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Background: Studies show follow-up phone calls decrease readmission rates (RR) in trauma patients and social vulnerabilities may play a role as well. Minimal literature exists comparing RR of trauma patients who required an inpatient stay to those whose treatment was limited to the Emergency Department (ED), as they are at high risk of recidivism. We hypothesized post-trauma follow-up calls would show higher RR for ED patients than those requiring inpatient stay, as well as potentially differing outcomes for minorities.Study Design: A retrospective analysis from 2019-2020 of 1328 trauma patients from UCI Medical Center, discharged from inpatient facilities or the ED. A questionnaire script read by a nurse practitioner to patients via phone call following discharge. Data associated with readmission were captured. Multivariable logistic regression analysis was performed, controlling for patient factors including severity of injury.Results: Patients discharged from the ED were 47.4% less likely to be readmitted than those who required an inpatient stay (P < .01). However, ED patients were 88.7% less likely to receive a prescription than inpatient stay patients (P < .01). No difference between ED and inpatient discharge contact rates was noted (P < .99). Furthermore, no difference in readmission rates was noted for minorities.Conclusion: Post-trauma follow-up calls showed lower RR for index ED visit patients than those requiring inpatient stay, contrary to expectations. However, ED visit patients were also less likely to receive/fill prescriptions compared to those requiring inpatient stay. Ongoing analysis is warranted to further validate and improve follow-up call programs to ensure equitable health care. [ABSTRACT FROM AUTHOR]

We analyzed the surgical outcomes of uncomplicated appendicitis in patients treated with conventional or laparoscopic appendectomy on an ambulatory basis compared with those who stayed overnight. Demographics, clinical course, surgery type, length of stay, and surgical outcomes of patients who underwent conventional or laparoscopic appendectomy for uncomplicated appendicitis were measured. Comparisons were performed using Student t test and chi square analysis. A total of 197 patients were enroll in the study, 69 (35%) patients were discharged within 12 h after their surgery with a mean age of 26.1 years ± 10.23, and the rest of the patients (n = 128,65%) were hospitalized, with a mean age of 27.0 years ± 12.2 (p < 0.608). Open treatment was practice on 124 (62.9%) patients, laparoscopic approach was achieved on 73 (37%) patients, and three (1.5%) patients underwent conversion due to difficult dissection. There was a 14-h mean difference between groups, from the initial time of abdominal pain until arrival to the emergency room, with a mean time in the ambulatory group of 27.7 h ± 19.7 and hospitalized group of 42.4 h ± 39.7 (p < 0.001). Five (7.2%) patients on the ambulatory group presented post-surgical complications, with no significant difference from the patients of the inpatient group (n = 6, 4.7%) (p < 0.456). Overall, mortality rate was 0%, and all patients are well and alive with a mean follow-up of 8 months (range, 6–18 months). This study confirms suitability of conventional appendectomy as an outpatient procedure for uncomplicated appendicitis' management. [ABSTRACT FROM AUTHOR]

Background: Predictive value of the umbilical nucleated red blood cells (NRBCs) at birth for neonatal outcomes has been assessed. Hence, the present study was conducted to compare NRBC between discharged and dead neonates. Methods: This cross-sectional study was performed on preterm newborns with a birth weight of < 1,500 g admitted to the Neonatal Intensive Care Unit of Ghaem Hospital, Mashhad, Iran, within 2012-2018. The subjects were divided into two groups of discharged and dead. Data collection tool was a researcher -made questionnaire containing three sections, namely maternal demographic information, neonatal data, and blood tests (measuring white blood cell [WBC], absolute NRBC, NRBC/100 WBC and blood gas). The collected data were analyzed in SPSS software (version 20), using t-test, Chi-square test, receiver operating characteristic curve, and regression models. Results: A total of 205 neonates, including 136 discharged neonates (66.03%) and 69 dead neonates (33.7%), were examined in the present study. The results demonstrated a significant difference between the two groups in terms of the first minute Apgar score (P=0.023), fifth minute Apgar score (P=0.010), gestational age (P=0.000), birth weight (P=0.000), WBC (P=0.020), absolute NRBC (P=0.004), NRBC percentage (P=0.001), duration of mechanical ventilation (P=0.029), duration of oxygen therapy (P=0.012).Moreover, mechanical ventilation (P=0.036), type of oxygen therapy (P=0.000), NRBC percentage (P=0.001), and absolute NRBC count (P=0.001) showed a statistically significant relationship with neonatal survival rate. Conclusion: As the findings indicated, mechanical ventilation, type of oxygen therapy, absolute NRBC count, and NRBC percentage can be used as markers for predicting neonatal mortality rate. [ABSTRACT FROM AUTHOR]

Background: Stroke is one of the major causes of loss of independence, decreased quality of life and mortality among elderly people. About half of the elderly stroke patients discharged after rehabilitation in a nursing home still experience serious impairments in daily functioning one year post stroke, which can lead to difficulties in picking up and managing their social life. The aim of this study is to evaluate the effectiveness and feasibility of anew multidisciplinary transmural rehabilitation programme for older stroke patients. Methods: A two group multicentre randomised controlled trial is used to evaluate the effects of the rehabilitation programme. The programme consists of three care modules: 1) neurorehabilitation treatment for elderly stroke patients; 2) empowerment training for patient and informal caregiver; and 3) stroke education for patient and informal caregiver. The total programme has a duration of between two and six months, depending on the individual problems of the patient and informal caregiver. The control group receives usual care in the nursing home and after discharge. Patients aged 65 years and over are eligible for study participation when they are admitted to a geriatricrehabilitation unit in a nursing home due to a recent stroke and are expected to be able to return to their originalhome environment after discharge. Data are gathered by face-to-face interviews, self-administered questionnaires,focus groups and registration forms. Primary outcomes for patients are activity level after stroke, functional dependence, perceived quality of life and social participation. Outcomes for informal caregivers are perceived care burden, objective care burden, quality of life and perceived health. Outcome measures of the process evaluation are implementation fidelity, programme deliverance and the opinion of the stroke professionals, patients and informal caregivers about the programme. Outcome measures of the economic evaluation are the healthcare utilisation and associated costs. Data are collected at baseline, and after six and 12 months. The first results of the study will be expected in 2014. [ABSTRACT FROM AUTHOR]

For patients with chest pain who are deemed clinically to be low risk and discharged home from the emergency department (ED), it is unclear whether further laboratory tests can improve risk stratification. Here, we investigated the utility of a clinical chemistry score (CCS), which comprises plasma glucose, the estimated glomerular filtration rate, and high-sensitivity cardiac troponin (I or T) to generate a common score for risk stratification. In a cohort of 14,676 chest pain patients in the province of Ontario, Canada and who were discharged home from the ED (November 2012–February 2013 and April 2013–September 2015) we evaluated the CCS as a risk stratification tool for all-cause mortality, plus hospitalization for myocardial infarction or unstable angina (primary outcome) at 30, 90, and 365 days post-discharge using Cox proportional hazard models. At 30 days the primary outcome occurred in 0.3% of patients with a CCS < 2 (n = 6404), 0.9% of patients with a CCS = 2 (n = 4336), and 2.3% of patients with a CCS > 2 (n = 3936) (p < 0.001). At 90 days, patients with CCS < 2 (median age = 52y (IQR = 46–60), 59.4% female) had an adjusted HR = 0.51 (95% confidence interval (CI) = 0.32–0.82) for the composite outcome and patients with a CCS > 2 (median age = 74y (IQR = 64–82), 48.0% female) had an adjusted HR = 2.80 (95%CI = 1.98–3.97). At 365 days, 1.3%, 3.4%, and 11.1% of patients with a CCS < 2, 2, or >2 respectively, had the composite outcome (p < 0.001). In conclusion, the CCS can risk stratify chest pain patients discharged home from the ED and identifies both low- and high-risk patients who may warrant different medical care. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to analyze the growth status and to identify the risk factors that influence the catch-up growth of preterm infants after discharge and to provide evidence for feeding strategies and the need for further research. Methods: A descriptive correlational analysis was applied. The sample consisted of 309 preterm infants and their caregivers selected from June to August 2017 from five women's and children's hospitals. Self-designed questionnaires based on knowledge, attitude and practice and the Health Belief Model (HBM) were used to measure the catch-up growth status of preterm infants after discharge. Logistic regression was used to determine the risk factors for the catch-up growth of preterm infants. Results: The results showed that of 309 preterm infants, only 14 (4.5%) were underweight, and 52 (17.4%) did not meet the criteria for catch-up growth at 12 months of actual age. The logistic regression analysis showed that gestational age, regular health care, caregivers' educational background, mothers' daily contact with the baby, monthly average family income, the addition of a breast milk supplement, and daily milk volume were risk factors that affected the catch-up growth of preterm infants after discharge. Conclusions: The rate of catch-up growth of preterm infants is still not high. We should pay much more attention to preterm infants of small gestational age and guide their child care on a regular basis to detect and correct risk factors in a timely fashion, especially those involving lower daily milk volume, lower degree of culture and family economic difficulties. Second, we suggest that the government publish relevant policy that appropriately increases the length of maternity leave for preterm mothers. Future studies should have larger sample sizes and explore other important factors influencing the catch-up growth of preterm infants. [ABSTRACT FROM AUTHOR]