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PURPOSE: Little is known about the shared decision-making (SDM) needs, barriers, and facilitators of patients with newly diagnosed advanced cancer in the hospital. Understanding this may improve SDM and cancer care quality in this vulnerable population. METHODS: A single-site, mixed-methods study of hospitalized patients with newly diagnosed advanced cancer, caregivers, and oncologists was conducted. After discharge, patient ± caregiver semi-structured interviews exploring SDM needs, barriers, and facilitators regarding their most important upcoming cancer-related decision were conducted. Oncologists were surveyed about patient knowledge and SDM needs using closed- and open-ended questions, respectively. Thematic analysis was performed for qualitative data with a focus on themes unique to or amplified by hospitalization. Descriptive statistics and the Chi-squared test were performed for quantitative data. RESULTS: Patients and caregivers reported high SDM needs surrounding treatment and prognostic information, leading to decisional conflict. Eight themes emerged: anticipated cancer treatment decisions, variable control preferences in decision-making, high cancer-related information needs and uncertainty, barriers and facilitators to information gathering during and post hospitalization, and decision-making facilitators. Among 32 oncologists, most (56%) reported patients were poorly informed about treatment and prognosis. Oncologists reported variable expectations about patient knowledge after hospitalization, facilitators to patient decision-making, and patient uncertainty while awaiting an outpatient oncologist appointment. CONCLUSION: Patients newly diagnosed with advanced cancer in the hospital have high SDM needs and experience decisional conflict. This may be due to barriers unique to or exacerbated by hospitalization. Further research is needed to develop strategies to address these barriers and enhance the facilitators identified in this study.

Individuals with mental illness have a high incidence of comorbid substance use, with one of the most prevalent being alcohol use disorder (AUD). Naltrexone, FDA-approved for AUD, decreases reward associated with alcohol-related social cues. This study aimed to determine if a pharmacist-driven screening tool would increase the use of extended-release naltrexone (XR-NTX) in patients with AUD and a comorbid psychiatric condition. Pharmacists screened and recommended XR-NTX for adults admitted to the inpatient psychiatric unit, who had a DSM-5 diagnosis of AUD, a negative urine drug screen for opioids, and were hospitalized for at least 1 day. Endpoints evaluated included the number of XR-NTX doses administered during the screening period to the prescreening period, 30-day readmission rates, recommendation acceptance rates, and reasons for not administering XR-NTX. Pharmacists identified 66 of 641 screened patients who met the inclusion criteria and were candidates for XR-NTX. Compared to the preintervention period, more patients received XR-NTX for AUD (2 vs. 8). Readmission rates were similar between those with AUD who received XR-NTX and those who did not. Pharmacist-driven screening for AUD led to greater administration of XR-NTX when compared to the same 4-month period the year prior to initiating the study.

Heart failure (HF) is a common disease with increasing prevalence around the world. There is high morbidity and mortality associated with poorly controlled HF along with increasing costs and strain on healthcare systems due to a high rate of rehospitalization and resource utilization. Despite the establishment of clear evidence-based guideline directed medical therapies (GDMT) proven to improve HF morbidity and mortality, there remains significant clinical inertia to optimizing HF patients on GDMT. Only a minority of HF patients are prescribed on all four classes of GDMT. To bridge the gap between the vulnerable population of HF patients and lifesaving GDMT, HF implementation is of increasing importance. HF implementation involves strategies and techniques to improve GDMT optimization along with other modalities to improve HF management. HF implementation meets patients where they are, including at the time of acute decompensation in the inpatient setting, at the vulnerable discharge stage, and at the chronic management stage in the outpatient setting. Inpatient HF implementation strategies include protocolized rapid titration of GDMT, site-level audit-and-feedback, virtual GDMT optimization teams, and electronic health record notifications and alerts. Discharge HF implementation strategies include education at patient and provider levels, discharge summaries, and HF transitional programs. Outpatient HF implementation strategies include digital innovations such as electronic health record utilization and mobile applications, population level strategies such as registries and clinical dashboards), changes in HF team structure and member roles, remote monitoring with implanted devices and telemonitoring, and hospital at home care model. With a growing population of HF patients, there is an increasing need for novel and creative HF implementation and monitoring methods.

Background: Higher level of care (HLOC) treatment for eating disorders (EDs) is sometimes necessary, but research is lacking on whether HLOCs are actually more effective than less structured, lower levels of care. The purpose of the current study was to compare outcomes for patients with EDs at low weights who entered 24/7 care (inpatient and residential) to those entering non-24/7 care (partial hospitalization programming and intensive outpatient programming). Methods: Participants were 1104 adults with body mass indices (BMI) between 14 and 17 receiving treatment for an ED at a large multisite treatment facility offering HLOCs between August 2019 and February 2024. The Eating Disorder Examination-Questionnaire (EDE-Q), assessing ED psychopathology, was completed at admission and discharge. Weight was taken throughout treatment. Results: In unadjusted analyses, there was a significant difference between those receiving 24/7 care (3.79) versus non-24/7 care (2.17) in BMI increase during treatment. In adjusted analyses controlling for ED diagnosis, length of stay, and admission BMI, results remained the same. Weight gain per week was significantly greater for patients in 24/7 care. Changes in ED psychopathology, as measured by the EDE-Q, were not significantly associated with 24/7 care. Conclusions: The current study suggests that patients with EDs at low BMIs gain more weight at a faster rate when participating in 24/7 care compared to non-24/7 care. Entering treatment at an appropriate level may result in shorter overall lengths of stay and may increase the chances of a positive long-term outcome. Plain English summary: Patients with eating disorders, particularly anorexia nervosa, are known to be ambivalent about receiving treatment. Because of this, they may be reluctant to enter higher level of care treatment, such as inpatient or residential care (24/7 care), because of the highly structured environment and the inability to engage in eating disordered behavior. Inpatient or residential treatment may be the best for them from a clinical standpoint, but there has been no evidence to show that 24/7 care is actually more effective than lower levels of treatment such as partial hospitalization or intensive outpatient programs (non-24/7 care). This study examined outcomes for 1104 adults with body mass indices (BMI) between 14 and 17, representing a fairly severe presentation, receiving either 24/7 or non-24/7 care for an eating disorder. We found that those receiving 24/7 care gained more weight than those in non-24/7 care (3.79 increase in BMI versus 2.17), and gained weight faster. Rate of weight gain has been found to be a significant predictor of good outcome after one year. There were no differences between groups on the Eating Disorder Examination-Questionnaire Global Score or subscales from admission to discharge. The findings from this study could be used as a guide for patients when helping them to make decisions about which level of care is most appropriate. [ABSTRACT FROM AUTHOR]

Background: This case study examines the application of Integrated Enhanced Cognitive Behavioural Therapy (I-CBTE) for a patient with severe, longstanding anorexia nervosa and multiple comorbidities, including organic hallucinosis, complex post-traumatic stress disorder (CPTSD), and severe self-harm. Such complex presentations often result in patients falling between services, which can lead to high chronicity and increased mortality risk. Commentaries from two additional patients who have recovered from severe and longstanding anorexia nervosa are included. Case study: The patient developed severe anorexia nervosa and hallucinosis after a traumatic brain injury in 2000. Despite numerous hospitalisations and various psychotropic medications in the UK and France, standard treatments were ineffective for 17 years. However, Integrated Enhanced Cognitive Behaviour Therapy (I-CBTE) using a whole-team approach and intensive, personalised psychological treatment alongside nutritional rehabilitation proved effective. Methods: In this paper, we describe the application of the I-CBTE model for individuals with severe, longstanding, and complex anorexia nervosa, using lived experience perspectives from three patients to inform clinicians. We also outline the methodology for adapting the model to different presentations of the disorder. Outcomes: The patient achieved and maintained full remission from her eating disorder over the last 6 years, highlighting the benefit of the I-CBTE approach in patients with complex, longstanding eating disorder histories. Successful treatment also saved in excess of £360 k just by preventing further hospitalisations and not accounting for the improvement in her quality of life. This suggests that this method can improve outcomes and reduce healthcare costs. Conclusion: This case study, with commentaries from two patients with histories of severe and longstanding anorexia nervosa, provides a detailed description of the practical application of I-CBTE for patients with severe and longstanding eating disorders with complex comorbidities, and extensive treatment histories. This offers hope for patients and a framework for clinicians to enhance existing treatment frameworks, potentially transforming the trajectory of those traditionally deemed treatment resistant. Recommendations: We advocate the broader integration of CBT for EDs into specialist services across the care pathway to help improve outcomes for patients with complex eating disorders. Systematic training and supervision for multidisciplinary teams in this specialised therapeutic approach is recommended. Future research should investigate the long-term effectiveness of I-CBTE through longitudinal studies. Patient feedback on experiences of integrated models of care such as I-CBTE is also needed. In addition, systematic health economics studies should be conducted. Plain language summary: This case study, with commentaries from two other patients who have recovered from severe and longstanding anorexia nervosa, examines the use of Integrated Enhanced Cognitive Behavioural Therapy (I-CBTE) for a patient with severe and longstanding anorexia nervosa and multiple comorbidities. The patient had a history of multiple hospitalisations and was treated with various psychotropic medications without success for 17 years. However, she responded to I-CBTE. The model integrates multidisciplinary treatment to address the eating disorder and co-occurring conditions effectively. The patient achieved and maintained full remission from her eating disorder over the last 6 years, highlighting the effectiveness of the I-CBTE approach in patients with complex, longstanding and severe eating disorders. This intervention is cost-effective and has significant financial advantages for healthcare systems. The authors recommend further research into the long-term effectiveness of I-CBTE and broader integration of CBT for ED into clinical services and existing treatment frameworks to enhance care for patients with severe and longstanding eating disorders. Systematic training and supervision for multidisciplinary teams is needed and patient feedback on experiences of integrated models of care such as I-CBTE is also needed. Finally, systematic health economics studies should be conducted. [ABSTRACT FROM AUTHOR]

Introduction: Substance use disorders (SUDs) are common, and there is evidence of clinically significant benefit of cognitive behavioral therapy (CBT). The efficacy of CBT in SUDs has been confirmed, although relapse rates of 40%– 60% have been reported. An enhancement of CBT-based therapy through an animal-assisted intervention (AAI) with sheep to normalize the occurrence of negative emotions and improve positive emotions as well as mindfulness and self-efficacy expectancy was investigated. Methods: A single-session AAI with sheep in a group setting was investigated against treatment as usual over time. N = 36 psychiatric inpatients with SUDs were examined by questionnaires before and 1 week after the intervention and additionally immediately after the intervention. Results: Positive emotions improved significantly in the AAI group 1 week after the intervention with a medium effect size, but not in the control group. Similarly, mindfulness and self-efficacy expectancy improved over time in the AAI group. When exploratory results were evaluated immediately after the intervention while still on the farm, the effects in favor of AAI were even larger. Conclusions: AAI can thus be considered effective in improving positive emotions, mindfulness, and self-efficacy expectancy. The impressive effect sizes immediately after the intervention encourage us to consider what can be done to maintain these even greater effect sizes over time. [ABSTRACT FROM AUTHOR]

Introduction: This Rapid Review (RR) aimed to assess the current literature over the past decade to determine the prevailing evidence regarding compulsory treatment* in eating disorders (ED). It is hoped that the review will help inform a consensus opinion as to whether this course of action confers significant clinical benefit, and importantly, to whom it should apply. The review also explores alternative options to involuntary care. Methods: Four indexing databases (OVID; ProQuest; Web of Science; PubMed/MedLine) were searched using variations of the following keywords: "coercive/detained/involuntary/least restrictive care" "treatment refusal" "incarcerated/forced/compulsory admission" "moral/ethic/legal/mental health act" "eating disorder". Research was restricted to articles published between 2013 and 2023 and included grey literature. Results: Of 9911 articles retrieved, 34 were included for final analyses, exploring ethical, legal, and physical and mental health outcomes of compulsory treatment. Studies comprised review papers, cohort studies, cross sectional research, case series reports, ethnography, commentary papers and grey literature. The majority of studies focused on individuals with anorexia nervosa (AN). Only two papers considered compulsory treatment in individuals with other eating disorders (EDs) Findings largely align with previous reviews suggesting compulsory treatment saves lives but comes at a therapeutic and personal cost. It remains unknown as to who may benefit from compulsory treatment. The decision to invoke compulsory treatment remains with the clinician and is a responsibility that is likely to be faced by most in their care of individuals with EDs. Conclusions: Significant gaps remain in the published literature and a clear road map for a clinician-informed decision on the submission of a compulsory treatment for a person with ED does not yet exist. Further, there is little evidence as to who is most likely to benefit from compulsory treatment. There is consensus that efforts should be concentrated on reducing instances of compulsory treatment and minimising coercion through the development of open, transparent and trusting relationships between individuals and their treating clinician. Co-produced research and the development of clinical guidelines guided by the voices of individuals with lived experience are needed to ensure minimisation of potential harm. Plain English Summary: Eating disorders are complex psychological disorders with numerous significant physical health consequences associated with lethality including heart attack, irregular heartbeat, dehydration, blood clots, and risk of suicide. Without indicated intervention for physical deterioration in the acute stages of illness, individuals are likely at best to develop a chronic course and at worst to lose their life. Despite this, individuals frequently refuse intervention and medical treatment due to fear of weight gain, the interruption of behaviours that are experienced as protective and the effects of past experiences of care. Many report a sense of hopelessness and fear due to past unsuccessful and at times harmful treatments. This presents treating clinicians with a practical and ethical conundrum: should treatment be delivered to an individual against their will? Researchers, policymakers, law professionals and lived experience alike are challenged as to the legal and ethical bounds around which practitioners can act with beneficence when considering compulsory treatment of an individual with an eating disorder. A Rapid Review was commissioned by the Victorian Government Department of Health to summarise the extant literature on the compulsory treatment* of individuals with eating disorders. * Involuntary treatment' and 'compulsory treatment' are synonymous, but we have chosen the term that is best understood by the general public/informed readers. [ABSTRACT FROM AUTHOR]

Background: Children with medical complexity (CMC) have high healthcare utilization and face unique challenges during hospital admissions. The evidence describing their experiences of inpatient care is distributed across disciplines. The aim of this scoping review was to map the evidence related to the inpatient experience of care for CMC and their families, particularly related to key aspects and methodological approaches, and identify gaps that warrant further study. Methods: This scoping review was conducted in accordance with JBI methodology and included all studies that reported experiences of acute hospital care for CMC/families. All study designs were included. Databases searched included EMBASE, CINAHL Plus with Full Text, Web of Science, MEDLINE(R) and APA PsycInfo from 2000 to 2022. Details about the participants, concepts, study methods and key findings were abstracted using a data abstraction tool. A thematic analysis was conducted. Results: Forty‐nine papers were included: 27 qualitative studies, 10 quantitative studies, six mixed methods studies, two descriptive studies and four reviews. Some quantitative studies used validated instruments to measure experience of care, but many used non‐validated surveys. There were a few interventional studies with a small sample size. Results of thematic analysis described the importance of negotiating care roles, shared decision‐making, common goal setting, relationship‐building, communication, sharing expertise and the hospital setting itself. Conclusion: CMC and families value relational elements of care and partnering through sharing expertise, decision‐making and collaborative goal‐setting when admitted to hospital. Patient or Public Contribution: This review was conducted in alignment with the principles of patient and family engagement. The review was conceptualized, co‐designed and conducted with the full engagement of the project's parent–partner. This team member was involved in all stages from constructing the review question, to developing the protocol, screening articles and drafting this manuscript. Practitioner Points: Qualitative research describes key elements of inpatient experience of care for CMC and their families as relationships, communication, respect for parent/provider expertise and the hospital setting. There is less evidence on measuring experience of care using quantitative methodology, particularly using validating instruments. This would be helpful to support the evaluation of inpatient interventions to improve the experiences of CMC. [ABSTRACT FROM AUTHOR]

Background Herein, we aimed to develop and test machine learning (ML) models to predict disease severity and/or progression in hospitalised COVID-19 patients through baseline laboratory features. Methods In this retrospective study of hospitalised COVID-19 patients admitted to a tertiary care centre, we evaluated routine admission data to determine the accuracy rates of different ML algorithms: k-nearest neighbour classifier, bagging classifier, random forest (RF), and decision tree. These models were compared over three outcomes: those who needed oxygen supplementation vs who did not on admission (Analysis 1, n: 180), those who later developed oxygen requirement vs those who did not (Analysis 2, n: 112), and those who needed invasive mechanical ventilation vs. those who did not during hospitalisation (Analysis 3, n: 164). Results The median age of the patients was 55 (44-68) years, with males constituting 47.2% of the subjects. At admission, 37.8% of the patients required oxygen supplementation. During hospitalisation, 17.5% needed mechanical ventilation, and 8.3% died. For all analyses, RF had the highest accuracy in classifying the need for oxygen supplementation on admission (89.4%) or during hospitalisation (91.1%) and for invasive mechanical ventilation (92.2%). These were followed by a bagging classifier for Analysis 1 (88.3%) and Analysis 3 (91.0%) and by a decision tree for Analysis 2 (88.4%). C-reactive protein, monocyte distribution width, and high-sensitive troponin-T were the most crucial laboratory contributors to Analysis 1, Analysis 2, and Analysis 3, respectively. Conclusion Our study showed that ML algorithms could predict the need for oxygen supplementation and mechanical ventilation during hospitalisation using baseline laboratory data, suggesting a slight superiority of RF, among others. [ABSTRACT FROM AUTHOR]

Certified therapeutic recreation specialists (CTRS®s) within pediatric rehabilitation inpatient (PR-I) units use a variety of treatment modalities. One such modality is adaptive sports. Positive emotions that can be generated when participating in an adaptive sports activity include enjoyment and gratification. CTRSs are able to provide youth in the PR-I unit with a unique experience that teaches them about adaptive sports while introducing a potential new leisure pursuit. Thus, the Introduction to Adaptive Sports program was developed with the intent of documenting youths' knowledge related to adaptive sports following brief exposure, their enjoyment of activities associated with four different adaptive sports, and their interest in future participation. The youth involved in the piloting of this protocol were asked to complete a Knowledge and Future Participation Quiz as well as an Enjoyment Scale to measure their level of knowledge about each adaptive sport presented, how much they enjoyed participating in each session, and if they would be interested in future participation. The results showed that the youth demonstrated strong knowledge about each adaptive sport (average scores of 5.06 out of 6). The scores on the Enjoyment Scale indicated that youth on the PR-I unit enjoyed the adaptive sports sessions (average scores of 8.38 out of 10). Additionally, participant responses indicated 78.13% overall interest in future participation in the four presented adaptive sports. Though the preliminary results from the trial of this protocol are encouraging, recommendations for revision and future study by CTRS professionals on PR-I units are included. [ABSTRACT FROM AUTHOR]

Background and Objectives: Constipation affects health-related quality of life and increases hospital visits. We conducted this prospective cohort study to assess laxative use, health outcomes of constipation in medically hospitalized patients, and related health outcomes. Materials and Methods: A prospective single-center study included all adult patients admitted under the General Internal Medicine Unit from 1 February 2022, to 31 August 2022. Constipation was defined using the Constipation Assessment Scale (CAS). Patients were assessed for 28 days during their hospital stay and up to 90 days post-discharge. Result: Among the included patients, 62.45% experienced constipation, which was associated with poor health outcomes including delirium (p = 0.048), intensive care admission (p < 0.01), cardiopulmonary arrest (p < 0.01), inpatient mortality (p < 0.01), longer hospital stay (p < 0.01), 90-day mortality (p < 0.01), and 90-day hospital readmission (p < 0.01). Laxative treatment was administered to only 33.93% of patients with constipation and was more commonly used among older patients (p < 0.01), those with high CAS scores (p < 0.01), longer hospital stays (p < 0.01), and critically ill patients (intensive care admission) (p = 0.01), as well as those who had cardiopulmonary arrest (p < 0.01) and high inpatient mortality (p < 0.01). Conclusions: This study identified several associations between constipation and poor health outcomes and highlighted the underutilization of laxatives in treating constipation. It is vital to interpret our results with caution. Therefore, we believe that a randomized controlled trial will help enhance our understanding of the interaction between constipation, laxative use, and poor health outcomes. [ABSTRACT FROM AUTHOR]

Objective: To examine the effectiveness of one-week inpatient cognitive behavioral therapy for insomnia (CBT-I) in patients without severe mental disorders in the real-world setting to answer the research question "Can inpatient CBT-I be abbreviated?". Methods: In this retrospective, single-group, pretest-posttest study, the clinical outcome data of 94 patients who underwent one-week inpatient CBT-I were collected. Self-report scale scores and hypnotic medication use were obtained at baseline and at the 3-month follow-up after therapy. Results: CBT-I significantly improved insomnia severity (Z = -7.65, P < 0.001, Cohen's d = 1.34), anxiety (Z = -6.23, P < 0.001, Cohen's d = 1.02), depression (Z = -6.42, P < 0.001, Cohen's d = 1.06), daytime sleepiness (Z = -2.40, P = 0.016, Cohen's d = 0.35), and fatigue severity (Z = -5.54, P < 0.001, Cohen's d = 0.88) and reduced hypnotic medication use (χ² = 33.62, P < 0.001). At the follow-up assessment, 58 patients (67.4%) had clinically meaningful changes in insomnia, and 51 patients (59.3%) met the criteria for insomnia remission. Conclusion: The results of this preliminary study imply that one-week inpatient CBT-I may be an effective intervention for the treatment of insomnia in patients without severe mental disorders. [ABSTRACT FROM AUTHOR]

Background: Anorexia nervosa (AN) is a severe psychiatric disorder, from which recovery is often protracted. The role of prior specialized inpatient treatment on subsequent treatment attempts for adults with chronic AN and predictors of treatment response for severe and enduring AN (SE-AN) are needed to improve outcomes. Method: Participants (N = 135) with chronic AN (ill ≥7 years) admitted to an integrated inpatient-partial hospitalization eating disorders (ED) unit with prior ED hospitalization(s) (+ PH; n = 100) were compared to those without prior ED hospitalizations (-PH; n = 35) on admission characteristics (BMI, length of illness, outpatient ED treatment history, symptomatology (ED, anxiety, and depressive), history of suicide attempts or non-suicidal self-injury (NSSI)), treatment motivation and recovery self-efficacy, and discharge outcomes (discharge BMI, rate of weight gain, length of stay, clinical improvement). Results: Groups were similar with regard to age, years ill, and admission BMI. The + PH group had lower desired weight, lifetime nadir BMI and self-efficacy for normative eating, and higher state and trait anxiety than the -PH group. +PH were also more likely to endorse history of NSSI and suicide attempt. Regarding discharge outcomes, most patients achieved weight restoration at program discharge (mean discharge BMI = 19.8 kg/m2). Groups did not differ on rate of weight gain, likelihood of attending partial hospital, partial hospital length of stay, program discharge BMI, or likelihood of clinical improvement (p's > 0.05) although inpatient length of stay was longer for the + PH group. Conclusions: Participants with chronic AN + PH exhibited more severe psychiatric comorbidity and lower self-efficacy for normative eating than AN -PH, however short-term discharge outcomes were similar. Future research should determine whether weight restoration and targeting comorbidities impacts relapse risk or need for rehospitalization among chronic and severe + PH. Despite similar illness durations, those with chronic AN -PH may be able to transition to partial hospital earlier. Conversely there is risk of undertreatment of chronic AN + PH given the recent shift promoting briefer self-directed admissions for adults with SE-AN. Research comparing + PH and -PH adults with chronic AN may facilitate efforts to individualize care and characterize relapse risk following intensive treatment. Plain English summary: Some individuals with longstanding anorexia nervosa (AN) remain ill despite multiple attempts at intensive treatment. Others reach a high level of specialty care (e.g. inpatient or residential) for the first time only late in their illness. This study compared 100 hospitalized patients with chronic AN (ill ≥ 7 years) who previously received specialty inpatient eating disorder care to 35 hospitalized patients with chronic AN and no prior intensive treatment. Participants completed questionnaires at admission and weight change and hospital course were assessed at program discharge by chart review. At admission, individuals with prior hospitalizations reported greater difficulties with anxiety and suicidal behavior, lower confidence for changing their eating habits, and lower desired body weight compared to those with no prior inpatient treatment. Both groups had similar weight change and clinical improvement during treatment with mean discharge BMI consistent with weight restoration. These outcomes suggest equivalent short term improvement and weight restoration for individuals with chronic AN regardless of whether they previously received inpatient treatment and call into question whether the recent shift to brief admissions for those with chronic and severe AN may result for some in undertreatment, given that weight restoration remains the strongest predictor of long-term recovery. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, patients with Alzheimer's disease and related dementias (ADRD) were especially vulnerable, and modes of medical care delivery shifted rapidly. This study assessed the impact of the pandemic on care for people with ADRD, examining the use of primary, emergency, and long-term care, as well as deaths due to COVID and to other causes. Methods: Among 4.2 million beneficiaries aged 66 and older with ADRD in traditional Medicare, monthly deaths and claims for routine care (doctors' office and telehealth visits), inpatient/emergency department (ED) visits, and long-term care facility use from March or June 2020 through December 2022 are compared to monthly rates predicted from January–December 2019 using OLS and logistic/negative binomial regression. Correlation analyses examine the association between excess deaths — due to COVID and non-COVID causes — and changes in care use in the beneficiary's state of residence. Results: Increased telehealth visits more than offset reduced office visits, with primary care visits increasing overall (by 9 percent from June 2020 onward relative to the predicted rate from 2019, p <.001). Emergency/inpatient visits declined (by 9 percent, p <.001) and long-term care facility use declined, remaining 14% below the 2019 trend from June 2020 onward (p <.001). Both COVID and non-COVID deaths rose, with 231,000 excess deaths (16% above the prediction from 2019), over 80 percent of which were attributable to COVID. Excess deaths were higher among women, non-White patients, those in rural and isolated zip codes, and those with higher social deprivation index scores. States with the largest increases in primary care visits had the lowest excess deaths (correlation -0.49). Conclusions: Older adults with ADRD had substantial deaths above pre-pandemic projections during the COVID-19 pandemic, 80 percent of which were attributed to COVID-19. Routine care increased overall due to a dramatic increase in telehealth visits, but this was uneven across states, and mortality rates were significantly lower in states with higher than pre-pandemic visits. [ABSTRACT FROM AUTHOR]

Heart transplantation is the gold-standard treatment for terminal heart failure. Despite being successful, pre- and post-transplant limitations interfere with patients' functional capacity, self-care, and quality of life post-surgery. Rehabilitation is necessary to address these limitations, prevent complications, and promote a safe return home. This study analyzes the safety of a phase 1 cardiac rehabilitation protocol (RN4HTx) in heart transplant patients and its effects on self-care capacity. A quantitative, descriptive study was conducted with 19 heart transplant recipients. The protocol was implemented in collaboration with a rehabilitation professional, who monitored adverse events, hemodynamic variables, self-care capacity (Barthel) pre- and post-transplant, and functional capacity at discharge (6 min walk test). The results showed that 68.42% of recipients were men, with an average age of 50.21 years and 15 days of hospitalization post-transplant. Approximately 73.68% of recipients were transferred from other wards with changes in functional capacity. All patients progressed to the final stage of the program without adverse events. There was a notable improvement in self-care capacity before and after transplantation, with a measure of functional status of 310.035 m (6MWT). The study found that RN4HTx is a feasible cardiac rehabilitation program without adverse events in the immediate postoperative period following heart transplantation, positively impacting functional recovery and therapeutic self-care capacity, thus increasing the safety of returning home. This study was retrospectively registered on Clinical Trials—NCT06552390. [ABSTRACT FROM AUTHOR]

BACKGROUND: Biportal spinal endoscopy is increasingly utilized for lumbar disc herniations and lumbar stenosis. The objective was to investigate the safety and effectiveness of the technique in the outpatient vs inpatient setting. METHODS: This is a comparative study of consecutive patients who underwent biportal spinal endoscopy by a single surgeon at a single institution. Demographics, surgical complications, and patient-reported outcomes were prospectively collected and retrospectively analyzed. Statistics were calculated among treatment groups using unpaired t test and χ 2 analysis where appropriate. Statistical significance was determined as P < 0.05. RESULTS: Eighty-four patients were included, 58 (69.0%) as outpatient, 26 (31.0%) as inpatient. Mean follow-up was 7.5 months. Statistically significant differences in age, American Society of Anesthesiologists classification, and Charleston Comorbidity Index scores were reported between cohorts, with younger and healthier patients undergoing outpatient surgery (P < 0.0001). Outpatients were more likely to have discectomies while inpatients were more likely to have decompressions for stenosis. No significant differences in postoperative complications were found between groups.Both cohorts demonstrated significant improvement in visual analog scale (VAS) back and leg pain scores and Oswestry Disability Index scores (P < 0.001). Outpatients had significantly lower postoperative VAS back pain (P = 0.001) and Oswestry Disability Index scores (P = 0.004) at 5-8 weeks compared with inpatients, but there was no significant difference for VAS leg pain scores at all time points between the cohorts. CONCLUSIONS: Early results demonstrate that biportal spinal endoscopy can safely and effectively be performed in both inpatient and outpatient settings. CLINICAL RELEVANCE: Outpatient biportal spinal endoscopy can be performed successfully in well selected patients, which may reduce the financial burden of spine surgery to the U.S. healthcare system.

Abstract Background This case study examines the application of Integrated Enhanced Cognitive Behavioural Therapy (I-CBTE) for a patient with severe, longstanding anorexia nervosa and multiple comorbidities, including organic hallucinosis, complex post-traumatic stress disorder (CPTSD), and severe self-harm. Such complex presentations often result in patients falling between services, which can lead to high chronicity and increased mortality risk. Commentaries from two additional patients who have recovered from severe and longstanding anorexia nervosa are included. Case study The patient developed severe anorexia nervosa and hallucinosis after a traumatic brain injury in 2000. Despite numerous hospitalisations and various psychotropic medications in the UK and France, standard treatments were ineffective for 17 years. However, Integrated Enhanced Cognitive Behaviour Therapy (I-CBTE) using a whole-team approach and intensive, personalised psychological treatment alongside nutritional rehabilitation proved effective. Methods In this paper, we describe the application of the I-CBTE model for individuals with severe, longstanding, and complex anorexia nervosa, using lived experience perspectives from three patients to inform clinicians. We also outline the methodology for adapting the model to different presentations of the disorder. Outcomes The patient achieved and maintained full remission from her eating disorder over the last 6 years, highlighting the benefit of the I-CBTE approach in patients with complex, longstanding eating disorder histories. Successful treatment also saved in excess of £360 k just by preventing further hospitalisations and not accounting for the improvement in her quality of life. This suggests that this method can improve outcomes and reduce healthcare costs. Conclusion This case study, with commentaries from two patients with histories of severe and longstanding anorexia nervosa, provides a detailed description of the practical application of I-CBTE for patients with severe and longstanding eating disorders with complex comorbidities, and extensive treatment histories. This offers hope for patients and a framework for clinicians to enhance existing treatment frameworks, potentially transforming the trajectory of those traditionally deemed treatment resistant. Recommendations We advocate the broader integration of CBT for EDs into specialist services across the care pathway to help improve outcomes for patients with complex eating disorders. Systematic training and supervision for multidisciplinary teams in this specialised therapeutic approach is recommended. Future research should investigate the long-term effectiveness of I-CBTE through longitudinal studies. Patient feedback on experiences of integrated models of care such as I-CBTE is also needed. In addition, systematic health economics studies should be conducted.

ObjectiveParental self-efficacy in the domain of weight restoration for adolescents with restrictive eating disorders is central to success in family-based interventions. We sought to characterize this parental self-efficacy during a brief hospitalization for medical stabilization and follow-up among patients with anorexia nervosa (AN) or atypical AN (AAN) enrolled in the StRONG clinical trial to understand the potential impact of inpatient treatment on caregiver empowerment.MethodsPatients were enrolled upon hospital admission and refed per protocol. We examined correlates of the Parents Versus Anorexia (PVA) scale, a measure of parental self-efficacy in the domain of weight restoration, at admission, discharge, 10-days, 1-month, and 3-months post-discharge. Multi-level models evaluated associations among PVA scores and change in %median BMI and Eating Disorder Examination-Questionnaire (EDE-Q) global scores over 3-months post-discharge.ResultsParents of N = 67 adolescents and young adults M(SD) age 15.79 (2.20) years and 85.00 (11.86) %median BMI participated. PVA scores did not change significantly during hospitalization (p = .053), which lasted on average 10.7 ± 4.5 days. PVA scores increased post-discharge (p = .009), with significant increase between discharge and 1-month post-discharge (p = .045). PVA scores were not associated with subsequent clinical outcomes. Rather, a main effect of time significantly predicted higher %median BMI and improved EDE-Q scores (p

Heart transplantation is the gold-standard treatment for terminal heart failure. Despite being successful, pre- and post-transplant limitations interfere with patients’ functional capacity, self-care, and quality of life post-surgery. Rehabilitation is necessary to address these limitations, prevent complications, and promote a safe return home. This study analyzes the safety of a phase 1 cardiac rehabilitation protocol (RN4HTx) in heart transplant patients and its effects on self-care capacity. A quantitative, descriptive study was conducted with 19 heart transplant recipients. The protocol was implemented in collaboration with a rehabilitation professional, who monitored adverse events, hemodynamic variables, self-care capacity (Barthel) pre- and post-transplant, and functional capacity at discharge (6 min walk test). The results showed that 68.42% of recipients were men, with an average age of 50.21 years and 15 days of hospitalization post-transplant. Approximately 73.68% of recipients were transferred from other wards with changes in functional capacity. All patients progressed to the final stage of the program without adverse events. There was a notable improvement in self-care capacity before and after transplantation, with a measure of functional status of 310.035 m (6MWT). The study found that RN4HTx is a feasible cardiac rehabilitation program without adverse events in the immediate postoperative period following heart transplantation, positively impacting functional recovery and therapeutic self-care capacity, thus increasing the safety of returning home. This study was retrospectively registered on Clinical Trials—NCT06552390.

Abstract Background The growing aging trend associated with a higher prevalence of chronic illnesses is increasing the demand for the development of person-centered practice in specific care settings. Knowing the person’s perception of the care and the care experience is essential to improving inpatient care toward person-centeredness. This study aims to characterize the perceptions of person-centered practice of hospitalized older adults with chronic illness at a Portuguese inpatient hospital department. Methods A quantitative, descriptive, cross-sectional approach was followed. Data were collected using a sociodemographic and health history questionnaire and the Person-Centered Practice Inventory - Care (PCPI-C). The effect of the different variables on each PCPI-C construct was determined using analysis of variance (ANOVA). Results The results show that person-centered practice was positively perceived in the five constructs of the person-centered processes domain (M = 3.92; SD = 0.47). The highest-scored construct was w orking with the person’s beliefs and values (M = 4.12; SD = 0.51), and the lowest was working holistically (M = 3.68; SD = 0.70). No significant effect of the independent variables was found to influence the perceptions of any of the constructs in the person-centered processes domain. Conclusions These results might indicate that person-centered processes are perceived uniquely by each person through individualized therapeutic relationships rather than a pattern of care shared by hospitalized older adults.

Abstract Background Patient experience plays an essential role in improving clinical effectiveness and patient safety. It’s important to identify factors influencing patient experience and to improve quality of healthcare. Objective To identify factors that influence patient experience in hospital wards. Methods We conducted a systematic review including six databases; they were PubMed, CINAHL, Embase, PsycInfo, ProQuest, and Cochrane. Studies were included if they met the inclusion criteria. The JBI checklist was used to perform quality appraisal. We used 5 domains of the ecological model to organize and synthesize our findings to comprehensively understand the multi-level factors influencing the issue. Result A total of 138 studies were included, and 164 factors were identified. These factors were integrated into 6 domains. All domains but one (survey-related factors) could be mapped onto the attributes of the ecological framework: intrapersonal, interpersonal, institutional, community, and public policy level factors. All factors had mixed effect on patient experience. The intrapersonal level refers to individual characteristics of patients. The interpersonal level refers to interactions between patients and healthcare providers, such as the caring time spent by a nurse. The institutional level refers to organizational characteristics, rules and regulations for operations, such as hospital size and accreditation. The community level refers to relationships among organizations, institutions, and informational networks within defined boundaries, such as a hospital located in a larger population area. Public policy level refers to local, state, national, and global laws and policies, including health insurance policies. The sixth domain, survey-related factors, was added to the framework and included factors such as survey response rate and survey response time. Conclusion The factors influencing patient experience are comprehensive, ranging from intrapersonal to public policy. Providers should adopt a holistic and integrated perspective to assess patient experience and develop context-specific interventions to improve the quality of care. PROSPERO registration number CRD42023401066

Jessica L Bourdon,1 Sidney Judson,1 Taylor Fields,1 Sabrina Verdecanna,1 Nehal P Vadhan,2 Jon Morgenstern3 1Wellbridge Addiction Treatment and Research, Calverton, NY, USA; 2Institute of Behavioral Science, Feinstein Institutes for Medical Research. Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempsted, NY, USA; 3Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempsted, NY, USACorrespondence: Jessica L Bourdon, Email jbourdon@wellbridge.orgBackground: There is a lack of consensus in the addiction field as to how to refer to alumni of residential treatment who no longer use substances or who reduce their use. In the literature, this label and broader identity are typically discussed in technical (amount and frequency of use) or social terms (environment and social network changes).Objective: The current paper seeks to simplify the discussion by focusing on personal labels without complex technical or social considerations. Alumni of an inpatient addiction treatment facility were asked how they refer to themselves regarding their sobriety status post-discharge.Methods: Forty-nine patients were contacted 3 months post-discharge from a residential inpatient addiction treatment (men = 67%; Mage = 47.75 years). The patients completed a post-discharge assessment that was conducted by a trained research assistant over a 20-minute video call. The current study focused on a “sobriety label” measure in which patients indicated what they want to be called. Patients also explained why they chose their answer in an open-ended question.Results: Most patients identified as in recovery (n = 29; 59.18%) followed by a sober person (n = 7; 14.29%) and four other responses. No alum selected the in remission option, which is notably a common way to refer to patients who no longer use substances.Conclusion: The current study adds a critical patient/alumni perspective to the existing body of literature and serves as a call to action for researchers to add a similar “sobriety label” measure to future assessments, studies, and batteries in effort to bring consistency to the labels, definitions, and identities that are published. This methodology of understanding how this population identifies will create uniformity in future literature and decrease the stigma surrounding addiction.Plain Language Summary: There is a history of inconsistent use of labels, definitions, and identities in the addiction treatment field. Few past studies have directly asked patients how they self-label, and it is important to ask those who use substances or who have reduced their use what they preferred to be called. This study asked a simple question to alumni of an inpatient treatment facility what they want to be called. We then asked them to explain why they chose that answer. Most alumni identified as “in recovery” or “a sober person”. This simple tool can be utilized by other facilities and also highlights that many research studies are referring to individuals by terms they do not prefer (eg, “in remission”).Keywords: sobriety, identity, label, addiction, discharge, recovery, sober person, inpatient

Objectives: Delayed bleeding is the most frequent adverse event associated with endoscopic mucosal resection (EMR) and hot snare polypectomy (HSP) of colorectal polyps. However, whether the incidence of delayed bleeding differs between outpatient and inpatient treatment is unknown. Therefore, in this study, we aimed to evaluate delayed bleeding rates between outpatient and inpatient endoscopic treatments and clarify the safety of outpatient treatment. Methods: We enrolled 469 patients (1077 polyps) and 420 patients (1080 polyps) in the outpatient and inpatient groups, respectively, who underwent EMR or HSP for colorectal polyps at our institution between April 2020 and May 2023. Using propensity score matching, we evaluated the delayed bleeding rates between the two groups. Delayed bleeding was defined as a hemorrhage requiring endoscopic hemostasis occurring within 14 days of the procedure. Results: Propensity score matching created 376 (954 polyps) matched patient pairs. The median maximum diameter of polyps removed was 10 mm in both groups. Delayed bleeding rates per patients were 1.3% (5/376) in the outpatient group and 2.9% (11/376) in the inpatient group (P=0.21). In term of per polyp, early delayed bleeding (occurring within 24 hours) rates were higher in the inpatient group than outpatient group (0.2% [2/954] vs. 1.1% [10/954], respectively; P=0.04). No severe bleeding requiring a transfusion occurred in either group. Conclusions: Outpatient endoscopic treatment did not increase delayed bleeding compared with inpatient treatment. Outpatient treatment would be safe and common for the removal of colorectal polyps.

Abstract Background Physical health inequalities of people with serious mental illness (SMI) have been labelled an international scandal; due to the 15–20-year reduction in life expectancy associated with poor physical health. This occurs at an early stage and evidence shows young people with and at risk for SMI are a particularly vulnerable group requiring intervention and support. However, most work has been conducted with adults and little is known about what affects physical health for young people, specifically those receiving inpatient care. Methods We conducted semi-structured qualitative interviews with 7 service users and 6 staff members (85% female, age 14–42) on a generic mental health inpatient unit for children and adolescents. Interviews aimed to identify how young people viewed theirphysical health and factors affecting physical health and lifestyle and identify any support needed to improve physical health. Thematic analysis was conducted. . Results Thematic analysis revealed the main factors affecting physical health and lifestyle for young people. Three main themes were individual factors (subthemes were mental health symptoms, knowledge, attitudes and beliefs), environmental factors (subthemes were opportunities in a restricted environment and food provision), and the influence of others (subthemes were peers, staff, family members). These factors often overlapped and could promote a healthy lifestyle or combine to increase the risk of poor physical health. Young people discussed their preferences for physical health initiatives and what would help them to live a healthier lifestyle. Conclusions Promoting physical health on inpatient units for young people is an important, yet neglected area of mental health research. We have identified a range of complex factors which have an impact on their physical health, and there is a pervasive need to address the barriers that young people experience to living a healthy lifestyle. There is an increasingly strong evidence base suggesting the benefits of physical health interventions to improve outcomes, and future work should identify ways to implement such interventions considering the barriers discussed in this article. Further collaborative research is needed with young people, clinical teams, caregivers, and commissioners to ensure improvements are made to clinical care provision and optimisation of the inpatient environment.

Abstract Background Diabetes inpatient specialist services vary across the country, with limited evidence to guide service delivery. Currently, referrals to diabetes inpatient specialists are usually ‘reactive’ after diabetes-related events have taken place, which are associated with an increased risk of morbidity/mortality and increased length of hospital stay. We propose that a proactive diabetes review model of care, delivered by diabetes inpatient specialist nurses, may contribute to the prevention of such diabetes-related events and result in a reduction in the risk of harm. Method We will conduct a cluster randomised feasibility study with process evaluation. The proactive diabetes review model (PDRM) is a complex intervention that focuses on the prevention of potentially modifiable diabetes-related harms. All eligible patients will receive a comprehensive, structured diabetes review that aims to identify and prevent potentially modifiable diabetes-related harms through utilising a standardised review structure. Reviews are undertaken by a diabetes inpatient specialist nurse within one working day of admission. This differs from usual care where patients are often only seen after diabetes-related harms have taken place. The trial duration will be approximately 32 weeks, with intervention delivery throughout. There will be an initial 8-week run-in phase, followed by a 24-week data collection phase. Eight wards will be equally randomised to either PDRM or usual care. Adult patients with a known diagnosis of diabetes admitted to an included ward will be eligible. Data collection will be limited to that typically collected as part of usual care. Data collected will include descriptive data at both the ward and patient level and glucose measures, such as frequency and results of capillary glucose testing, ketonaemia and hypoglycaemic events. The analysis aims to determine the fidelity and acceptability of the intervention and the feasibility of a future definitive trial. Whilst this study is primarily about trial feasibility, the findings of the process evaluation may lead to changes to both trial processes and modifications to the intervention. A qualitative process evaluation will be conducted in parallel to the trial. A minimum of 22 patients, nurses, doctors, and managers will be recruited with methods including direct non-participant observation and semi-structured interviews. The feasibility of a future definitive trial will be assessed by evaluating recruitment and randomisation processes, staffing resources and quality of available data. Discussion The aim of this cluster randomised feasibility trial with a process evaluation is to explore the feasibility of a definitive trial and identify appropriate outcome measures. If a trial is feasible and the effectiveness of PDRM can be evaluated, this could inform the future development of inpatient diabetes services nationally. Trial registration UK Clinical Research Network, 51,167. ISRCTN, ISRCTN70402110. Registered on 21 February 2022.

Abstract Objective To compare the predictive efficacy of the PADUA and Caprini models for pulmonary embolism (PE) in gynecological inpatients, analyze the risk factors for PE, and validate whether both models can effectively predict mortality rates. Methods A total of 355 gynecological inpatients who underwent computed tomography pulmonary angiography (CTPA) were included in the retrospective analysis. The comparative assessment of the predictive capabilities for PE between the PADUA and Caprini was carried out using receiver operating characteristic (ROC) curves. Logistic regression analysis was used to identify risk factors associated with PE. Additionally, Kaplan–Meier survival analysis plots were generated to validate the predictive efficacy for mortality rates. Results Among 355 patients, the PADUA and Caprini demonstrated the area under the curve (AUC) values of 0.757 and 0.756, respectively. There was no statistically significant difference in the AUC between the two models (P = 0.9542). Multivariate logistic analysis revealed immobility (P

Abstract Background Dermatology grand rounds are popular educational activities among dermatologists and trainees, contributing to improved knowledge and skills. Dermatology hospital conferences at Mayo Clinic Dermatology are separate from dermatology grand rounds in that they focus on inpatient consultations and dermatology admissions. Objectives This study aimed to determine the types of cases presented during dermatology hospital grand rounds and evaluate the educational value of this continuing medical education (CME)‐accredited activity. Methods This retrospective study reviewed all inpatient dermatology cases presented during hospital grand rounds at Mayo Clinic Dermatology in Rochester, MN from 2019 to 2022; this study also reviewed the compiled surveys of faculty participants at our institution from 2019 to 2022. Results A total of 389 cases met the inclusion criteria for analysis. The most common diagnostic category was inflammatory/autoimmune diseases (157 cases, 40%), followed by infection or infestation (73 cases, 19%), drug‐induced eruptions (49 cases, 13%), neoplastic or metastatic diseases (41 cases, 11%), genetic/congenital disorders (21 cases, 5%), depositional/nutritional/metabolic conditions (15 cases, 4%) and wound/traumatic/iatrogenic dermatoses (12 cases, 3%), which were the least common. Most cases were presented for discussion of diagnosis and management (246 cases, 63%), but others focused on the arrival of diagnosis (119 cases, 31%) or management alone (24 cases, 6%). The compiled surveys of faculty participants (n = 50) indicated high satisfaction with dermatology hospital grand rounds, with the majority expressing that evidence‐based research was incorporated and positively impacted their practice. Most respondents indicated that hospital conference participation improved knowledge (97%), competence (64%), clinician performance (54%), patient outcomes (52%) and team performance (50%). Conclusions The cases presented during these conferences spanned from challenging inflammatory diseases to simple dermatoses, with over 800 literature references reviewed. Dermatology hospital grand rounds provide high value as a CME‐accredited activity for dermatology faculty, even for those without a specific interest in hospital/inpatient dermatology.

Background: The growing aging trend associated with a higher prevalence of chronic illnesses is increasing the demand for the development of person-centered practice in specific care settings. Knowing the person's perception of the care and the care experience is essential to improving inpatient care toward person-centeredness. This study aims to characterize the perceptions of person-centered practice of hospitalized older adults with chronic illness at a Portuguese inpatient hospital department. Methods: A quantitative, descriptive, cross-sectional approach was followed. Data were collected using a sociodemographic and health history questionnaire and the Person-Centered Practice Inventory - Care (PCPI-C). The effect of the different variables on each PCPI-C construct was determined using analysis of variance (ANOVA). Results: The results show that person-centered practice was positively perceived in the five constructs of the person-centered processes domain (M = 3.92; SD = 0.47). The highest-scored construct was working with the person's beliefs and values (M = 4.12; SD = 0.51), and the lowest was working holistically (M = 3.68; SD = 0.70). No significant effect of the independent variables was found to influence the perceptions of any of the constructs in the person-centered processes domain. Conclusions: These results might indicate that person-centered processes are perceived uniquely by each person through individualized therapeutic relationships rather than a pattern of care shared by hospitalized older adults. [ABSTRACT FROM AUTHOR]

Background: Eating disorders are complex difficulties that impact the individual, their supporters and society. Increasing numbers are being admitted to intensive treatment settings (e.g., for inpatient treatment, day-patient treatment or acute medical treatment). The lived experience perspectives of what helps and hinders eating disorder recovery during intensive treatment is an emerging area of interest. This review aims to explore patients' perspectives of what helps and hinders recovery in these contexts. Methods: A systematic review was conducted to identify studies using qualitative methods to explore patients' experiences of intensive treatment for an eating disorder. Article quality was assessed using the Critical Appraisal Skill Programme (CASP) checklist and thematic synthesis was used to analyse the primary research and develop overarching analytical themes. Results: Thirty articles met inclusion criteria and were included in this review. The methodological quality was mostly good. Thematic synthesis generated six main themes; collaborative care supports recovery; a safe and terrifying environment; negotiating identity; supporting mind and body; the need for specialist support; and the value of close others. The included articles focused predominantly on specialist inpatient care and were from eight different countries. One clear limitation was that ethnicity data were not reported in 22 out of the 30 studies. When ethnicity data were reported, participants predominantly identified as white. Conclusions: This review identifies that a person-centred, biopsychosocial approach is necessary throughout all stages of eating disorder treatment, with support from a sufficiently resourced and adequately trained multidisciplinary team. Improving physical health remains fundamental to eating disorder recovery, though psychological support is also essential to understand what causes and maintains the eating disorder and to facilitate a shift away from an eating disorder dominated identity. Carers and peers who instil hope and offer empathy and validation are valuable additional sources of support. Future research should explore what works best for whom and why, evaluating patient and carer focused psychological interventions and dietetic support during intensive treatment. Future research should also explore the long-term effects of, at times, coercive and distressing treatment practices and determine how to mitigate against potential iatrogenic harm. Plain English summary: Some people with eating disorders will need intensive treatment (e.g., inpatient treatment, day-patient treatment or acute medical treatment) during the course of their illness. Understanding what helps and hinders eating disorder recovery during intensive treatment is an important part of developing effective interventions. This review summarises research exploring people with eating disorders' perspectives of intensive treatment, with the aim of identifying what helps and hinders eating disorder recovery. We searched in scientific databases for all published qualitative studies that explored people with eating disorders' perspectives of intensive treatment. Thirty studies meet the inclusion criteria of this literature review. The results sections of these studies were analysed by extracting relevant findings relating to eating disorder recovery. We found that a person-centred, holistic approach is necessary throughout all stages of eating disorder treatment, with support from healthcare professionals and carers with specialist knowledge of how to support people with eating disorders. Improving physical health is fundamental to eating disorder recovery. However, psychological support is also essential to help people with eating disorders to understand what causes and maintains the eating disorder and support them to move away from an eating disorder dominated identity. Areas for future research are outlined. [ABSTRACT FROM AUTHOR]

Background: Patient experience plays an essential role in improving clinical effectiveness and patient safety. It's important to identify factors influencing patient experience and to improve quality of healthcare. Objective: To identify factors that influence patient experience in hospital wards. Methods: We conducted a systematic review including six databases; they were PubMed, CINAHL, Embase, PsycInfo, ProQuest, and Cochrane. Studies were included if they met the inclusion criteria. The JBI checklist was used to perform quality appraisal. We used 5 domains of the ecological model to organize and synthesize our findings to comprehensively understand the multi-level factors influencing the issue. Result: A total of 138 studies were included, and 164 factors were identified. These factors were integrated into 6 domains. All domains but one (survey-related factors) could be mapped onto the attributes of the ecological framework: intrapersonal, interpersonal, institutional, community, and public policy level factors. All factors had mixed effect on patient experience. The intrapersonal level refers to individual characteristics of patients. The interpersonal level refers to interactions between patients and healthcare providers, such as the caring time spent by a nurse. The institutional level refers to organizational characteristics, rules and regulations for operations, such as hospital size and accreditation. The community level refers to relationships among organizations, institutions, and informational networks within defined boundaries, such as a hospital located in a larger population area. Public policy level refers to local, state, national, and global laws and policies, including health insurance policies. The sixth domain, survey-related factors, was added to the framework and included factors such as survey response rate and survey response time. Conclusion: The factors influencing patient experience are comprehensive, ranging from intrapersonal to public policy. Providers should adopt a holistic and integrated perspective to assess patient experience and develop context-specific interventions to improve the quality of care. PROSPERO registration number CRD42023401066: [ABSTRACT FROM AUTHOR]

Background: Inpatient use of insulin pump therapy has been increasing due to greater availability of this technology, however there is a paucity of research that investigates glycemic control of inpatient insulin pump users. Objective: To compare the glycemic control of hospitalized patients with type 1 diabetes (T1D) who used insulin pump vs. multiple daily injections (MDI). Design: Retrospective chart review. Participants: Patients with T1D who were hospitalized between January 1, 2017, and December 31, 2019, in an academic medical center in the New York metropolitan area. Main Measures: Patients were categorized into three groups based on their method of insulin administration: "pump only" group used insulin pump exclusively, "MDI only" group used MDI only, and "intermittent pump" group used a combination of both methods. The primary endpoints are mean blood glucose, rates of hypoglycemic events (blood glucose < 70 mg/dL), and rates of hyperglycemic events (blood glucose > 250 mg/dL). Separate multivariable Poisson regressions were performed to determine the association between the type of insulin administration and rate outcomes (i.e., rate of hypoglycemic events and rate of hyperglycemic events). Results: The study included 78 patients with a mean age of 51, who were mostly male (54%), and white (72%). The average proportion of glucose measurements that were hyperglycemic for the "pump only", "MDI only", and "intermittent pump" groups were 0.11 (SD = 0.11), 0.25 (SD = 0.19), and 0.24 (SD = 0.25), respectively. The "pump only" group has a significantly lower proportion of hyperglycemic events as compared to the "MDI only" group (p = 0.0227). Conclusions: In this sample, patients who exclusively used their insulin pump while inpatient had a lower rate of hyperglycemic events than patients who used MDI only; suggesting that select patients can safely continue their insulin pump therapy in the inpatient setting. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the burden and impact of cardiac and cerebrovascular disease (CCD) on hospital inpatients with type 1 diabetes mellitus (T1DM). Methods: This is a retrospective nationwide cohort study of people with T1DM with or without CCD in the US National Inpatient Sample between 2016 and 2019. The in-hospital mortality rates, length of stay (LoS), and healthcare costs were determined. Results: A total of 59,860 T1DM patients had a primary diagnosis of CCD and 1,382,934 did not. The median LoS was longer for patients with CCD compared to no CCD (4.6 vs. 3 days). Patients with T1DM and CCD had greater in-hospital mortality compared to those without CCD (4.1% vs. 1.1%, p < 0.001). The estimated total care cost for all patients with T1DM with CCD was approximately USD 326 million. The adjusted odds of mortality compared to patients with non-CCD admission was greatest for intracranial hemorrhage (OR 17.37, 95%CI 12.68–23.79), pulmonary embolism (OR 4.39, 95%CI 2.70–7.13), endocarditis (OR 3.46, 95%CI 1.22–9.84), acute myocardial infarction (OR 2.31, 95%CI 1.92–2.77), and stroke (OR 1.47, 95%CI 1.04–2.09). Conclusions: The burden of CCD in patients with T1DM is substantial and significantly associated with increased hospital mortality and high healthcare expenditures. [ABSTRACT FROM AUTHOR]

Background: The challenge of emerging antimicrobial resistance and variation in antibiotic use across provinces in China call for knowledge on antibiotic utilization at the regional level. This study aims to evaluate the long-term trends and patterns of antibiotic usage in Xinjiang Province, the largest provincial-level division located in the northwest of China, aiming to provide evidence in enhancing provincial antimicrobial stewardship (AMS) and developing policy measures to optimize regional antimicrobial use. Methods: This was an ecological study with temporal trend analysis on inpatient antibiotic utilization, with antibiotic use data from 92 public hospitals covered by Xinjiang's Center for Antibacterial Surveillance from 2012 to 2022. Antibiotic use was measured by the number of daily defined doses per 100 patient days (DDDs/100 pds). Patterns of antibiotic use were described by Anatomical Therapeutic Chemical (ATC) subgroups and the Access, Watch, Reserve (AWaRe) classification. The Average Annual Percent Change (AAPC) of antibiotic use and the corresponding 95% confidence intervals (CIs) were calculated to describe the trend of antibiotic use over time. Joinpoint regression was performed using the Weighted Bayesian Information Criteria (WBIC) model with a parametric method. A pairwise comparison between secondary and tertiary hospitals was conducted to explore disparities in antibiotic use across hospital levels. The most commonly used antibiotics were also analyzed. Results: The total inpatient antibiotic use in Xinjiang was 27.6 DDDs/100 patient days in 2022, with a significant decreasing trend during 2012–2022 (AAPC, −2.0%; 95% CI, −3.6% to −0.4%). The Watch group antibiotics were the most used AWaRe category, with the Access-to-Watch ratio decreasing significantly from 46.4% to 24.4% (AAPC, −6.8%; 95% CI, −8.4% to −5.1%). No significant difference was found in the trend of total antibiotic use between secondary and tertiary hospitals, but there were disparities across hospital levels in subgroups. Third-generation cephalosporins, second-generation cephalosporins, and fluoroquinolones remained the top three antibiotic class throughout the study period. The number of antibiotics accounting for 90% of the total antibiotic use decreased from 34 antibiotics in 2012 to 18 antibiotics in 2022. Conclusions: The decreasing trend of inpatient antibiotic use in Xinjiang's public hospitals reflects the effects of continuous AMS implementation. Patterns of antibiotic use underscore the need for further efforts on evidence-based antibiotic selection and for analyses on the appropriateness of antibiotic use. [ABSTRACT FROM AUTHOR]

Background: Physical health inequalities of people with serious mental illness (SMI) have been labelled an international scandal; due to the 15–20-year reduction in life expectancy associated with poor physical health. This occurs at an early stage and evidence shows young people with and at risk for SMI are a particularly vulnerable group requiring intervention and support. However, most work has been conducted with adults and little is known about what affects physical health for young people, specifically those receiving inpatient care. Methods: We conducted semi-structured qualitative interviews with 7 service users and 6 staff members (85% female, age 14–42) on a generic mental health inpatient unit for children and adolescents. Interviews aimed to identify how young people viewed theirphysical health and factors affecting physical health and lifestyle and identify any support needed to improve physical health. Thematic analysis was conducted.. Results: Thematic analysis revealed the main factors affecting physical health and lifestyle for young people. Three main themes were individual factors (subthemes were mental health symptoms, knowledge, attitudes and beliefs), environmental factors (subthemes were opportunities in a restricted environment and food provision), and the influence of others (subthemes were peers, staff, family members). These factors often overlapped and could promote a healthy lifestyle or combine to increase the risk of poor physical health. Young people discussed their preferences for physical health initiatives and what would help them to live a healthier lifestyle. Conclusions: Promoting physical health on inpatient units for young people is an important, yet neglected area of mental health research. We have identified a range of complex factors which have an impact on their physical health, and there is a pervasive need to address the barriers that young people experience to living a healthy lifestyle. There is an increasingly strong evidence base suggesting the benefits of physical health interventions to improve outcomes, and future work should identify ways to implement such interventions considering the barriers discussed in this article. Further collaborative research is needed with young people, clinical teams, caregivers, and commissioners to ensure improvements are made to clinical care provision and optimisation of the inpatient environment. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Patient falls during hospitalisation can cause catastrophic injuries and remain one of the major patient-safety issues faced by hospitals. This study was designed to determine the inpatient falls rate and the association between fall-related injury and sociodemographic variables. MATERIALS AND METHODS: A retrospective record review was conducted for a one-time inpatient fall in a single centre between January 2017 and December 2019. Pearson chi-square or Fisher's exact test were performed to assess association between the categorical variables. RESULTS: There were 44 inpatient falls who fell one time between January 2017 and December 2019. The inpatients fall rate was 3.0 per 10000 patient-days from 2017 to 2019. Overall, the patients who fell experienced an injury (n=24, 55%). There was no significant difference between age group, gender, time of fall, assisted type, history of fall, fall risk assessment, mental status, the department involved, and injurious fall outcome. CONCLUSION: Our study showed a low incidence of fall rate per 10000 patientdays for 2017-2019. More than half of the fallers experienced an injurious fall. The highest fall rate was noted in the surgical based departments. However, there was no significant difference between injurious fall outcomes and sociodemographic variables. Risk assessments and management strategies should focus on education, particularly bed safety. [ABSTRACT FROM AUTHOR]

This study aimed to describe the effect of the pandemic on epidemiologic trends and disparities in outcomes for patients hospitalized with acute hyperglycemic complications (AHC). This was a retrospective study of the National Inpatient Sample (NIS) database from 2016 to 2020. The population included adults hospitalized with AHCs as a principal diagnosis using the Clinical Classifications Software Refined code. There was a decrease in the AHC hospitalization rate per 100,000 admissions for type 1 diabetes (T1D) during the pandemic (577 vs 600). However, there was an increase for type 2 diabetes (T2D) (117 vs 125). The mean age during the pandemic versus prepandemic was 34.8 ± 14.1 vs 34.7 ± 14.2 (P = 0.41) and 59.1 ± 14.4 vs 58.8 ± 14.7 (P = 0.51) for T1D and T2D, respectively. No statistically significant difference was observed in mortality in T1D (0.20 vs 0.23; P = 0.42) or T2D (1.1 vs 0.8; P = 0.09). There was no difference in mortality after stratifying results by gender, race, median household income, or hospital region. During the pandemic, COVID-19 was the principal diagnosis in 5.5% of those with AHC in T1D and 9.1% in those with AHC in T2D. The pandemic had a significant impact on the hospitalization rate for both T1D and T2D. [ABSTRACT FROM AUTHOR]

Background: Total ankle arthroplasty (TAA) has primarily been performed in the inpatient setting. However, with the advent of fast-tracked joint arthroplasty protocols, TAA has slowly been shifting to the outpatient setting. Therefore, this systematic review aims to evaluate outcomes of outpatient TAA and compare them to inpatient TAA. Methods: A literature search was performed on October 23, 2023, in the PubMed, Embase, and CENTRAL databases using the PRISMA guidelines. Studies were included if they reported on outcomes of outpatient TAA or compared outcomes between outpatient and inpatient TAA. Pooled odds ratios (ORs) and mean differences were calculated using a random effects model. Quality assessment was performed using the MINORS criteria. Results: 12 studies were included, with 4 outpatient-only and 8 outpatient-inpatient comparative studies. Patients in the outpatient group were relatively younger, had a lower body mass index, and had fewer comorbidities relative to the inpatient group. For outpatient vs inpatient TAA, the pooled complication rate was 2.6% vs 3.6%, readmission rate was 2.5% vs 4%, and reoperation rate was 3.6% vs 5.5%. We found significantly lower odds of complications (OR = 0.47, CI: 0.26-0.85; P =.01), readmissions (OR = 0.63, CI: 0.54-0.74; P <.00001), and reoperations (OR = 0.66, CI: 0.46-0.95; P =.03) in the outpatient vs inpatient group. Conclusion: Although this analysis is limited by the dominance of data included from a single study, we found that outpatient TAA was generally performed on lower-risk patients and was associated with lower rates of complications, readmissions, and reoperations compared with inpatient TAA. [ABSTRACT FROM AUTHOR]

While several studies have shown that insulin pens are more convenient and accurate than conventional administration with syringes and vials (syringes/vials), there is a frequent need for low-dose insulin injections administered by nurses using syringes/vials in hospital settings, particularly for critically ill patients. However, there is a lack of research investigating factors related to the accuracy of low-dose insulin administration using syringes/vials, particularly in hospital settings. We therefore performed a cross-sectional study to assess the accuracy of low-dose insulin administration by registered nurses using syringes/vials and to determine whether time of day, years of experience and adherence to proper injection procedures (vertical insertion/drawing and air bubble checking) affected the accuracy. The participants were 33 registered nurses working in the diabetes ward, and a total of 198 trials were analyzed. Using syringes/vials, the median errors converted to insulin units were found to be 0.6 units for the 2- and 6-unit target doses, and 0.7 units for the 10-unit target dose. In cases with the largest error, errors for the 2-, 6-, and 10-unit target doses were observed to be 2.3, 4.0, and 3.3 units, respectively. In our study, time of day, years of experience and vertical insertion/drawing did not correlate with errors, but errors were significant in the participants who did not check for air bubbles. Nurses can make non-negligible dosage errors when administering low-dose insulin using syringes/vials, and this is particularly likely when air bubble checks are missed. [ABSTRACT FROM AUTHOR]

Introduction: The care of people with schizophrenia (PWS) is usually provided in an outpatient setting by community mental health teams. However, PWS frequently require inpatient treatment because of a wide array of clinical, personal and/or social situations. Unfortunately, to our knowledge, there are no guidelines available to help psychiatrists in the decision-making process on hospital discharge for PWS. The aim of this project was to develop an expert consensus on discharge criteria for PWS after their stay in an acute inpatient psychiatric unit. Methods: Using a modified Delphi method a group of 42 psychiatrists throughout Spain evaluated four areas of interest regarding this issue: clinical symptomatology, treatment-related factors, follow-up health care units after discharge, and physical health and monitoring. Results: After two rounds, among the 64 statements, a consensus was reached for 59 (92.2%) statements. In three (17.7%) of the 17 statements on 'clinical symptomatology' and 2 (13.3%) of the 15 statements on 'follow-up health care units after discharge', a consensus was not reached; in contrast, a consensus was reached for all statements concerning 'treatment-related factors' and those concerning 'physical health and monitoring'. The consensus results highlight the importance for discharge of the control of symptoms rather than their suppression during admission and of tolerability in the selection of anantipsychotic. Discussion: Although there is a lack of relevant data for guiding the discharge of PWS after hospitalization in an acute inpatient psychiatric unit, we expect that this consensus based on expert opinion may help cl inicians to take appropriate decisions. [ABSTRACT FROM AUTHOR]

Background: Diabetes inpatient specialist services vary across the country, with limited evidence to guide service delivery. Currently, referrals to diabetes inpatient specialists are usually 'reactive' after diabetes-related events have taken place, which are associated with an increased risk of morbidity/mortality and increased length of hospital stay. We propose that a proactive diabetes review model of care, delivered by diabetes inpatient specialist nurses, may contribute to the prevention of such diabetes-related events and result in a reduction in the risk of harm. Method: We will conduct a cluster randomised feasibility study with process evaluation. The proactive diabetes review model (PDRM) is a complex intervention that focuses on the prevention of potentially modifiable diabetes-related harms. All eligible patients will receive a comprehensive, structured diabetes review that aims to identify and prevent potentially modifiable diabetes-related harms through utilising a standardised review structure. Reviews are undertaken by a diabetes inpatient specialist nurse within one working day of admission. This differs from usual care where patients are often only seen after diabetes-related harms have taken place. The trial duration will be approximately 32 weeks, with intervention delivery throughout. There will be an initial 8-week run-in phase, followed by a 24-week data collection phase. Eight wards will be equally randomised to either PDRM or usual care. Adult patients with a known diagnosis of diabetes admitted to an included ward will be eligible. Data collection will be limited to that typically collected as part of usual care. Data collected will include descriptive data at both the ward and patient level and glucose measures, such as frequency and results of capillary glucose testing, ketonaemia and hypoglycaemic events. The analysis aims to determine the fidelity and acceptability of the intervention and the feasibility of a future definitive trial. Whilst this study is primarily about trial feasibility, the findings of the process evaluation may lead to changes to both trial processes and modifications to the intervention. A qualitative process evaluation will be conducted in parallel to the trial. A minimum of 22 patients, nurses, doctors, and managers will be recruited with methods including direct non-participant observation and semi-structured interviews. The feasibility of a future definitive trial will be assessed by evaluating recruitment and randomisation processes, staffing resources and quality of available data. Discussion: The aim of this cluster randomised feasibility trial with a process evaluation is to explore the feasibility of a definitive trial and identify appropriate outcome measures. If a trial is feasible and the effectiveness of PDRM can be evaluated, this could inform the future development of inpatient diabetes services nationally. Trial registration: UK Clinical Research Network, 51,167. ISRCTN, ISRCTN70402110. Registered on 21 February 2022. [ABSTRACT FROM AUTHOR]

Objective: To compare the predictive efficacy of the PADUA and Caprini models for pulmonary embolism (PE) in gynecological inpatients, analyze the risk factors for PE, and validate whether both models can effectively predict mortality rates. Methods: A total of 355 gynecological inpatients who underwent computed tomography pulmonary angiography (CTPA) were included in the retrospective analysis. The comparative assessment of the predictive capabilities for PE between the PADUA and Caprini was carried out using receiver operating characteristic (ROC) curves. Logistic regression analysis was used to identify risk factors associated with PE. Additionally, Kaplan–Meier survival analysis plots were generated to validate the predictive efficacy for mortality rates. Results: Among 355 patients, the PADUA and Caprini demonstrated the area under the curve (AUC) values of 0.757 and 0.756, respectively. There was no statistically significant difference in the AUC between the two models (P = 0.9542). Multivariate logistic analysis revealed immobility (P < 0.001), history of venous thromboembolism (VTE) (P = 0.002), thrombophilia (P < 0.001), hormonal treatment (P = 0.022), and obesity (P = 0.019) as independent risk factors for PE. Kaplan–Meier survival analysis demonstrated the reliable predictive efficacy of both the Caprini (P = 0.00051) and PADUA (P = 0.00031) for mortality. ROC for the three- and six-month follow-ups suggested that the Caprini model exhibited superior predictive efficacy for mortality. Conclusions: The PADUA model can serve as a simple and effective tool for stratifying high-risk gynecological inpatients before undergoing CTPA. The Caprini model demonstrated superior predictive efficacy for mortality rates. [ABSTRACT FROM AUTHOR]

Background: The incidence of a disease can help health professionals to identify risk factors and health-care policymakers to develop corresponding policies. The realization of both purposes depends on comprehensive studies, especially studies done on a large scale. However, comprehensive studies on the incidence of anaphylaxis among inpatients in China are still notably scarce. Hence we aim to explore the incidence and clinical characteristics of anaphylaxis among inpatients over a span of 21 years in Wuhan, China. Methods: We retrieved data on anaphylaxis cases from the Data Platform Application Portal (DPAP) across 3 medical centers of Tongji Hospital, Wuhan, China from January 1, 2003, to December 31, 2023. Results: The data encompassed a total of 362 anaphylaxis patients from 2,139,272 inpatients. Among them 204 (56.4%) were male, and the median age was 45 years old. Over the past 2 decades, the incidence rate of anaphylaxis at Tongji Hospital was 16.92 per 100,000 individuals. After adjusting for gender and age, the annual standardized incidence rate was 234.53 per 100,000 individuals. The incidence rate of anaphylaxis among the inpatients revealed a relatively stable but slowly rising trend over the 21-year observation period. As for the triggers of anaphylaxis, drugs were responsible for 73.6% of triggers, with antibiotics representing the highest proportion of these cases (38.4%). Drug triggers also showed age-specific features: chemotherapy (17.9%) had the highest proportions among children aged 0–3 years; blood products were more prevalent in school-age children. 13.5% of the cases had an unknown cause. In anaphylaxis cases, despite that only 36.0% received epinephrine treatment, the application of epinephrine still showed an ascending trend. Moreover, the mortality rate for anaphylaxis was relatively low (1.6%), displaying a consistent downward trend. Conclusion: Our study provides insights into the incidence of anaphylaxis among inpatients in Wuhan over a 21-year period. Drugs are the most common triggers for anaphylaxis, and the use of epinephrine in anaphylaxis management is far from optimal.

Background: Corticosteroids raise blood glucose concentrations; however, it remains unknown which form of administration, oral or intravenous, is associated with the greatest degree of blood glucose rise in hospitalised patients. Furthermore, it is not known whether the pattern of the associated hyperglycaemia throughout the day differs depending on the route of administration. Methods: This was a single centre retrospective study of 384 adult inpatients receiving oral or intravenous hydrocortisone and dexamethasone. Data on capillary glucose concentrations and time taken over 7 days were collected. A mixed model for repeated measures was applied to compare changes in glucose concentration over time for oral and intravenous corticosteroids. An auto-regressive covariance structure was employed to model correlations between repeated measurements. This was adjusted for age, sex, pre-admission diabetes, and/or pre-admission corticosteroid status. Results: No significant difference was found between oral and intravenous hydrocortisone on day 1 or across all 7 days (mean difference 0.17 mmol/L (−1.39, 1.75), p = 0.827, and mean difference 0.20 mmol/L (−0.61, 1.01), p = 0.639 respectively). There were no differences in mean glucose concentrations between those on oral or intravenous dexamethasone on day 1 or across all 7 days (mean difference 0.41 mmol/L (−0.55, 1.38), p = 0.404 and mean difference −0.09 mmol/L (−1.05,0.87), p = 0.855, respectively). Conclusion: This study found that oral and intravenous administration of hydrocortisone and dexamethasone do not have a significantly differing impact on blood glucose levels. Capillary glucose monitoring is strongly recommended in all individuals who are on either oral or intravenous corticosteroids.

ABSTRACT Background Children with medical complexity (CMC) have high healthcare utilization and face unique challenges during hospital admissions. The evidence describing their experiences of inpatient care is distributed across disciplines. The aim of this scoping review was to map the evidence related to the inpatient experience of care for CMC and their families, particularly related to key aspects and methodological approaches, and identify gaps that warrant further study. Methods This scoping review was conducted in accordance with JBI methodology and included all studies that reported experiences of acute hospital care for CMC/families. All study designs were included. Databases searched included EMBASE, CINAHL Plus with Full Text, Web of Science, MEDLINE(R) and APA PsycInfo from 2000 to 2022. Details about the participants, concepts, study methods and key findings were abstracted using a data abstraction tool. A thematic analysis was conducted. Results Forty‐nine papers were included: 27 qualitative studies, 10 quantitative studies, six mixed methods studies, two descriptive studies and four reviews. Some quantitative studies used validated instruments to measure experience of care, but many used non‐validated surveys. There were a few interventional studies with a small sample size. Results of thematic analysis described the importance of negotiating care roles, shared decision‐making, common goal setting, relationship‐building, communication, sharing expertise and the hospital setting itself. Conclusion CMC and families value relational elements of care and partnering through sharing expertise, decision‐making and collaborative goal‐setting when admitted to hospital. Patient or Public Contribution This review was conducted in alignment with the principles of patient and family engagement. The review was conceptualized, co‐designed and conducted with the full engagement of the project's parent–partner. This team member was involved in all stages from constructing the review question, to developing the protocol, screening articles and drafting this manuscript.

IntroductionSubstance use disorders (SUDs) are common, and there is evidence of clinically significant benefit of cognitive behavioral therapy (CBT). The efficacy of CBT in SUDs has been confirmed, although relapse rates of 40%–60% have been reported. An enhancement of CBT-based therapy through an animal-assisted intervention (AAI) with sheep to normalize the occurrence of negative emotions and improve positive emotions as well as mindfulness and self-efficacy expectancy was investigated.MethodsA single-session AAI with sheep in a group setting was investigated against treatment as usual over time. N = 36 psychiatric inpatients with SUDs were examined by questionnaires before and 1 week after the intervention and additionally immediately after the intervention.ResultsPositive emotions improved significantly in the AAI group 1 week after the intervention with a medium effect size, but not in the control group. Similarly, mindfulness and self-efficacy expectancy improved over time in the AAI group. When exploratory results were evaluated immediately after the intervention while still on the farm, the effects in favor of AAI were even larger.ConclusionsAAI can thus be considered effective in improving positive emotions, mindfulness, and self-efficacy expectancy. The impressive effect sizes immediately after the intervention encourage us to consider what can be done to maintain these even greater effect sizes over time.Clinical Trial Registrationhttps://drks.de/search/de/trial/DRKS00027539, identifier DRKS 00027539.

BACKGROUND: In-hospital dermatological care has shifted from dedicated dermatology wards to consultation services, and some consulted patients may require postdischarge follow-up in outpatient dermatology. Safe and timely care transitions from inpatient-to-outpatient specialty care are critical for patient health, but communication around these transitions can be disjointed, and workflows can be complex. OBJECTIVE: In this 3-phase quality improvement effort, we developed and evaluated an intervention that leveraged an electronic health record (EHR) feature, known as SmartPhrase, to enable a new workflow to improve transitions from inpatient care to outpatient dermatology. METHODS: Phase 1 (February-March 2021) included interviews with patients and process mapping with key stakeholders to identify gaps and inform an intervention: a SmartPhrase table and associated workflow to promote collection of patient information needed for scheduling follow-up and closed-loop communication between dermatology and scheduling teams. In phase 2 (April-May 2021), semistructured interviews-with dermatologists (n=5), dermatology residents (n=5), and schedulers (n=6)-identified pain points and refinements. In phase 3, the intervention was evaluated by triangulating data from these interviews with measured changes in scheduling efficiency, visit completion, and messaging volume preimplementation (January-February 2021) and postimplementation (April-May 2021). RESULTS: Preintervention pain points included unclear workflow for care transitions, limited patient input in follow-up planning, multiple messaging channels (eg, EHR based, email, and phone messages), and time-inefficient patient tracking. The intervention addressed most pain points; interviewees reported the intervention was easy to adopt and improved scheduling efficiency, workload, and patient involvement. More visits were completed within the desired timeframe of 14 days after discharge during the postimplementation period (21/47, 45%) than the preimplementation period (28/41, 68%; P=.03). The messaging workload also decreased from 88 scheduling-related messages sent for 25 patients before implementation to 30 messages for 8 patients after implementation. CONCLUSIONS: Inpatient-to-outpatient specialty care transitions are complex and involve multiple stakeholders, thus requiring multifaceted solutions. With deliberate evaluation, broad stakeholder input, and iteration, we designed and implemented a successful solution using a standard EHR feature, SmartPhrase, integrated into a standardized workflow to improve the timeliness of posthospital specialty care and reduce workload.

Abstract Background Body worn cameras (BWC) are mobile audio and video capture devices that can be secured to clothing allowing the wearer to record some of what they see and hear. This technology is being introduced in a range of healthcare settings as part of larger violence reduction strategies aimed at reducing incidents of aggression and violence on inpatient wards, however limited evidence exists to understand if this technology achieves such goals. Aim This study aimed to evaluate the implementation of BWCs on two inpatient mental health wards, including the impact on incidents, the acceptability to staff and patients, the sustainability of the resource use and ability to manage the use of BWCs on these wards. Methods The study used a mixed-methods design comparing quantitative measures including ward activity and routinely collected incident data at three time-points before during and after the pilot implementation of BWCs on one acute ward and one psychiatric intensive care unit, alongside pre and post pilot qualitative interviews with patients and staff, analysed using a framework based on the Consolidated Framework for Implementation Research. Results Results showed no clear relationship between the use of BWCs and rates or severity of incidents on either ward, with limited impact of using BWCs on levels of incidents. Qualitative findings noted mixed perceptions about the use of BWCs and highlighted the complexity of implementing such technology as a violence reduction method within a busy healthcare setting Furthermore, the qualitative data collected during this pilot period highlighted the potential systemic and contextual factors such as low staffing that may impact on the incident data presented. Conclusion This study sheds light on the complexities of using such BWCs as a tool for ‘maximising safety’ on mental health settings. The findings suggest that BWCs have a limited impact on levels of incidents on wards, something that is likely to be largely influenced by the process of implementation as well as a range of contextual factors. As a result, it is likely that while BWCs may see successes in one hospital site this is not guaranteed for another site as such factors will have a considerable impact on efficacy, acceptability, and feasibility.