Hospital Visits Research Articles

FP1.10 - Functional Outcomes of a Standard vs Modified Brooke Ileostomy – A Quality of Life Study

Abstract Aim Previous studies have shown that IBD patients with a modified Brooke ileostomy, where there is retention of the ileocolic sphincter, may have improved stoma function by preserving a functional high pressure zone. This study aims to review functional outcomes through a patient-reported quality of life survey. Methods This cohort study was conducted across two sites, one performing Standard Brooke Ileostomy (SBI), and the other Modified Brooke Ileostomy (MBI), as standard practice. Patients with diagnosis of colitis were identified from a prospectively collected database. A stoma activity log and a validated stoma Quality of Life survey (PRATO) was sent, with 23 responses obtained (14 MBI, 9 SBI). Activity log included bag emptying, hours of interrupted sleep, and number of visits to stoma nurse. Results For QoL survey (minimum score 20, max 80), patients with MBI scored higher (mean 55.36), compared to SBI (mean 48.22), (p=0.037). Bag emptying over 24 hours was similar (MBI mean 5.71, SBI mean 5.86), as was bag emptying overnight (MBI mean 1 (range 0-3), SBO mean 1 (range 1-2). MBI patients reported longer mean uninterrupted sleep (7.07 hours vs 5.43 hours (p=0.005)). MBI patients required fewer stoma nurse visits in the first year (mean 5.3, median 5, range 0-13). SBI (mean 10.7, median 10, range 2-33). Conclusion A practice of Modified Brooke Ileostomy has comparable patient reported quality of life outcomes to a standard Brooke Ileostomy and performs better overall in terms of less interruption to sleep and lower disruption of daily life through hospital visits.

Factors Of Accidental Falls Among In Elderly Living Alone In Phetchaburi Province Thailand

This research was to study the factors of accidental falls among elderly living alone. The researcher conducted a mixed methods research (Mixed Methods Research) to study factors affecting the incidence of falls and falls in elderly people who live alone. The research results found that Factors that result in falls and falls in elderly people who live alone. Phetchaburi Province has a total of 5 main factors and 24 sub-factors, consisting of main physical factors. Sub-factors were eye disease (p = 0.001, β =1.063), osteoarthritis (p = 0.001, β = 0.955), urinary system intelligence (p = 0.001, β =1.588), frequently going to the bathroom at night (p = 0.001, β =1.236) Congenital disease (p = 0.001, β = 1.638) Regular hospital visits (p = 0.001, β = 1.494) Main behavioral factors Sub-factors include taking medicine to treat chronic diseases (p = 0.001, β = 2.959), using alcoholic beverages (p = 0.001, β = 4.014), not exercising (p = 0.001, β = 5.350), wearing comfortable shoes. Inappropriate (p = 0.001, β = 2.723) Inappropriate clothing (p = 0.001, β = 3.574) Main environmental factors Sub-factors: regularly using stairs (p = 0.001, β = 3.354), two-story house (p = 0.001, β = 4.571), split-level house (p =0.001, β = 2.296), light switch not nearby. mattress (p = 0.001, β =2.363) main economic and social factors The sub-factor was frequently attending social events (p = 0.001, β = 6.633), missing home visits from the health service unit (p = 0.001, β = 3.916). The main factor was caregiver. The sub-factor is living with offspring (p = 0.001, β = 6.019 ) and having to live alone (p =0.001, β = 1.002 ).

Assessing Response Rates and Sleep Disorder Prevalence: Insights from a Propranolol Treatment Study for Infantile Haemangiomas.

Infantile haemangiomas (IHs) sometimes require treatment with propranolol. Sleep disturbances are the most frequently reported side effects. Monitoring adverse drug events necessitates repeated hospital visits, which can be challenging during a pandemic. To explore the effectiveness of a new electronic questionnaire in identifying sleep disturbances related to treatment with propranolol and potential confounding factors. To evaluate the response rate to the questionnaire. To report the proportion of patients on propranolol with sleep disturbances. In an observational, prospective cohort study, caregivers provided clinical information during ambulatory visits and via an electronic questionnaire after an 8-week treatment course with propranolol and at the time of treatment interruption. Adverse drug reaction reporting forms were assessed for causality. The questionnaire response rate was 91%, and the completion rate was 100%. A total of 59% of patients experienced sleep disturbances during propranolol treatment, which were considered adverse reactions. Sleep disorders were frequent during sleep regression phases and in subjects who fell asleep during physical contact with caregivers or bed-sharing with parents. The application of this questionnaire allows for identifying adverse sleep events associated with propranolol in IHs and potential confounders. Counselling on sleep hygiene is recommended before treatment onset.

Women’s economic empowerment and intimate partner violence

This study explores the relationship between women’s economic empowerment and intimate partner violence (IPV), measured as women’s hospital visits for assault. Using longitudinal Swedish administrative data, I proxy women’s economic empowerment with a measure of potential relative earnings of married spouses caused by local changes in gender-specific labour demand. The findings reveal that an increase in potential relative earnings increases the probability of women’s hospital visits for injuries caused by assault, and the effect is particularly pronounced for women with low baseline bargaining power. Furthermore, exploiting detailed information on type of hospital visit, diagnosis and medical actions taken at the hospital, I show that the increase in hospital visits for assault is, at least in part, driven by an increase in care-seeking for IPV-related injuries rather than an increase in IPV itself.

Impact of family doctor system on diabetic patients with distinct service utilisation patterns: a difference-in-differences analysis based on group-based trajectory modelling

IntroductionThis study examines the impact of China’s family doctor system (FDS) on healthcare utilisation and costs among diabetic patients with distinct long-term service utilisation patterns.MethodsConducted in City A, eastern China,...

Human echinococcosis incidence in Canada: A retrospective descriptive study using administrative hospital and ambulatory visit data, 2000-2020.

Echinococcosis is a zoonotic disease caused by the ingestion of tapeworm eggs shed by canids. The potential recent establishment of a more virulent European-type strain may be impacting human echinococcosis in Canada, yet information is limited. Administrative hospital and ambulatory visit data were used to provide a baseline of human echinococcosis cases in Canada between 2000-2020. Canadian Institute of Health Information's Discharge Abstract Database, Hospital Morbidity Database and National Ambulatory Care Reporting System were combined to identify cases. Risk ratios (RR) by demographic factors and cumulative incidences (CIN) over place and time were calculated. A total of 806 echinococcosis cases were identified in Canada between 2000-2020, for a mean annual CIN of 1.3 cases per million population. Over the two decades, the mean annual CIN of cases increased nationally (1.3-1.4 cases per million), in the Northwest Territories (6.3-9.1 cases per million), in Alberta (1.5-2.4 cases per million) and in the Atlantic provinces (0.2-0.6 cases per million). Those from the Territories had the highest risk of echinococcosis (RR 17.1; 95% confidence interval: 8.7-33.7). Though explanations are multifactorial, the new European-type strain may have a role in the small absolute increase in echinococcosis CIN in Canada observed over the study period. The CIN is likely underestimated and the validity of administrative data for analyzing zoonoses warrants investigation. Though this study contributes important awareness and a baseline, improved data are needed to clarify the effects of the new strain and inform public health response.

Immunodeficiency: Burden of Illness.

Immunodeficiency disorders pose substantial burdens on the health-care system and the patients affected. Broadly, immunodeficiencies can be divided into primary immunodeficiency disorders (PIDDs) and secondary immunodeficiency disorders. This review will focus on PIDDs. The overall prevalence for PIDDs is estimated to be ∼1-2% of the population but may be underestimated due to underdiagnosis of these conditions. PIDDs affect males slightly more often than females. The mortality rates differ based on the specific condition but can be extremely high if the condition is left undiagnosed or untreated. The most common causes of death are infections, respiratory complications, and cancers (e.g., lymphoma). Comorbidities and complications include infection, chronic lung disease, granulomatous lymphocytic interstitial lung disease, and autoimmune disorders. The disease burden of patients with common variable immunodeficiency (CVID) is estimated to be greater than patients with diabetes mellitus and chronic obstructive pulmonary disease. PIDDs have a serious impact on the quality of life of the patients, including sleep disturbance, anxiety, and social participation as well as other psychosocial burdens associated with these disorders. The financial cost of PIDDs can be substantial, with the cost of untreated CVID estimated to be $111,053 per patient per year. Indirect costs include productivity loss and time lost due to infusion and hospital visits. Secondary immunodeficiency is not fully discussed in this review but likely contributes equally to the burden of overall immunodeficiency disorders. Management of patients with PIDDs should use a comprehensive approach, including medical, nursing, psychiatric, and quality of life, to improve the outcome.

Sex-based differences in treatment approaches and outcomes among patients with mpox: Limitations of real-world data.

Limited data on females with mpox restricts understanding of potential sex-based disparities in treatment and outcomes. This study aims to investigate these differences using administrative claims and clinical data repositories. We retrospectively analyzed adults diagnosed with mpox using TriNetX, stratifying cohorts by sex. The primary outcome included urgent care, emergency room, and hospitalization visits, with secondary outcomes including clinical findings, vaccination, and treatment. Among 2011 cases, 90% were male. Males were older, more likely to identify as Hispanic or Latino, and had higher HIV prevalence and sexually transmitted infection rates. Hospitalization rates were low for both groups, with similar healthcare utilization. However, males received fewer opioid analgesics, glucocorticoids, and antiemetics versus females. Vaccination and tecovirimat use were minimal in both groups. Addressing sex disparities in mpox treatment and outcomes is crucial, but existing data sources like administrative claims and clinical data repositories pose limitations.

Finerenone in Heart Failure with Mildly Reduced or Preserved Ejection Fraction

BackgroundSteroidal mineralocorticoid receptor antagonists reduce morbidity and mortality among patients with heart failure and reduced ejection fraction, but their efficacy in those with heart failure and mildly reduced or preserved ejection fraction has not been established. Data regarding the efficacy and safety of the nonsteroidal mineralocorticoid receptor antagonist finerenone in patients with heart failure and mildly reduced or preserved ejection fraction are needed.MethodsIn this international, double-blind trial, we randomly assigned patients with heart failure and a left ventricular ejection fraction of 40% or greater, in a 1:1 ratio, to receive finerenone (at a maximum dose of 20 mg or 40 mg once daily) or matching placebo, in addition to usual therapy. The primary outcome was a composite of total worsening heart failure events (with an event defined as a first or recurrent unplanned hospitalization or urgent visit for heart failure) and death from cardiovascular causes. The components of the primary outcome and safety were also assessed.ResultsOver a median follow-up of 32 months, 1083 primary-outcome events occurred in 624 of 3003 patients in the finerenone group, and 1283 primary-outcome events occurred in 719 of 2998 patients in the placebo group (rate ratio, 0.84; 95% confidence interval [CI], 0.74 to 0.95; P=0.007). The total number of worsening heart failure events was 842 in the finerenone group and 1024 in the placebo group (rate ratio, 0.82; 95% CI, 0.71 to 0.94; P=0.006). The percentage of patients who died from cardiovascular causes was 8.1% and 8.7%, respectively (hazard ratio, 0.93; 95% CI, 0.78 to 1.11). Finerenone was associated with an increased risk of hyperkalemia and a reduced risk of hypokalemia.ConclusionsIn patients with heart failure and mildly reduced or preserved ejection fraction, finerenone resulted in a significantly lower rate of a composite of total worsening heart failure events and death from cardiovascular causes than placebo. (Funded by Bayer; FINEARTS-HF ClinicalTrials.gov number, NCT04435626.)

Abstract MP24: Relationship of Socioeconomic Position on Incident Hypertension-related Hospitalization and Blood Pressure Control among participants in the Coronary Artery Risk Development in Young Adults (CARDIA)

Background: Hypertension hospitalization, defined as being admitted to the hospital with a primary diagnosis of hypertension, has been increasing among US adults. Individuals with low socioeconomic position have higher rates of uncontrolled blood pressure (BP). We evaluated the relationship of socioeconomic position on incident hypertension hospitalization and BP control rates following hospitalization. Methods: We analyzed data from CARDIA, a prospective cohort that enrolled 5,115 adults (2,637 self-identified Black and 2,478 White adults) 18 to 30 years old from 4 urban US areas in 1985-1986. Hypertension hospitalizations were ascertained by manual chart review over 34 years of annual follow-up. We compared the incidence rate of hypertension hospitalization and prevalence of uncontrolled BP, systolic/diastolic BP ≥140/90 mm Hg, at the study visit after hospitalization by socioeconomic position. Socioeconomic position included education, income, insurance status and neighborhood deprivation factor score at the last visit before hypertension hospitalization or last CARDIA visit attended for participants who were not hospitalized. Results: Overall, 67 CARDIA participants (1.3%) were hospitalized for hypertension. Participants hospitalized for hypertension had a median age of 47 years at time of hospitaliization, 51% were male, and 87% were Black. Among those hospitalized for hypertension, 12% had less than high school education, 44% had a family income < $25,000, 30% were on Medicaid or Medicare, and 58% lived in a socially deprived neighborhood. The risk of hypertension hospitalization was higher for participants with less education and who lived in more socially deprived neighborhoods ( Table 1 ). At the first study visit following hospital discharge, 67% of participants had uncontrolled BP and there was no difference by socioeconomic position. Conclusion: The incidence rate of hypertension hospitalization was higher among people with low socioeconomic position. Uncontrolled BP was common following hypertension hospitalization.

Impact of COVID-19 Pandemic on Chronic Obstructive Pulmonary Disease Healthcare Use, Exacerbations, and Mortality: A Population Study.

Rationale: Existing work suggests that patients with chronic obstructive pulmonary disease (pwCOPD) presented less frequently to the emergency department and were less likely to be hospitalized during the coronavirus disease (COVID-19) pandemic, but it is unclear if this was due to improved health and disease management or to increased barriers and/or avoidance of health care. Objectives: The objective of this study was to determine the impact of the pandemic on inpatient and outpatient healthcare use, disease incidence, and mortality rates in pwCOPD. Methods: A retrospective population-based analysis using linked administrative datasets from Alberta, Canada 18 months before and after March 12, 2020 was conducted to measure hospitalization, emergency department and outpatient visits, and COPD outpatient exacerbations during these time periods. Mortality data were also analyzed before versus after the pandemic, taking confirmed COVID-19 infection within 30 days into account. Subgroup analysis based on COPD exacerbation risk stratification was undertaken to determine if healthcare use differed based on exacerbation risk. Finally, sex-based analysis of healthcare use during the pandemic was also completed. Results: Hospitalization or emergency department visits and outpatient treatment for acute exacerbations of COPD dropped, whereas total outpatient COPD visits, including both virtual and in person, increased during the pandemic for pwCOPD. The mortality rate increased even after adjusting for COVID-19-associated deaths. Sex-based subgroup analysis showed a greater drop in acute care use for females, but the rise in mortality was seen for both sexes, with men experiencing a greater rate of mortality than women. Conclusions: Overall, pwCOPD accessed acute care resources less during the pandemic, which may have contributed to a rise in non-COVID-19 all-cause mortality.

Winifred Holtby (1898-1935): a mental hospital visit, early 1930s - Psychiatry in literature.

Winifred Holtby (1898-1935): a mental hospital visit, early 1930s - Psychiatry in literature.

Application of a specialist nurse–led wireless smart monitoring system in elderly patients with persistent atrial fibrillation

Background: With the increase in the elderly population, the prevalence of persistent atrial fibrillation (AF) among older adults has significantly risen, becoming one of the crucial cardiovascular diseases affecting the health and quality of life of the elderly. Patients with persistent AF require continuous cardiac function monitoring to prevent possible complications such as stroke and heart failure. Traditional monitoring methods often necessitate frequent hospital visits, increasing the economic burden and psychological stress on patients. With advancements in medical technology, wireless smart monitoring systems have emerged as a new remote health care technology, offering a more convenient and effective monitoring option for patients with persistent AF. Specialist nurses play a pivotal role in monitoring and managing patients using these systems. Their professional knowledge and skills are vital for improving monitoring efficiency and patient compliance. Therefore, this study aims to explore the application of wireless smart monitoring systems led by specialist nurses in elderly patients with persistent AF, in hopes of providing a scientific basis for improving the monitoring and management of this patient group. Methods: A total of 88 elderly patients with persistent atrial fibrillation admitted to the Cardiology Ward of a tertiary hospital in Weifang City from October 2021 to April 2023 were selected as research subjects. They were divided into an intervention group and a control group with conventional care, with 44 cases in each group, according to the order of admission. The control group received conventional hospitalization guidance, while the intervention group utilized a wireless smart monitoring system led by specialist nurses. The effects before and after the intervention in both groups were compared. Results: The intervention group patients had better scores in terms of mental stress, sleep quality, and comfort compared with the control group, and the nursing shift change time during hospitalization for the intervention group was shorter than that of the control group (P<0.05). Conclusions: The wireless smart monitoring system led by specialist nurses can improve the mental stress and sleep conditions of elderly patients with persistent atrial fibrillation, increase comfort, and enhance the efficiency of nursing shift changes.

Optimizing Antenatal Care: The Effects of a Holistic Nursing Android Application for Pregnant Women

Background: During the COVID-19 pandemic, face-to-face Ante Natal Care (ANC) services were limited. To address this, we developed the Android digital application “Guide Me” based on a holistic care concept to optimize ANC.Purpose: This study aimed to evaluate the effect of the Android digital application “Guide Me” on optimizing ANC.Methods: This study used an experimental research design. The participants included 302 pregnant women selected through block randomization, with 160 in the intervention group and 142 in the control group. The intervention involved providing ANC services using a digital Android application at home, with health services visited only when treatment was necessary. The intervention group received usual care along with the Android application, “Guide Me”, which included a holistic nursing concept program, while the control group received only the usual care. Data were collected three times, and the ANC scale was used to measure ANC optimization. Repeated measures ANOVA was used to analyze the data.Results: Significant differences were found in ANC optimization between the intervention and control groups ([F= 96.887, df (1, 300), p <0.001]). The intervention group showed significant improvements over three time points [F= 118.35, df (1, 308), p <0.001], with ANC optimization increasing from 45.79 to 59.16 in the intervention group compared to 44.09 to 45.77 in the control group.Conclusions: The “Guide Me” program effectively increased ANC optimization. Pregnant women reported feeling more at ease with home-based care and showed a preference for online apps and telemonitoring as alternatives to hospital visits. Healthcare providers may consider implementing this program in all antenatal clinics across Indonesia

Design specifications and capabilities of a 3D simulation software for clinical education of physiotherapy students in the neurology department

IntroductionIn this revolutionized era, thanks to cutting-edge technological breakthroughs like 3-dimensional (3D) computerized environments, physiotherapy trainers can improve their knowledge and confidence by using such training tools. Hence, there is room for developing these technologies for training medical students to expand their skills and expertise. This study aims to identify the design requirements and key functionalities of a 3D simulation software for the clinical education of physiotherapy students in neurology departments.MethodFirst, by carefully reviewing neurological books, scientific articles, curriculum, and medical records, and consulting with experts, a scenario was compiled. In the next step, a researcher-developed questionnaire was designed. Then, experts’ opinions were considered to confirm the validity and reliability of the questionnaire. The designed questionnaire was distributed among several neurological physiotherapists. Finally, the information elements, contents, and functional capabilities of the 3D software were determined by analyzing the data obtained from the questionnaire.FindingsThe main components for the design of physiotherapy educational software were identified based on the findings of the literature review, curriculum analysis, and medical record review. A survey of physiotherapy professors was conducted using a questionnaire created by the researcher in order to enhance the capabilities of simulation software and ascertain its primary functions. Following an analysis of the data from the distributed questionnaire, 37 essential features and contents have been proven to be more crucial than the rest for the creation of 3D simulation software. As a result, the essential and fundamental needs for the patient’s training in reading their medical records and performing muscle strength assessments were recognized and extracted. Based on these findings, a researcher-developed scenario for the various real cases was then established. In the patient’s medical record reading scenario, the student is required to read the patient’s record in text format. Similarly, in the section on cranial nerves, pictures are utilised to reinforce the student’s assessment skills in addition to textual content. Together with the audio and pop-up texts, the simulated 3D environment also offers training for the assessment of muscle strength.ConclusionAs an educational tool, this software can enhance students’ learning and assist in addressing the drawbacks of conventional teaching methods like lectures and hospital visits.

Nasopharyngeal carriage, antimicrobial susceptibility patterns, and associated factors of Gram-positive bacteria among children attending the outpatient department at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

Gram-positive bacteria residing in the nasopharynx can lead to severe illnesses in children, such as otitis media, pneumonia, and meningitis. Despite the potential threat, there is a lack of comprehensive data regarding the carriage rates of these bacteria among children in outpatient departments in the study area. This study aimed to assess the nasopharyngeal carriage, antimicrobial resistance patterns, and associated factors of Gram-positive bacteria among children attending the outpatient department at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. A hospital-based cross-sectional study was conducted from May 1, 2023, to August 30, 2023. A total of 424 nasopharyngeal swab samples were collected using sterile nasopharyngeal swabs, inoculated on Blood Agar and Mannitol Salt Agar plates, and identified through colony morphology, Gram stain, and biochemical tests. Antimicrobial susceptibility of the identified bacterial isolates was determined employing both the Kirby-Bauer and modified Kirby-Bauer methods. D-tests were conducted using clindamycin and erythromycin discs to detect inducible clindamycin resistance, while cefoxitin disc tests were utilized to ascertain methicillin resistance. Data entry was executed using Epi-Data version 4.6, and subsequent analysis was performed utilizing SPSS version 25. Bivariable and multivariable logistic regression analyses were employed to identify associated factors. An adjusted odds ratio at a 95% confidence interval with a P-value of < 0.05 was considered statistically significant. The overall nasopharyngeal carriage rate of Gram-positive bacteria was 296/424 (69.8%, 95% CI: 65.3-74.0). Staphylococcus aureus was the most prevalent 122/424 (28.8%), followed by Streptococcus pneumoniae 92/424 (21.7%). Methicillin resistance was observed in 19/122 (15.6%) of S. aureus and 3/60 (5%) of coagulase-negative staphylococcus (CoNS) species. Inducible clindamycin resistance was 10/122 (8.2%) in S. aureus and 4/53 (7.5%) in coagulase-negative staphylococcus species. Multidrug resistance was found in 146/296 (49.3%, 95% CI: 43.6-55.0) of the isolates. Associated factors with a bacterial carriage were large family size (AOR = 3.061, 95% CI: 1.595-5.874, P = 0.001), having siblings under five years old (AOR = 1.991, 95% CI: 1.196-3.313, P = 0.008), indoor cooking (AOR = 2.195, 95% CI: 1.275-3.778, P = 0.005), an illiterate mother (AOR = 3.639, 95% CI: 1.691-7.829, P = 0.001), and hospital visits (AOR = 2.690, 95% CI: 1.405-5.151, P = 0.003). The study found a high nasopharyngeal carriage of Gram-positive bacteria in outpatient children, including notable levels of methicillin-resistant S. aureus and multi-drug-resistant isolates. Clindamycin, rifampin, and erythromycin were the most effective antimicrobials for the tested isolates. Factors contributing to bacterial carriage include visits to healthcare facilities, larger family sizes, having younger siblings, maternal illiteracy, and indoor cooking. This emphasizes the need for methicillin-resistant S. aureus surveillance in pediatric outpatient settings and community health education, especially for children's guardians. Additionally, improving household ventilation by separating kitchens from sleeping areas and regular screening of younger siblings in healthcare environments were recommended to reduce bacterial transmission within family members. The study also called for studies with advanced procedures like minimum inhibitory concentration testing and molecular characterization to better comprehend the resistance patterns and genes in circulating bacteria.

Construction of a novel predictive model for hope level in patients with primary liver cancer from a positive psychology perspective

This study aimed to investigate the current hope levels in patients with primary liver cancer by analyzing the risk indicators of hope levels, constructing and validating a novel hope score-based predictive model. A total of 206 patients with primary liver cancer admitted to the hepato-pancreato-biliary surgery department of a tertiary hospital from October 2020 to June 2021 were included. The Herth Hope Index was utilized to assess hope levels, and based on the questionnaire results, the patients were categorized into low-hope (≤ 30 points) and high-hope (> 30 points) groups. Single-factor analysis and logistic multivariate regression analysis were conducted to explore the factors influencing hope levels in patients with primary liver cancer. A nomogram was plotted, and a risk prediction model for hope levels in these patients was developed. The predictive performance of the nomogram model was evaluated using calibration plots, the Hosmer–Lemeshow test, and other relevant assessments. Total of 206 patients participated in the questionnaire survey, with 82 patients (39.81%) categorized as belonging to the low-hope group. The results of the single-factor analysis showed statistically significant differences (all P < 0.05) in marriage status, education level, residence, occupation, family monthly income, reason for hospitalization or outpatient visit, pressure caused by the disease on the family, history of cirrhosis, and level of social support between the two groups. These variables were subsequently included in the logistic multivariate regression model. The results of the regression analysis indicated that marriage status, residence, family monthly income, and level of social support were independent risk factors. These four influencing factors were transformed into a visual predictive model, which yielded an area under the ROC curve of 0.931 (95% CI 0.899–0.963) and demonstrated model significance (Hosmer–Lemeshow test: χ2 = 4.008, P = 0.856, P > 0.05). The observed and expected values generated by the Hosmer–Lemeshow test were plotted as a scatter plot with a fitted linear trend, showing good consistency between the predictive model and actual risk. The constructed predictive model developed in this study exhibited good predictive capability for assessing the hope levels of patients with primary liver cancer. This model can assist clinical staff in rapidly identifying the psychological risk of low hope levels in patients, thereby providing valuable insights for the timely implementation of proactive management measures.

Potential harms resulting from patient–clinician real-time clinical encounters using video-based telehealth: A making healthcare safer rapid evidence review

Objectives To review the evidence on harms associated with patient–clinician real-time encounters using video-based telehealth and determine the effectiveness of any related patient safety practices (PSPs), which are interventions, strategies, or approaches intended to prevent or mitigate unintended consequences of healthcare delivery and improve patient safety. Methods We searched PubMed, EMBASE, and Cochrane to identify eligible studies published from 2012 to 2022, supplemented by grey literature search. Outcomes of interest included adverse events and other specified harms (i.e., preventable hospitalizations, inappropriate treatment, missed or delayed diagnoses, duplication of services, privacy breaches). Findings Our search retrieved 7155 citations, of which 23 studies (including six randomized controlled trials [RCTs]) were eligible for review. Fourteen studies reported on adverse events or unintended effects of telehealth conducted in diverse settings. Adverse events such as death, reoperation, infection, or major complications were infrequent in both telehealth and usual care groups. Thirteen studies examined preventable hospitalizations or emergency department (ED) visits and reported mixed findings. Of the six RCTs, three showed no difference in risk of hospitalization or ED visits for telehealth compared to usual care and three showed reduced risk for patients receiving telehealth. We found no studies on the effectiveness of PSPs in reducing harms associated with real-time telehealth. Conclusions Telehealth was not inferior to usual care in terms of hospitalizations or ED visits. No studies evaluated a specific PSP. More research is needed to improve understanding of harms associated with real-time use of telehealth and how to prevent or mitigate those harms.

Impact of oncology pharmacy services on the management of chemotherapy-induced nausea and vomiting: A systematic review and meta-analysis.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. To evaluate the effect of oncology services rendered by clinical pharmacists on reducing chemotherapy-induced nausea and vomiting (CINV) and improving overall treatment experiences. A systematic review and meta-analysis were conducted using studies retrieved from PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Research Information Sharing Service (RISS). The incidence and severity of CINV were evaluated as primary outcomes. Secondary outcomes were patient adherence, patient satisfaction, quality of life (QoL), emergency department (ED) visits, hospitalizations, and costs. A total of 12 studies were selected for systematic review, with 8 studies eligible for meta-analysis. We found that clinical pharmacy services contributed to preventing and alleviating CINV as well as improving patient's medication adherence, treatment satisfaction, and QoL, reducing hospital visits, and achieving cost savings. In the meta-analysis, pharmacists' interventions were notably effective in reducing the incidence of nausea (odds ratio [OR], 1.917; 95% CI, 1.243-2.955; P = 0.003) and vomiting (OR, 2.491; 95% CI, 1.199-5.177; P = 0.014) during overall treatments periods relative to results in control groups. In addition, the impact of clinical pharmacy services on CINV control was greater during the delayed phase compared to the acute phase. This study demonstrated the important role of clinical pharmacy services in controlling CINV and enhancing the overall treatment experience for patients with cancer. Further studies with standardized pharmacists' services and outcome measures are needed to validate our findings.

End-of-Life Healthcare Utilization in Lewy Body Dementia.

Lewy body dementia (LBD) is the second most common neurodegenerative dementia in the US, presenting unique end-of-life challenges. This study examined healthcare utilization and care continuity in the last year of life in LBD. Medicare claims for enrollees with LBD, continuously enrolled in the year preceding death, were examined from 2011-2018. We assessed hospital stays, emergency department (ED) visits, intensive care unit (ICU) admissions, life-extending procedures, medications, and care continuity. We identified 45,762 LBD decedents, predominantly female (51.8%), White (85.9%), with average age of 84.1 years (SD 7.5). There was a median of 2 ED visits (IQR 1-5) and 1 inpatient stay (IQR 0-2). Higher age was inversely associated with ICU stays (Odds Ratio [OR] 0.96; 95% Confidence Interval [CI] 0.96-0.97) and life-extending procedures (OR 0.96; 95% CI 0.95-0.96). Black and Hispanic patients experienced higher rates of ED visits, inpatient hospitalizations, ICU admissions, life-extending procedures, and in-hospital deaths relative to White patients. On average, 15 (7.5) medications were prescribed in the last year. Enhanced care continuity correlated with reduced hospital (OR 0.72; 95% CI 0.70-0.74) and ED visits (OR 0.71; 95% CI 0.69-0.87) and fewer life-extending procedures (OR 0.71; 95% CI 0.64-0.79). This study underscored the complex healthcare needs of people with LBD during their final year, which was influenced by age and race. Care continuity may reduce hospital and ED visits and life-extending procedures.