and evacuation planning problem

We consider an integrated location–allocation and evacuation planning problem in a disaster context, where the effects of a disaster, including the uncertain capacities of relief facilities (rescue centers and distribution centers), uncertain demands for relief supplies and casualty treatment services, and uncertain availability of transportation links are characterized by a discrete scenario set. Instead of complete failures, we allow the disrupted relief facilities only lose part of their capacity. To deal with the uncertainties, we propose a two-stage recoverable robust optimization model, where the location decision of relief facilities, the allocation decision of delivering relief supplies from relief facilities to affected areas, the transfer decision of transporting casualties from affected areas to rescue centers etc are defined in two stages where the first-stage solution should be robust against the possible effects of a disaster that are revealed in the second stage, and the second-stage solution involves some recovery actions, which we term as multi-mitigation strategies: re-opening and re-operation, re-allocation, and relief supply sharing, to mitigate the effects. To solve the model to optimality, we develop a nested two-stage decomposition algorithm that iterates between a master problem considering only a subset of disaster scenarios solved by a Benders decomposition algorithm that incorporates some non-trivial acceleration strategies, and an adversarial separation problem that identifies disaster scenarios to enhance the worst-case recovery cost of the master problem. We introduce some warm-start techniques to accelerate the convergence of the solution algorithm. We conduct numerical studies on simulation instances to assess the performance of the solution algorithm, and analyze the robustness and recoverability of the model. We also conduct extensive numerical studies on realistic instances from Ya’an and Ganzi to demonstrate the benefits of accounting for recoverable robustness over a stochastic policy and a robust policy without recovery actions, the benefits of considering integrated optimization over sequential optimization, and the benefits of considering partial capacity loss and multi-mitigation strategies.

A forecasting tool for a hospital to plan inbound transfers of COVID-19 patients from other regions

BackgroundIn April 2021, the province of Ontario, Canada, was at the peak of its third wave of the COVID-19 pandemic. Intensive Care Unit (ICU) capacity in the Toronto metropolitan area was insufficient to handle local COVID patients. As a result, some patients from the Toronto metropolitan area were transferred to other regions.MethodsA spreadsheet-based Monte Carlo simulation tool was built to help a large tertiary hospital plan and make informed decisions about the number of transfer patients it could accept from other hospitals. The model was implemented in Microsoft Excel to enable it to be widely distributed and easily used. The model estimates the probability that each ward will be overcapacity and percentiles of utilization daily for a one-week planning horizon.ResultsThe model was used from May 2021 to February 2022 to support decisions about the ability to accept transfers from other hospitals. The model was also used to ensure adequate inpatient bed capacity and human resources in response to various COVID-related scenarios, such as changes in hospital admission rates, managing the impact of intra-hospital outbreaks and balancing the COVID response with planned hospital activity.ConclusionsCoordination between hospitals was necessary due to the high stress on the health care system. A simple planning tool can help to understand the impact of patient transfers on capacity utilization and improve the confidence of hospital leaders when making transfer decisions. The model was also helpful in investigating other operational scenarios and may be helpful when preparing for future outbreaks or public health emergencies.

Abstract 129: An Automated Perfusion Collateral Score as a Tool to Predict Inter-Hospital Infarct Growth and Functional Outcome

Background: The accuracy of infarct growth prediction based on collateral scores, assessed on CT perfusion (CTP) and CT angiography, has been modest. We aimed to investigate the accuracy of infarct growth prediction using a novel collateral score based on two CTP parameters. Methods: Patients were included from CRISP2, a multi-center prospective cohort study of stroke patients with an anterior circulation large vessel occlusion who are transferred from a primary stroke center (PSC) to a comprehensive stroke center (CSC). CTP was performed at the PSC, and MRI was performed immediately after arrival at the CSC. The inter-hospital infarct growth rate was calculated as the difference between the co-registered infarct volumes on MRI and CTP divided by the time interval between the scans, with fast inter-hospital growth ≥ 5ml/h. The hypoperfusion intensity ratio (HIR) was defined as the ratio of the volumes of Tmax >6s and Tmax >10s, and the CBV index as the ratio of mean CBV values within the Tmax >6s volume and the mean CBV in normal brain regions. An automated collateral score, based on the HIR and CBV index, was calculated from the CTP images at the PSC ( Fig 1A ). Results: Of 183 patients who were included, 111 (61%) were classified as having good collaterals and 72 (39%) as poor. Patients with poor collaterals experienced more rapid early infarct growth (median 2.19 ml/h IQR [0.32, 5.46] vs 7.92 [4.23, 16.23]; p-value <0.001) and had worse 90-day functional outcomes (p=0.01). The combined collateral score, based on both HIR and CBVindex, showed a trend towards better prediction of fast infarct growth compared to HIR alone (HIR ≥ 0.40 = poor collaterals) and CBV alone (CBVindex < 0.85 = poor collaterals) ( Fig 1B ). Conclusion: A perfusion collateral score, based on HIR and CBV index, is strongly associated with inter-hospital infarct growth rate and functional outcome. This automated tool can aid in patient selection for (neuroprotective) treatment strategies and transfer decisions.

How to promote knowledge transfer within R&D team? An evolutionary game based on prospect theory

Knowledge transfer is the basis for R&D teams and enterprises to improve innovation performance, win market competition and seek sustainable development. In order to explore the path to promote knowledge transfer within the R&D team, this study considers the bounded rationality and risk preference of individuals, incorporates prospect theory into evolutionary game, constructs a perceived benefits matrix distinct from the traditional benefits matrix, and simulates the evolutionary game process. The results show that, R&D personnel’s knowledge transfer decisions depend on the net income difference among strategies; only if perceived cost is less than the sum of perceived synergy benefit, perceived organization reward value, and perceived organization punishment value, can knowledge be fully shared and transferred within the R&D team. Moreover, R&D personnel’s knowledge transfer decisions are interfered by the irrational psychological factors, including overconfidence, reflection, loss avoidance, and obsession with small probability events. The findings help R&D teams achieve breakthroughs in improving the efficiency of knowledge transfer, thereby enhancing the capacity of enterprises for collaborative innovation.

Compensatory advantage after the first year at university in the Catalan system: between continuing, transferring and dropping out

ABSTRACT Abundant research has shown the influence of social background on university dropout. However, there is little research that considers the different progression options for analysing the structure of the decisions that students make. This article explores the possible alternative decisions of: (1) continuing the initial degree course chosen; (2) persisting but transferring to other degrees or institutions; (3) dropping out of university. To this effect, we seek whether the decision structure follows a compensatory advantage pattern, according to which poor performance during the first year at university unequally affects students from low and high social backgrounds. The latter compensates for poor results by using alternative strategies to minimise the negative consequences. We analyse longitudinal data from a cohort of students entering any on-site university in the Catalan system in 2012–13 (n = 36909). The results show the importance of performance in predicting university progression decisions. No differences by social origin are perceived in the decisions to continue the same course of study, while differences are observed in dropout and transfer decisions which, for their part, follow a compensatory advantage structure. The results show the need to consider the interaction between performance and social background, and to broaden our view of students’ trajectories.

Defining pediatric trauma center resource utilization: Multidisciplinary consensus-based criteria from the Pediatric Trauma Society.

Pediatric trauma triage and transfer decisions should incorporate the likelihood that an injured child will require pediatric trauma center (PTC) resources. Resource utilization may be a better basis than mortality risk when evaluating pediatric injury severity. However, there is currently no consensus definition of PTC resource utilization that encompasses the full scope of PTC services. Consensus criteria were developed in collaboration with the Pediatric Trauma Society (PTS) Research Committee using a modified Delphi approach. An expert panel was recruited representing the following pediatric disciplines: prehospital care, emergency medicine, nursing, general surgery, neurosurgery, orthopedics, anesthesia, radiology, critical care, child abuse, and rehabilitation medicine. Resource utilization criteria were drafted from a comprehensive literature review, seeking to complete the following sentence: "Pediatric patients with traumatic injuries have used PTC resources if they..." Criteria were then refined and underwent three rounds of voting to achieve consensus. Consensus was defined as agreement of 75% or more panelists. Between the second and third voting rounds, broad feedback from attendees of the PTS annual meeting was obtained. The Delphi panel consisted of 18 members from 15 institutions. Twenty initial draft criteria were developed based on literature review. These criteria dealt with airway interventions, vascular access, initial stabilization procedures, fluid resuscitation, blood product transfusion, abdominal trauma/solid organ injury management, intensive care monitoring, anesthesia/sedation, advanced imaging, radiologic interpretation, child abuse evaluation, and rehabilitative services. After refinement and panel voting, 14 criteria achieved the >75% consensus threshold. The final consensus criteria were reviewed and endorsed by the PTS Guidelines Committee. This study defines multidisciplinary consensus-based criteria for PTC resource utilization. These criteria are an important step toward developing a criterion standard, resource-based, pediatric injury severity metric. Such metrics can help optimize system-level pediatric trauma triage based on likelihood of requiring PTC resources. Diagnostic Test/Criteria; Level II.

How do socioeconomic differentiation and rural governance affect households' land transfer decisions? Evidence from China

AbstractIn rural areas, social and economic differentiation profoundly impact rural development patterns, which, in return, impacts rural village social and economic structures and the land transfer decisions of rural households residing within the village. Research on agricultural land transfer has rarely been discussed under the lens of the differentiated socioeconomic structure of rural villages, as well as rural governance capacities. This paper contributes to the existing body of research on the determinants of rural land transfer by examining the role of village socioeconomic differentiation and rural governance based on a quantitative analysis of factors at different scales. The results show that: (1) compared with clan‐based unity structure, kinship‐based split structure and dispersed structure have a positive effect on household land out‐transfer and a negative effect on land in‐transfer. (2) The homogeneity of residents had a negative impact on out‐transfer, while the financial revenue of the village had significant positive influences on households' out‐transfer. (3) The higher the trust in cadres and the evaluation of the local government, the greater the tendency of households to transfer land in, but none of this effect is significant. (4) The socialized agricultural services and the share of non‐farm have significant effects on land transfer. Moreover, households with better geographical conditions, such as those near the county capital and towns, are more likely to transfer their land out. These findings offer significant insights for the management of agricultural scale and the revitalization of rural areas in China, while also offering valuable ideas for the implementation of differentiated agricultural control and rural governance policies in other countries.

Dissemination of public health research evidence and guidelines to Australian Early Childhood Education and Care staff: Views about source, content and format.

Effective dissemination of public health research and evidence-based guidelines to Early Childhood Education and Care (ECEC) staff is critical for promoting research transfer and uptake and achieving positive outcomes for children. A cross-sectional study was conducted during August 2021 to March 2022, with a sub-sample of Australian ECEC services participating in a larger survey completed online and via Computer-Assisted Telephone Interview. Survey items assessed: influential source for receiving research, type of content that would influence decisions to adopt research and preferred formats for receiving research. Overall, 993 service managers or staff from 1984 (50.0%) invited and eligible services completed the larger survey. Of these, 463 randomly allocated services (46.7%) had staff complete the dissemination items. The Australian Children's Education and Care Quality Authority, ECEC agencies and Government Departments were most frequently selected as influential sources of research evidence. Staff were most interested in content providing evidence-based recommendations for future actions and descriptions of health issues addressed. Workshops or conferences and webinars were the preferred format for receiving research. Findings highlight the importance of tailoring dissemination strategies to meet ECEC staff needs and engaging influential sources to disseminate research evidence. SO WHAT?: Understanding dissemination preferences of ECEC staff is crucial for supporting uptake of evidence-based health promotion in this setting. By developing tailored strategies based on ECEC preferences, research transfer and evidence-based decision making can be supported more effectively. These findings contribute to bridging the evidence-practice gap and improving the quality of care and health outcomes for children in ECEC settings.

Transferring With TACT: A Novel Tool to Standardize Transfer Decisions From a Level IV NICU: Erratum.

Transferring With TACT: A Novel Tool to Standardize Transfer Decisions From a Level IV NICU: Erratum.

Money matters: How social class shapes students’ understandings of financing their education

Higher education is increasingly expensive, and access disparities by race and social class exist. Yet, we lack nuance in the scholarly literature about students’ understandings of how they finance their college education. We examine how class-based differences influence how students finance college education. We draw on concepts from economic sociology and sensemaking to examine how class backgrounds shape students’ meaning-making of finance and funding their college education. Through interviews with 56 community college students, we examine what money means to students and how that varies across classes, with implications for transfer decisions and outcomes. We surface important implications for students’ behaviors and decisions in college.

Transfer of Minors to Adult Court in California: Investigating the Legal/Demographic Factors that Make the Difference.

In light of California's passage of Proposition 57 in 2016, the present study examined the relationship between legal/demographic variables and decisions to transfer juveniles to the adult court system. Following Prop 57, transfer decisions were entrusted solely with judges and prosecutors could no longer direct file. We used a sample of 106 reports written by forensic psychologists on behalf of the defense examining the life circumstances of minors who allegedly committed serious crimes. Close to two-thirds of minors were kept in the juvenile system whereas the rest were transferred. Utilizing regression analysis, we found that minors with at least one murder charge were more likely to end up in adult court. In regards to race, we detected an overall considerable overrepresentation of Black and Latino juveniles and an underrepresentation of Whites with charges against them but no support of racial bias in transfer decisions in our restricted data set.

Statewide availability of acute stroke treatment, services, and programs: A survey of North Carolina Hospitals

IntroductionWe conducted a statewide assessment of the availability of stroke treatment, services, and programs in North Carolina (NC) hospitals. We also examined differences in stroke care capabilities between urban, suburban, and rural hospitals and trends over the past 2 decades. MethodsAn electronic survey was distributed to all 111 licensed hospitals in NC. Survey questions asked about stroke center certification status (i.e., standardized levels of stroke care capabilities), diagnostic testing, acute treatments and protocols, and post-acute management. Responses were collected from October 2020-April 2021. Select characteristics were compared to those from prior NC surveys in 1998, 2003, and 2008. ResultsAll 111 hospitals responded to the survey (100% response rate). Among 108 hospitals providing acute stroke care, 12 (11%) were Comprehensive Stroke Centers or Thrombectomy-Capable Stroke Centers, which were all located in urban or suburban areas. While 38% of urban/suburban hospitals were non-certified, 48% of rural hospitals were non-certified. Non-contrast computed tomography (CT), CT angiography, and alteplase treatment were widely available (100%, 95%, and 99%, respectively). Endovascular thrombectomy was solely available in urban/suburban hospitals (29%). Of non-tertiary hospitals, 81% were using telestroke for treatment and transfer decisions. Compared to prior survey results, the availability of CT angiography (76% in 2008 to 95% in 2020-2021), alteplase treatment (69% in 2008 to 99% in 2020-2021), and acute stroke clinical pathways (47% in 2008 to 90% in 2020-2021) increased. However, having an in-house neurologist on staff dropped from approximately 55% in prior surveys to 21% in the current survey. ConclusionsRural NC hospitals were less likely to have advanced diagnostic imaging and treatment capabilities for acute stroke. Temporal trends in staffing with an in-house neurologist and use of telestroke services should be further examined.

Examining the Use of Text Messages Among Multidisciplinary Care Teams to Reduce Avoidable Hospitalization of Nursing Home Residents with Dementia: Protocol for a Secondary Analysis.

Reducing avoidable nursing home (NH)-to-hospital transfers of residents with Alzheimer disease or a related dementia (ADRD) has become a national priority due to the physical and emotional toll it places on residents and the high costs to Medicare and Medicaid. Technologies supporting the use of clinical text messages (TMs) could improve communication among health care team members and have considerable impact on reducing avoidable NH-to-hospital transfers. Although text messaging is a widely accepted mechanism of communication, clinical models of care using TMs are sparsely reported in the literature, especially in NHs. Protocols for assessing technologies that integrate TMs into care delivery models would be beneficial for end users of these systems. Without evidence to support clinical models of care using TMs, users are left to design their own methods and protocols for their use, which can create wide variability and potentially increase disparities in resident outcomes. Our aim is to describe the protocol of a study designed to understand how members of the multidisciplinary team communicate using TMs and how salient and timely communication can be used to avert poor outcomes for NH residents with ADRD, including hospitalization. This project is a secondary analysis of data collected from a Centers for Medicare & Medicaid Services (CMS)-funded demonstration project designed to reduce avoidable hospitalizations for long-stay NH residents. We will use two data sources: (1) TMs exchanged among the multidisciplinary team across the 7-year CMS study period (August 2013-September 2020) and (2) an adapted acute care transfer tool completed by advanced practice registered nurses to document retrospective details about NH-to-hospital transfers. The study is guided by an age-friendly model of care called the 4Ms (What Matters, Medications, Mentation, and Mobility) framework. We will use natural language processing, statistical methods, and social network analysis to generate a new ontology and to compare communication patterns found in TMs occurring around the time NH-to-hospital transfer decisions were made about residents with and without ADRD. After accounting for inclusion and exclusion criteria, we will analyze over 30,000 TMs pertaining to over 3600 NH-to-hospital transfers. Development of the 4M ontology is in progress, and the 3-year project is expected to run until mid-2025. To our knowledge, this project will be the first to explore the content of TMs exchanged among a multidisciplinary team of care providers as they make decisions about NH-to-hospital resident transfers. Understanding how the presence of evidence-based elements of high-quality care relate to avoidable hospitalizations among NH residents with ADRD will generate knowledge regarding the future scalability of behavioral interventions. Without this knowledge, NHs will continue to rely on ineffective and outdated communication methods that fail to account for evidence-based elements of age-friendly care. DERR1-10.2196/50231.

Helicopter Ambulance Transport to the Emergency Department: Demographic and Clinical Factors Impacting Outcomes in a Turkish Medical Center.

BACKGROUND Helicopter ambulances (HAs) are a significant component of pre-hospital emergency medical services. This study presents a report on the demographic and clinical factors associated with transport to the emergency department (ED) by HA of 161 patients to a single center in Turkey. MATERIAL AND METHODS Demographic data, diagnoses in arriving center's ED, transferred distance, and outcomes of 161 patients transferred by HAs between March 01, 2019 and May 31, 2021 were retrospectively evaluated. Mortality rates of the cases were compared both with age and according to the distance traveled within the diagnostic groups. RESULTS There were 134 patients (83.2%) with internal diseases, and cardiovascular diseases were the leading cause (68 patients, 41.6%); 27 patients (16.7%) were transferred due to trauma. The mean distance traveled with HAs was 167.1 km (range, 47.0-1316.0) and the median transfer time was 50 min. The most common form of hospitalization after ED arrival was intensive care hospitalization (n=78, 48.4%). Mortality increased as the transfer distance increased in elderly patients, as well as those with a cardiac or trauma-related diagnosis (P=0.015, P=0.044, P=0.028, respectively). CONCLUSIONS Most patients transferred by HA had severe disease. ED physicians dealing with patient transfer by HAs should be prepared for severe cases, both in the HA and in the ED. HAs may be preferred when making the transfer decision for elderly patients, trauma patients, and those with cardiac disease.

In-Hospital Acute Ischemic Stroke Case Fatality: Experience from a University Hospital in Bogota, Colombia (2018-2019).

Introduction Until 2020, stroke was the second cause of death in Colombia and worldwide. In-hospital case fatality accounts for the majority of deaths. Multiple risk factors for in-hospital mortality have been described in the stroke population and their recognition could reduce stroke-related death. Aims To describe a single center experience of in-hospital acute ischemic stroke case fatality and its risk factors. Methodology Single center, retrospective, cross-sectional study between august 2018 and august 2019. Admitted consecutive patients with acute ischemic stroke brain infarct type were included. Admission sociodemographic, clinical, laboratory and imaging studies variables were drawn out. Quantitative variables were summarized as means, medians and interquartile ranges. Bivariate analysis was used to evaluate associations of in-hospital stroke case fatality and imputed variables. Results 402 stroke brain infarct type patients were included, mean age 73,28 years (SD±14,53), 50,4% men. Prevalent vascular risks factors were hypertension (70,90%), diabetes mellitus type 2 (24,13%) and previous stroke (20,90%). There were 13 (3,2%) in-hospital case fatalities. Mean time from admission to death was 11.38 days (SD±10,8). Lower hemoglobin levels (p=0.002), lower total, LDL and HDL serum cholesterol levels (p=0.02), internal carotid artery stenosis >50% by duplex ultrasound (p=0.01) and stroke severity as measured by NIHSS score (p<0,0001) showed association with in-hospital stroke case fatality. Conclusions NIHSS score, hemoglobin level, and cholesterol (total, LDL, HDL) levels upon admission may be used by clinicians to make the appropriate early transfer decisions to facilities with the capacity to offer advance in-hospital stroke care. The cholesterol paradox in acute stroke fatality warrants further studies.

Intensive Care Unit Transfer Decisions—Science or Art?

Intensive Care Unit Transfer Decisions—Science or Art?

Family carers' experiences regarding patient transfers between care settings in palliative care: an interview study.

To understand how family carers experienced the illness trajectory of their next of kin related to transfers taken place between care settings in palliative care, their experiences and attitude regarding the transfer decision and their experiences regarding patient transfers across settings. Semi-structured interviews were held with 21 family carers. A constant comparative approach was used to analyze data. Three themes were identified after data analysis: (I) patient transfer dynamics, (II) experiences regarding the changed care environment and (III) impact of the transfer on the family carer. The dynamics of the patient's transfer were affected by the balance between the care provision (professional and informal care) and the changes in the patient's needs. Experiences regarding patient transfers strongly varied depending on the setting and were based on the personnel's conduct and the quality of receiving information. Study results revealed shortcomings in perceived inter-professional communication and continuity of information during a patient's hospitalization. Concomitant feelings of relief, anxiety or feeling insecure could arise in situations of a patient's transfer. This study highlighted the adaptability of family carers when caring for their next of kin with palliative care needs. To support carers in coping with their role as caregivers and to share the responsibility of caregiving, involved healthcare professionals should timely evaluate family carers' preferences and needs and adapt the care organization accordingly. A pro-active attitude, which anticipates on the possibility of an impending decompensation of the family carer, is recommended. When the decision for a patient's transfer is taken, multiple factors influenced the choice of the care setting. Healthcare professionals need to take these factors into account when discussing, with patients and carers, the need for a transfer. Continuity of information can be improved. Further development and evaluation of interventions, aimed at improving informational continuity can be recommended.