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During the initial wave of coronavirus disease of 2019 (COVID-19), patients were rapidly discharged from acute hospitals in anticipation of an expected influx of patients with COVID-19. Patients that were no longer receiving acute medical care but were waiting for their next destination (i.e., delayed hospital discharge) were particularly affected. The objectives of this study were to examine the impact of COVID-19 onset on healthcare utilization and mortality among those who experienced delayed discharge from acute care. We conducted a population-based retrospective cohort study using linked administrative data. We included persons discharged from acute care who experienced a delayed hospital stay between April 1, 2019 and September 30, 2020. The onset of COVID-19 was the exposure (March 1, 2020), while the period of April 1, 2019 to February 29, 2020 was considered as a comparator. Primary outcomes included healthcare utilization and mortality following discharge, stratified by care setting (homecare, inpatient rehabilitation or long-term care). Multivariable logistic, zero-inflated Poisson regressions, and Cox proportional hazard models were used to examine the impact of COVID-19 on outcomes while adjusting for covariates. Those discharged home were more likely to receive homecare and physician visits within 30 days during COVID-19. The type of visits examined included both in-person as well as virtual visits. Individuals discharged to inpatient rehabilitation experienced lower rates of general physician visits but higher rates of specialist and homecare visits. Patients discharged to long-term care were significantly less likely to receive a physician visit following COVID-19, and significantly more likely to be readmitted within 7-days. There were no significant differences in mortality irrespective of discharge destination during the two time periods. Overall, the onset of the initial wave of COVID-19 significantly impacted healthcare utilization among those with a delayed discharge but varied depending on destination, with those in long-term care being most impacted. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionsExisting research suggests that emotion plays an important role in airway inflammation and asthma symptom control. The objective of this study was to determine whether difficulties regulating emotion were associated with overuse of short-acting inhaled medications and acute medical care usage in adults with asthma.The sample included 401 adults with asthma recruited from an online panel of adults with chronic respiratory disease. Sequential binary logistic regression models were used to examine the associations of emotion regulation with short-acting inhaled medication use and acute medical care use, controlling for patient characteristics and comorbid mental health conditions.Greater difficulties with emotion regulation were significantly associated with greater odds of short-acting inhaler medication overuse (p < 0.001), emergency department visits (p < 0.001), and hospitalizations (p = 0.001).Emotion dysregulation may play an important role in asthma management. Evidence-based interventions to reduce difficulties in emotion regulation may help improve problematic patterns of short-acting medication overuse and acute service use. The current findings should be interpreted in the context of several limitations, including the use of self-report measures. Future research should use electronic medical records or metered dose inhalers to objectively assess short-acting inhaler overuse and acute medical care use. [ABSTRACT FROM AUTHOR]

Purpose: Older patients have a higher risk of aspiration pneumonia and mortality if they are hospitalized. We aimed to assess the effectiveness of an aspiration prevention quality improvement (QI) program that utilizes the Gugging Swallowing Screen (GUSS) in older patients. Patients and Methods: This retrospective cohort study was conducted in an acute medical care unit of a tertiary hospital in South Korea. The study used one-to-one propensity matching and included 96 patients who received the QI program and 96 who did not. All patients were aged 65 years or older and had risk factors for aspiration, including neurological and non-neurological disorders, neuromuscular disorders, impaired airway defenses, and dysphagia due to esophageal or gastrointestinal disorders. The primary outcomes included the duration of the fasting period during hospitalization, changes in nutritional status before admission and at discharge, in-hospital mortality, and readmission due to pneumonia within 90 days. Results: Fasting period, changes in weight and albumin levels upon discharge after hospitalization, and length of stay did not differ significantly between patients in the GUSS and non-GUSS groups. However, the risk of readmission within 90 days was significantly lower in patients who underwent the GUSS than in those who did not (hazard ratio, 0.085; 95% confidence interval, 0.025– 0.290; p = 0.001). Conclusion: The GUSS aspiration prevention program effectively prevented readmission due to pneumonia within 90 days in older patients with acute illnesses. This implies that the adoption of efficient aspiration prevention methods in older patients with acute illnesses could play a pivotal role by enhancing patient outcomes and potentially mitigating the healthcare costs linked to readmissions. [ABSTRACT FROM AUTHOR]

Background: Patients with language barriers encounter healthcare disparities, which may be alleviated by leveraging interpreter skills to reduce cultural, language, and literacy barriers through improved bidirectional communication. Evidence supports the use of in-person interpreters, especially for interactions involving patients with complex care needs. Unfortunately, due to interpreter shortages and clinician underuse of interpreters, patients with language barriers frequently do not get the language services they need or are entitled to. Health information technologies (HIT), including artificial intelligence (AI), have the potential to streamline processes, prompt clinicians to utilize in-person interpreters, and support prioritization. Methods: From May 1, 2023, to June 21, 2024, a single-center stepped wedge cluster randomized trial will be conducted within 35 units of Saint Marys Hospital & Methodist Hospital at Mayo Clinic in Rochester, Minnesota. The units include medical, surgical, trauma, and mixed ICUs and hospital floors that admit acute medical and surgical care patients as well as the emergency department (ED). The transitions between study phases will be initiated at 60-day intervals resulting in a 12-month study period. Units in the control group will receive standard care and rely on clinician initiative to request interpreter services. In the intervention group, the study team will generate a daily list of adult inpatients with language barriers, order the list based on their complexity scores (from highest to lowest), and share it with interpreter services, who will send a secure chat message to the bedside nurse. This engagement will be triggered by a predictive machine-learning algorithm based on a palliative care score, supplemented by other predictors of complexity including length of stay and level of care as well as procedures, events, and clinical notes. Discussion: This pragmatic clinical trial approach will integrate a predictive machine-learning algorithm into a workflow process and evaluate the effectiveness of the intervention. We will compare the use of in-person interpreters and time to first interpreter use between the control and intervention groups. Trial registration: NCT05860777. May 16, 2023. [ABSTRACT FROM AUTHOR]

Background: Emergency departments are a last resort for some socially vulnerable patients without an acute medical illness (colloquially known as "socially admitted" patients), resulting in their occupation of hospital beds typically designated for patients requiring acute medical care. In this study, we aimed to explore the perceptions of health care providers regarding patients admitted as "social admissions." Methods: This qualitative study was informed by grounded theory and involved semistructured interviews at a Nova Scotia tertiary care centre. From October 2022 to July 2023, we interviewed eligible participants, including any health care clinician or administrator who worked directly with "socially admitted" patients. Virtual or in-person individual interviews were audio-recorded and transcribed, then independently and iteratively coded. We mapped themes on the 5 domains of the Quintuple Aim conceptual framework. Results: We interviewed 20 nurses, physicians, administrators, and social workers. Most identified as female (n = 11) and White (n = 13), and were in their mid to late career (n = 13). We categorized 9 themes into 5 domains: patient experience (patient description, provision of care); care team well-being (moral distress, hierarchy of care); health equity (stigma and missed opportunities, prejudices); cost of care (wait-lists and scarcity of alternatives); and population health (factors leading to vulnerability, system changes). Participants described experiences caring for "socially admitted" patients, perceptions and assumptions underlying "social" presentations, system barriers to care delivery, and suggestions of potential solutions. Interpretation: Health care providers viewed "socially admitted" patients as needing enhanced care but identified individual, institutional, and system challenges that impeded its realization. Examining perceptions of the people who care for "socially admitted" patients offers insights to guide clinicians and policy-makers in caring for socially vulnerable patients. [ABSTRACT FROM AUTHOR]

The article discusses the concept of "Placement" in the context of hospital care for older adults. It explores the historical background of hospitals and the shift towards acute medical care. The article highlights the pressures faced by healthcare providers to discharge patients quickly and the impact on patients' experiences. It also emphasizes the challenges of finding appropriate placements for patients who cannot return home or require specialized care. The authors call for healthcare professionals to resist cynicism and burnout and to advocate for improvements in the healthcare system. [Extracted from the article]

Gun violence is a serious public health problem that places surviving victims at increased risk for a variety of mental health problems, including posttraumatic stress disorder (PTSD) and depression. Recognizing that many gunshot injury survivors lack access to mental health care in the early aftermath of a shooting, there has been growing interest in the use of early, preventive mental health interventions to help prevent long-term mental health complications like PTSD as part of routine care for survivors in acute medical settings, where initial outreach to survivors may be more successful. This study evaluates clinical outcomes associated with one such early intervention—Skills for Psychological Recovery (SPR)—provided to gunshot injury survivors as part of a hospital-based early intervention program embedded in a Level 1 trauma center in the Midwestern United States. Clinic data from 100 survivors (74.0% male, 78.0% Black/African American) who received SPR were included in the present study. Results suggest that receiving SPR in the early aftermath of a shooting is associated with statistically significant reductions in both PTSD, F(1, 26.77) = 22.49, p <.001, and depression, F(1, 29.99) = 6.49, p =.016, symptoms. Outcomes did not vary as a function of either PTSD risk status or intervention delivery method (i.e., in-person, telehealth). These findings support the effectiveness and acceptability of SPR as an early intervention for gunshot injury survivors when delivered as part of a hospital-based early intervention program. Public Policy Relevance Statement: With a growing number of hospitals across the United States developing early intervention programs for gunshot injury survivors and other patients traumatically injured as a result of community violence, the need for structured interventions that aim to prevent long-term mental health complications and address risk factors for future reinjury is critical. These findings suggest that one early, skills-based intervention—Skills for Psychological Recovery (SPR)—was associated with reductions in both PTSD and depression symptoms among recent gunshot injury survivors who were seen as part of a hospital-based early mental health intervention program, typically within the first 3 months postinjury. Identifying data-driven interventions like SPR that flexibly address mental health and social determinants of health should be considered essential to a comprehensive approach to patient care and ensuring the sustainability of hospital-based violence and early mental health intervention programs. [ABSTRACT FROM AUTHOR]

Viral infections spread by mosquitoes are a growing threat to human health and welfare. Zika virus (ZIKV) is one of them and has become a global worry, particularly for women who are pregnant. To study ZIKV dynamics in the presence of demographic stochasticity, we consider an established ZIKV transmission model that takes into consideration the disease transmission from human to mosquito, mosquito to human, and human to human. In this study, we look at the local stability of the disease-free and endemic equilibriums. By conducting the sensitivity analysis both locally and globally, we assess the effect of the model parameters on the model outcomes. In this work, we use the continuous-time Markov chain (CTMC) process to develop and analyze a stochastic model. The main distinction between deterministic and stochastic models is that, in the absence of any preventive measures such as avoiding travel to infected areas, being careful from mosquito bites, taking precautions to reduce the risk of sexual transmission, and seeking medical care for any acute illness with a rash or fever, the stochastic model shows the possibility of disease extinction in a finite amount of time, unlike the deterministic model shows disease persistence. We found that the numerically estimated disease extinction probability agrees well with the analytical probability obtained from the Galton–Watson branching process approximation. We have discovered that the disease extinction probability is high if the disease emerges from infected mosquitoes rather than infected humans. In the context of the stochastic model, we derive the implicit equation of the mean first passage time, which computes the average amount of time needed for a system to undergo its first state transition. [ABSTRACT FROM AUTHOR]

Background and objective: Political, economic, communicative and cultural borders still limit the accessibility of acute healthcare services for patients so that they frequently have to accept longer distances to travel to the next provider within their own country. In this paper, we analyze the impact of borders and opening of borders on acute medical care in hospitals and on patients in border regions. Methods: We develop a conceptual framework model of cross-border healthcare and apply it to the Polish–German border area. The model combines the distance decay effect, a catchment area analysis, economies of scale and the learning curve. Results: Borders have a major impact on acute medical care in hospitals and on patients. Setting of new borders will reduce the accessibility of health facilities for patients or require the establishment of new hospitals. Reopening borders might induce a vicious circle leading to the insolvency of a hospital which might result in poorer health for some patients. Conclusion: Strong effort should be invested to overcome political and cultural borders to improve the health of the population in border regions. Similarly, increased cross-border acute healthcare must be seen in the context of rural health and the special situation of small rural hospitals in rural peripheral areas. [ABSTRACT FROM AUTHOR]

Introduction: Glycemic control is associated with better outcomes among individuals with type 2 diabetes (T2D). This research examines total US all-cause medical costs for adults with T2D with recommended glycemic control (HbA1c < 7%) compared to poor glycemic control (HbA1c ≥ 7%). Methods: The study used administrative claims data linked to HbA1c laboratory test results from January 1, 2015 through June 30, 2021 to identify adults with T2D with a recorded HbA1c test. Patients with recommended glycemic control at index date were propensity score matched to patients with poor glycemic control. General linear models and two-part models were used to compare all-cause outpatient, drug, acute care and total costs for 1 year post index date. Results: The study included 59,830 propensity-matched individuals. Results indicate that recommended glycemic control, compared to poor glycemic control, was associated with statistically significantly lower all-cause acute care ($23,868 ± $21,776 vs. $24,352 ± $22,223), drug ($10,277 ± $14,671 vs. $10,540 ± $14,928), and total medical costs ($41,381 ± $42,757 vs. $42,054 ± $43,422) but significantly higher outpatient costs ($7290 ± $12,028 vs. $7026 ± $11,587) (all p < 0.0001). Sensitivity analyses examined results based upon alternative HbA1c thresholds of ≤ 6.5% and < 8%. Results were generally robust to alternative HbA1c thresholds, with higher HbA1c thresholds associated with higher all-cause total costs as well as increased savings for having HbA1c below threshold. Conclusions: Glycemic control was associated with significantly lower all-cause total, drug, and acute care medical costs. Given the high prevalence of T2D in the USA, our results suggest potential economic benefits associated with glycemic control for healthcare providers. [ABSTRACT FROM AUTHOR]

In the latter half of the twentieth century, south Florida became a hub of Afro-Cuban religious practice. The influx of Cuban immigrants has influenced healthcare institutions in the area. This article explores how devotees of one Afro-Cuban religion, Lucumí, popularly known as Santería, create space within hospitals to conduct religious rituals that facilitate the healing of patients. It argues that the creation of space for hospital rituals is a counter-hegemonic practice that can be mapped onto the relationship that Lucumí historically had to the Catholic Church, one of being both seen and unseen within this hegemonic institution. Through an analysis of the “symbolic power” embedded in language usage to create unsanctioned ritual space in the hospital, I build on Pierre Bourdieu’s work by that title. In examining three types of space—secret space, talking space, and familiarity space— this article highlights the counter-hegemonic practices used to heal Lucumí patients in south Florida. [ABSTRACT FROM AUTHOR]

Background: Psychotic disorders are common and contribute significantly to morbidity and mortality of people with psychiatric diseases. Therefore, early screening and detection may facilitate early intervention and reduce adverse outcomes. Screening tools that lay persons can administer are particularly beneficial in low resource settings. However, there is limited research evaluating the validity of psychosis screening instruments in Uganda. We aimed to assess the construct validity and psychometric properties of the Psychosis Screening Questionnaire (PSQ) in Uganda in a population with no history of a psychotic disorder. Methods: The sample consisted of 2101 Ugandan adults participating as controls in a larger multi-country case-control study on psychiatric genetics who were recruited between February 2018 and March 2020. Participants were individuals seeking outpatient general medical care, caretakers of individuals seeking care, and staff or students recruited from five medical facilities that were age 18 years or older and able to provide consent. Individuals were excluded who had acute levels of alcohol or substance use, including being under inpatient hospitalization or acute medical care for one of these conditions. We used confirmatory factor analysis (CFA) and item response theory (IRT) to evaluate the factor structure and item properties of the PSQ. Results: The overall prevalence screening positive for psychotic symptoms was 13.9% 95% CI (12.4,15.4). "Strange experiences" were the most endorsed symptoms 6.6% 95% CI (5.6,7.8). A unidimensional model seemed to be a good model or well-fitting based on fit indices including the root mean square error of approximation (RMSEA of 0.00), comparative fit index (CFI of 1.000), and Tucker-Lewis Index (TLI of 1.000). The most discriminating items along the latent construct of psychosis were items assessing thought disturbance followed by items assessing paranoia, with a parameter (discrimination) value of 2.53 and 2.40, respectively. Conclusion: The PSQ works well in Uganda as an initial screening tool for moderate to high-level of psychotic symptoms. [ABSTRACT FROM AUTHOR]

Background: No systematic review on delirium prevention within early, hospital-based rehabilitation on implementation of approaches specifically tailored for patients with cognitive impairment (PwCI), such as Alzheimer's disease or vascular dementia, has been published despite the high relevance of specific medical care in this vulnerable population. Objective: To document design and effectiveness of delirium prevention programs by early rehabilitation during acute, hospital-based medical care and implementation of programs specifically tailored to PwCI. Methods: In a three-step approach, we first identified published systematic reviews of hospital-based, early rehabilitation interventions for older persons (>65 years) in relevant databases. In a second step, we screened each single trial of included reviews according to predefined inclusion criteria. In a third step, we analyzed studies with focus on delirium prevention. Results: Among n = 25 studies identified, almost all intervention programs did not specifically target cognitive impairment (CI). Interventions were heterogeneous (modules: n = 2–19); almost all study samples were mixed/unspecified for cognitive status with more affected patients excluded. Only one study exclusively included delirium patients, and only one included CI patients. Results of random effect meta-analysis showed significant effects of generic programs to reduce delirium incidence during hospitalization by 41% (p < 0.001, odds ratio, 95% confidence interval: 0.59 [0.49, 0.71] with modest heterogeneity (I2: 30%). Conclusions: Study results document a lack of implementation for delirium prevention programs specifically tailored to PwCI by early, hospital-based rehabilitation. Specifying existing rehab concepts or augmenting them by CI-specific modules may help to develop, optimize, and implement innovative delirium prevention in PwCI in acute medical care. [ABSTRACT FROM AUTHOR]

Background: Esophageal varices, which are caused by portal hypertension in patients with chronic liver disease, affect approximately 50% of patients with cirrhosis of the liver. Present study aimed to identify non-invasive parameters for prediction of esophageal varices in newly diagnosed patients with cirrhosis, without previous upper gastro intestinal bleed. Material & Method: The present prospective observational study was conducted among the patients attending to medical wards and acute medical care unit, department of medicine, SVRRGGH, Tirupati. From June 2021 to May 2022 with suggestive of liver cirrhosis. Patients with liver cirrhosis with portal hypertension between 18-80yrs of age were included. The study was conducted after obtaining the clearance from ethics committee, and written consent from participants. At the time of admission, all patients underwent a thorough clinical evaluation. Relevant history, etiology of liver disease, and physical characteristics such as age, gender, symptoms and signs of liver failure, hepatomegaly, splenomegaly, and abdominal vein collaterals were all recorded. Endoscopy and ultrasound investigation were performed along with the blood parameter profile. The collected data were analysed using SPSS v23.0 with significance of 0.05. Result: A fifty patients with mean age of 47.1yrs were included. Among them 14 were female and 36 were male patients (male preponderance). Etiology of liver disease in the study was alcohol for 24 patients, followed by HBV for 2, autoimmune hepatitis for 2, HCV for 1 patient. Severity of liver disease calculated by CTP is as follows, Class A: 6, Class B: 16, Class C: 27, five had suffered with Encephalopathy, 20 had splenomegaly. There was significant association of grade of varices with platelet count, prothrombin time, low albumin level, presence of encephalopathy and presence of portal hypertension. Also the child-pugh score had a linear relation with grade of varices. Conclusion: It is concluded that non-endoscopic factors like splenomegaly, decreased platelet count, hypoalbuminemia, mean portal vein diameter and mean splenic diameter, Child-Pugh score or a combination of multiple indices, as well as ultrasonographic (US) elastography proved to be the more accurate non-endoscopic predictors of esophageal varices and can also differentiate between the variceal size. [ABSTRACT FROM AUTHOR]

This article discusses the increasing popularity and growth of interventional pulmonology (IP) fellowship training. The Accreditation Council of Graduate Medical Education (ACGME) has recognized IP medicine as a new subspecialty, presenting new challenges and opportunities. The article highlights the need for program requirements, funding, training, and assessment of new procedures in IP fellowship programs. It also emphasizes the importance of diversity, equity, and inclusion in recruiting talented individuals and addresses the wellness of fellows and faculty. The article calls for collaborative efforts to improve the field of IP. [Extracted from the article]

Normal Pressure Hydrocephalus (iNPH) typically affects the elderly and can cause cognitive decline, resulting in its differential diagnosis with other neurodegenerative conditions. Moreover, it is probably underdiagnosed; such under- and misdiagnosis prevents the patient from receiving the right treatment and significantly affects the quality of life and life expectancy. This investigation is an in-depth analysis of the actual incidence of iNPH in the population of the province served by our hospital (circa 580,000 individuals). The first phase of this study was conducted by visualizing a total of 1232 brain CT scans performed in the Emergency Departments of the four hospitals of our network on patients who were admitted for different complaints yet screened as suspicious for iNPH. Subsequently, corresponding Emergency Department medical records were investigated to understand the medical history of each patient in search of elements attributable to an alteration of CSF dynamics. The cohort of positive CT scans, according to the radiological and clinical inclusion criteria, included 192 patients. Among the reasons to require acute medical care, "Fall" was the most common. The cumulative incidence of CT scans suggestive of iNPH among the patients undergoing CT scans was as high as 15.58%, and the period prevalence calculated for the total amount of patients accessing the Emergency Departments was 1.084%. The real incidence of iNPH in the population may be underestimated, and the social burden linked to the assistance of patients suffering from such untreated conditions could be significantly relieved. [ABSTRACT FROM AUTHOR]

Objective Thrombectomy may provide superior results compared to best medical care for acute posterior circulation strokes (PCS). Contact aspiration (CA), stent retriever (SR), and combined SR+CA (SRA) are commonly employed as first-line techniques. However, the optimal strategy and the role of SRA remain uncertain. Methods Systematic searching was conducted in three databases (PubMed, Embase, and Cochrane). Network meta-analyzes were performed using random-effects models. The reperfusion and clinical outcomes were compared. Pooled outcomes were presented as odds ratios (OR) with 95% confidence intervals (CI). Rankograms with surface under the cumulative ranking curve (SUCRA) were calculated. Results Seventeen studies were included, involving a total of 645 patients who received first-line CA, 850 patients who received SR, and 166 patients who received SRA. Regarding final recanalization outcomes, both first-line SRA (OR = 3.2, 95%CI 1.4--11.0) and CA (OR = 2.1, 95%CI 1.3--3.7) demonstrated superiority over SR in achieving successful reperfusion [modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3], with values of SUCRA 91.1, 58.5, and 0.4%, respectively. In addition, first-line SRA showed an advantage in achieving final mTICI 2c/3 compared to CA (OR = 3.6, 95%CI 0.99--16.0) and SR (OR = 6.4, 95%CI 1.3--35.0), with SUCRA value of 98.0, 44.7, and 7.2%, respectively. Regarding reperfusion outcome after the first pass, SRA also achieved a higher rate of mTICI 3 than SR (OR = 4.1, 95%CI 1.3--14.0), while CA did not (SUCRA 97.4, 4.6, 48.0%). In terms of safety outcomes, first-line CA was associated with a lower incidence of symptomatic intracranial hemorrhage (sICH) compared to SR (OR = 0.38, 95%CI 0.1--1.0), whereas the SRA technique did not (SUCRA 15.6, 78.6, 55.9%). Regarding clinical prognosis, first-line CA achieved a higher proportion of functional independence (modified Rankin Scale (mRS) 0--2) at 90 days than SR (OR = 1.4, 95%CI 1.1--1.9), whereas SRA did not (SUCRA 90.5, 17.4, 42.1%). Conclusion For acute PCS, a first-line CA strategy yielded better results in terms of final successful reperfusion and 90-day functional independence compared to SR. As the combined technique, first-line SRA was associated with superior first-pass and final reperfusion outcomes compared to SR. However, no significant difference was observed in functional independence achieved by first-line SRA compared to the other two strategies. Further high-quality studies are warranted. [ABSTRACT FROM AUTHOR]

Health care personnel (HCP) are recommended to receive annual vaccination against influenza to reduce influenza-related morbidity and mortality. Every year, acute care hospitals report receipt of influenza vaccination among HCP to CDC's National Healthcare Safety Network (NHSN). This analysis used NHSN data to describe changes in influenza vaccination coverage among HCP in acute care hospitals before and during the COVID-19 pandemic. Influenza vaccination among HCP increased during the prepandemic period from 88.6% during 2017-18 to 90.7% during 2019-20. During the COVID-19 pandemic, the percentage of HCP vaccinated against influenza decreased to 85.9% in 2020-21 and 81.1% in 2022-23. Additional efforts are needed to implement evidence-based strategies to increase vaccination coverage among HCP and to identify factors associated with recent declines in influenza vaccination coverage. [ABSTRACT FROM AUTHOR]

Operation Allies Welcome provided a unique opportunity for military medical personnel to engage in humanitarian assistance operations on military bases in the USA. With thousands of Afghan nationals evacuated from Kabul in August 2021 to various military installations across the USA, the Military Health System was tasked with health screening, emergency care, and disease prevention and surveillance in resource-limited settings. Marine Corps Base Quantico served as a "safe haven" site from August to December 2021, providing refuge to nearly 5000 travelers awaiting resettlement. During this time, active duty medical personnel provided 10,122 primary and acute patient encounters to patients aged < 1 to 90 years. Pediatrics represented 44% of the total encounters and children aged less than 5 years represented nearly 62% of the pediatric visits. In caring for this population, the authors were able to learn important lessons about humanitarian assistance capabilities, the difficulties of establishing acute care centers in a resource-limited environment, and the importance of cultural competency. Recommendations include staffing with medical providers that can see a large volume of pediatric, obstetrics, and urgent care visits, with less emphasis on trauma and surgical capabilities, which are the more traditional focus of military medicine. To this end, the authors advocate for the creation of specific humanitarian assistance supply blocks that would focus more on urgent and primary care treatments as well as an ample supply of pediatric, neonatal, and prenatal medicines. Further, early engagement with telecommunications companies when practicing in a remote location can be crucial to mission success. Finally, the medical care team should maintain continued mindfulness of the cultural norms of the population to which aid is given, particularly the gender norms and expectations of Afghan nationals. The authors hope that these lessons can prove informative and may provide increased readiness for future humanitarian assistance missions. [ABSTRACT FROM AUTHOR]

The purpose of this study is to find out treatment in patients dress (drug reaction with eosinophilia and systemic symptoms). Drug reactions with eosinophilia and systemic symptom syndrome (DRESS) are rare and potentially lifethreatening severe skin adverse reactions (SCAR) The mean age at diagnosis is approximately 50-55 years and less than 10% of patients are under 20 years men : women 0.7-0.8. All drugs used by the patient during DRESS should be stopped immediately. Complications of DRESS are myocarditis, Pneumocystis jiroveciipneumonia, sepsis, liver failure, and gastro-intestinal bleeding. Systemic corticosteroids (prednisolone 1 mg/kg/day) are the gold standard of treatment in the acute phase of patients with severe organ involvement. Therefore, the importance of appropriate therapy to reduce the occurrence of complications from DRESS disease. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis (TB), which is caused by bacteria of the Mycobacterium tuberculosis complex, is one of the oldest diseases known to affect humans and a major cause of death worldwide. This disease most often affects the lungs, although other organs are involved in up to one-third of cases. Tuberculous meningitis (TBM) is a non-suppurative inflammatory disease of the dura mater and spinal cord meninges caused by tubercle bacillus. About 5-15% of extrapulmonary tuberculosis involves the nervous system. TBM is a major one of extrapulmonary tuberculosis with involvement of the nervous system and accounts for about 70% of nervous system tuberculosis. Materials and Methods: This is a single centre prospective study was conducted including the patients who were admitted in Department of General Medicine at Siddhartha Medical College, Vijayawada from November 2022 to October 2023. Patients selected for the study, satisfied all the inclusion and exclusion criteria. Patients attending Medicine OPD, Acute Medical Care are included after satisfying the inclusion criteria and written consent is taken. Initial history was directed towards obtaining the details of duration of the symptoms, night sweats, contact with tuberculosis, seizures, weakness, bowel and bladder disturbances, ear discharge, loss of weight etc. Results: Majority of the patients are in the age group (16-35 yrs) 2nd, 3rd & 4th decades (30 out of 50). Half (50%) of the patients have Glasgow coma scale < 9. 25 patients (50%) 16 males, 9 females are in stage III. (Deeply comatose with decerebrate or decorticate posturing, irregular pulse and respiration). Hydrocephalus is the most common finding seen in 56% of cases (All are of communicating variety). Poor functional outcome is seen in 8.33%, 38.46%, 88% of stage I, II & III meningitis respectively. Out of 50 patients CT brain evidence of Hydrocephalus is found in 28 patients. Conclusion: In Tuberculous meningitis duration of illness 3 weeks or more at diagnosis, stage-III meningitis, GCS score less than 9 at admission, presence of focal deficit, and hydrocephalus on neuroimaging are the predictors of poor outcome. Patients can be categorized into high risk and low risk groups depending on the presence or absence of poor prognostic factors. Early diagnosis and prompt initiation of treatment reduces the mortality and morbidity. [ABSTRACT FROM AUTHOR]

During the initial COVID-19 surge, one public hospital in NYC updated their post-discharge outreach approach for patients with substance use disorder, as part of the CATCH (Consult for Addiction Treatment and Care in Hospitals) program. Beginning April 1, 2020, three peers and two addiction counselors attempted telephonic outreach to patients who received a CATCH consultation during hospitalization from program launch (October 7, 2019) through March 31, 2020 (n = 329). Outreach calls could include counseling, in-depth peer support, and referrals to substance use services (SUS)—a significant expansion of the services offered via outreach pre-pandemic. CATCH staff successfully reached 29.5% of patients and provided 77.6% of them with supportive counseling and referrals. Thirty percent of unsuccessful calls were due to inactive numbers, and only 8% of patients without housing were reached. Telephonic outreach established a low-barrier connection between patients and SUS that may be valuable during any period, including non-COVID times. Future interventions that address social determinants such as housing and cell phone access concomitantly with substance use should be considered by addiction consultation services to potentially reduce acute care utilization and improve health outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Many current cell phone (mobile phone, smartphone) batteries are lithium-ion. These batteries can overheat and catch fire under certain conditions. If it happens during a flight or air activity, this might compromise aviation safety. We report a case of a man whose phone caught fire during a parachute jump. CASE REPORT: The individual, a member of Police Special Forces, is required to regularly perform parachute jumps. During the incident flight, the man had a cell phone in a pocket that ignited during the jump. He was able to land and then extract the phone with burns requiring acute medical care and later a skin graft. DISCUSSION: This is a cautionary tale of lithium-ion batteries in flight. Many other situations could also occur with these batteries. There is little medical documentation of the risk of fire with lithium-ion batteries causing injuries during flight operations. To reduce the risk of fire, the devices should be powered down and phones should not be worn directly touching the skin. Damaged devices are more prone to overheating. [ABSTRACT FROM AUTHOR]

Background: Low mobility during an acute care medical hospitalization is frequent and associated with adverse outcomes, particularly among older patients. Better understanding barriers and facilitators to improve mobility during hospitalization could help develop effective interventions. The goal of this study was to assess barriers and facilitators to older medical patients' hospital mobility, from the point of view of patients and clinicians, to develop a framework applicable in clinical practice. Methods: We conducted a qualitative study in one university and two non-university hospitals of two different language and cultural regions of Switzerland, including 13 focus groups (FGs; five with patients, eight with clinicians). We included 24 adults aged 60 years or older hospitalized on an acute general internal medicine ward of one of the three participating hospitals during the previous years, and 34 clinicians (15 physicians, nine nurses/nursing assistants, 10 physiotherapists) working on those wards. The FG guides included open-ended questions exploring mobility experiences, expectations, barriers and facilitators to mobility, consequences of low mobility and knowledge on mobility. We applied an inductive thematic analysis. Results: We identified four themes of barriers and facilitators to mobility: 1) patient-related factors; 2) clinician-related factors; 3) social interactions; and 4) non-human factors. Clinician-related factors were only mentioned in clinician FGs. Otherwise, subthemes identified from patient and clinician FGs were similar and codes broadly overlapped. Subthemes included motivation, knowledge, expectations, mental and physical state (theme 1); process, knowledge – skills, mental state – motivation (theme 2); interpersonal relationships, support (theme 3); hospital setting – organization (theme 4). Conclusions: From patients' and clinicians' perspectives, a broad spectrum of human and structural factors influences mobility of older patients hospitalized on an acute general internal medicine ward. New factors included privacy issues and role perception. Many of those factors are potentially actionable without additional staff resources. This study is a first step in participatory research to improve mobility of older medical inpatients. [ABSTRACT FROM AUTHOR]

Background: People with substance use disorder are at risk of complications of drug use and frequent hospitalization and may continue to use substances during admission to acute care. Acute care harm reduction strategies including oral or injectable prescription opioids may aid in care retention and improve health outcomes in this patient population. Case presentation: A 58-year-old woman with refractory opioid use disorder was admitted to hospital for management of dysphagia secondary to esophageal stricture. She received injectable opioid agonist therapy using a continuous ambulatory drug delivery (CADD) pump in order to facilitate completion of her hospital admission. Conclusions: The patient successfully received acute medical care with the use of a CADD pump for consistent, patient-controlled opioid administration, with the support of an interdisciplinary team and by respecting the patient's own substance use goals. [ABSTRACT FROM AUTHOR]

Objectives Smart technology (ST) is starting to be integrated into cardiology medical practice. Therefore, this work aims to assess the extent of ST utilization among young pediatricians in acute pediatric cardiology consultations. Methods Between December 2021 and May 2022, a survey was distributed online to pediatricians linked to emergency services regarding pediatric cardiology consultations. The questionnaire was formulated to gather demographic data of participants, ST devices, and applications used. Questions explored cardiac diseases and acute presentations where ST was used. Pediatrician's perspective of the benefits, outcome, limitations, and drawbacks of this consultation form was investigated. Results Smartphones were the most used ST device 83/85 (97.65%) for acute cardiac consultation in pediatrics, especially messaging applications such as WhatsApp (92.94%); none of participants chose emails or simple short message service. The most accurately transferred data were vitals, laboratory results, and electrocardiogram. Arrhythmia was reported as the disease benefits the most from ST consultations. Starting supportive therapy was the highest immediate benefit from pediatricians' perspectives. Although it could not impact mortality, ST was thought to shorten the waiting time for consultations by 65 (76.47%). The major ST limitation was network coverage difficulties (50.58%), and possible consultation delay was the significant drawback in acute settings. Conclusion Smartphones are widely utilized for pediatric cardiac consultations in acute conditions, especially messaging applications. Most acute cardiac consultations are performed for heart failure and arrhythmia in children with the high benefit of shortening the waiting time for preliminary cardiac specialized opinion. However, several concerns about the limitations and drawbacks of ST use in acute cardiac specialty consultations warrant further research and organization. [ABSTRACT FROM AUTHOR]

Sepsis, life-threatening organ dysfunction secondary to infection, contributes to at least 1.7 million adult hospitalizations and at least 350,000 deaths annually in the United States. Sepsis care is complex, requiring the coordination of multiple hospital departments and disciplines. Sepsis programs can coordinate these efforts to optimize patient outcomes. The 2022 National Healthcare Safety Network (NHSN) annual survey evaluated the prevalence and characteristics of sepsis programs in acute care hospitals. Among 5,221 hospitals, 3,787 (73%) reported having a committee that monitors and reviews sepsis care. Prevalence of these committees varied by hospital size, ranging from 53% among hospitals with 0-25 beds to 95% among hospitals with >500 beds. Fifty-five percent of all hospitals provided dedicated time (including assigned protected time or job description requirements) for leaders of these committees to manage a program and conduct daily activities, and 55% of committees reported involvement with antibiotic stewardship programs. These data highlight opportunities, particularly in smaller hospitals, to improve the care and outcomes of patients with sepsis in the United States by ensuring that all hospitals have sepsis programs with protected time for program leaders, engagement of medical specialists, and integration with antimicrobial stewardship programs. CDC's Hospital Sepsis Program Core Elements provides a guide to assist hospitals in developing and implementing effective sepsis programs that complement and facilitate the implementation of existing clinical guidelines and improve patient care. Future NHSN annual surveys will monitor uptake of these sepsis core elements. [ABSTRACT FROM AUTHOR]

Introduction: Patients admitted to the pediatric intensive care unit (PICU) typically transfer to an acute care floor prior to discharge (ACD). Various circumstances, including rapid clinical improvement, technology dependence, or capacity constraints, may lead to discharge directly to home from a PICU (DDH). This practice has been studied in adult intensive care units, but research is lacking for PICU patients. Methods: We aimed to describe characteristics and outcomes of patients requiring PICU admission who experienced DDH versus ACD. We conducted a retrospective cohort study of patients ≤18 years old admitted to our academic, tertiary care PICU between 1/1/15 and 12/31/20. Patients who died or were transferred to another facility were excluded. Baseline characteristics (including home ventilator dependence) and markers of illness severity, specifically the need for vasoactive infusion or new mechanical ventilation, were compared between groups. Admission diagnoses were categorized using the Pediatric Clinical Classification System (PECCS). Our primary outcome was hospital readmission within 30 days. Results: Of 4042 PICU admissions during the study period, 768 (19%) were DDH. Baseline demographic characteristics were similar, although DDH patients were more likely to have a tracheostomy (30% vs 5%, P <.01) and require a home ventilator at discharge (24% vs 1%, P <.01). DDH was associated with being less likely to have required a vasoactive infusion (7% vs 11%, P <.01), shorter median length of stay (LOS) (2.1 days vs 5.9 days, P <.01) and increased rate of readmission within 30 days of discharge (17% vs 14%, P <.05). However, repeat analysis after removing ventilator-dependent patients at discharge (n = 202) showed no difference in rates of readmission (14% vs 14%, P =.88). Conclusions: Direct discharge home from the PICU is a common practice. DDH and ACD groups had similar 30-day readmission rate when patient admissions with home ventilator dependence were excluded. [ABSTRACT FROM AUTHOR]

Falls are a significant public health concern for the elderly population. This study investigates the relationship between individual perception of perceived susceptibility to fall risk and fall risk level among elderly adult patients admitted to an acute care setting in a Saudi Arabian hospital. A convenience sample of 150 patients aged 60 to 89 years was enrolled in the study. The perceived susceptibility to fall risk was measured using a scale with high internal consistency (Cronbach's alpha = 0.87). Fall risk was assessed as a dichotomous variable (No Fall Risk or High Fall Risk). The results revealed a significant association between individual perception and fall risk level, with higher perceived susceptibility scores in patients classified as No Fall Risk compared to those in the High Fall Risk group (p < 0.001). The study also explored the impact of demographic variables, frailty, and high-risk medications on fall risk. Binary logistic regression analysis indicated that age and frailty were positively associated with an increased fall risk, while the use of certain high-risk medications was associated with a decreased risk. These findings contribute to the understanding of how individual perceptions and frailty influence fall risk and can inform the development of targeted fall prevention interventions for elderly patients in acute care settings. This research adds to the limited existing literature on perception and fall risk, particularly in the context of the Saudi population, and provides valuable insights for healthcare practitioners seeking to enhance fall prevention programs and patient outcomes. [ABSTRACT FROM AUTHOR]

A Pre-Conference PSPCON 2023 workshop on Acute Medical Care for Adult patients with acute medical needs was organized on May 18th 2023 by the Department of Medicine in collaboration with Pakistan Society of Physicians. It was attended by PGRs and Faculty of Department of Medicine, Neurology, Emergency Medicine, Pulmonology and Gynaecology MTI-LRH, Peshawar. Dean LRH Prof. Junaid Sarfaraz Khan, Medical Director Dr Hamid Shahzad and Hospital Director Dr Muhammad Abrar Kuan also attended the symposium and appreciated the efforts of organizers and speakers. [Extracted from the article]

Introduction: The impact of the COVID-19 pandemic on non‐COVID-19 pathologies has been experienced worldwide. While people appropriately avoided social interactions, many also avoided essential medical care for acute and chronic conditions. This delay in seeking care has been associated with increased morbidity and mortality in several conditions, including life-threatening infections such as necrotizing fasciitis. Methods: We retrospectively reviewed the records of patients that presented to the University of Vermont Medical Center for necrotizing fasciitis during the 1-year period following the declaration of a global pandemic on March 11, 2020. We subsequently compared this data with that of the previous 4 years. Results: During the period of March 12, 2020 to March 12, 2021, there were 17 cases of newly diagnosed necrotizing fasciitis. Compared with an average per year of 8 cases over the previous 4 years, this represents a 113% percent increase in cases of necrotizing fasciitis during the study period (P =.071861). Out of the 17 cases, 4 patients died during their admission, producing a case-fatality rate of 23.5%. This represents a statistically significant increase from previous years (P =.003248), where the average case-fatality rate was 6.3%. Conclusion: Our study demonstrates a substantial increase in cases of necrotizing fasciitis following the onset of the coronavirus pandemic. A significant increase in the case-fatality rate was also observed. Given the growing body of literature describing the negative impact of the pandemic on non-COVID-19 morbidity and mortality, our study posits necrotizing fasciitis as one of many affected pathologies. Level of Evidence: Level IV. Epidemiological [ABSTRACT FROM AUTHOR]

Background: The Emergency Department (ED) plays a key role in the identification and care of acute medical conditions, including cancer. In this scoping review, we aimed to determine the role of the ED in the acute diagnosis of cancer. Methods: We conducted a scoping review of articles according to Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA) using PubMed and Google Scholar. We screened studies of adults with a new diagnosis of cancer in the ED. We included randomized control trials, prospective, retrospective, and cross‐sectional observational studies, and case reports published in English since 2000. We grouped the articles into categories based on their objectives and findings. Results: Of the 4459 articles, we included 47 in the review. The identified studies fell into three major categories: (1) studies describing the incidental diagnosis of cancer in the ED (n = 11, 23%), (2) studies characterizing the acute initial presentation of cancer in the ED (n = 19, 41%), and (3) studies describing the ED as a pathway to cancer diagnosis in the healthcare system (n = 17, 36%). Across the studies, cancer diagnoses in the ED were more likely in patients with higher comorbidities, occurred at later stages, and resulted in worse survival rates. Conclusions: The ED plays a prominent role in the initial diagnosis of cancer. Efforts must be made to integrate the ED within the cancer care continuum. [ABSTRACT FROM AUTHOR]

In this study, the authors assessed return on investment (ROI) associated with a forensic assertive community treatment (FACT) program. A retrospective secondary data analysis of a randomized controlled trial comprising 70 legal-involved patients with severe mental illness was conducted in Rochester, New York. Patients were randomly assigned to receive either FACT or outpatient psychiatric treatment including intensive case management. Unit of service costs associated with psychiatric emergency department visits, psychiatric inpatient days, and days in jail were obtained from records of New York State Medicaid and the Department of Corrections. The total dollar value difference between the two trial arms calculated on a per-patient-per-year (PPPY) basis constituted the return from the FACT intervention. The FACT investment cost was defined by the total additional PPPY cost associated with FACT implementation relative to the control group. ROI was calculated by dividing the return by the investment cost. The estimated return from FACT was $27,588 PPPY (in 2019 dollars; 95% confidence interval [CI]=$3,262–$51,913), which was driven largely by reductions in psychiatric inpatient days, and the estimated investment cost was $18,440 PPPY (95% CI=$15,215–$21,665), implying an ROI of 1.50 (95% CI=0.35–2.97) for FACT. The Rochester FACT program was associated with approximately $1.50 return for every $1 spent on its implementation, even without considering potential returns from other sources, including reductions in acute medical care, crime-related damages, and public safety costs. ROI estimates were highly dependent on context-specific factors, particularly Medicaid reimbursement rates for assertive community treatment and hospital stays. [ABSTRACT FROM AUTHOR]

Given the ongoing national shortage of RNs, doctors, and other health care professionals, the temptation will be even greater for H@H programs to permanently substitute lower-skilled health care workers for health care professionals. Keywords: Centers for Medicare and Medicaid; Healthcare costs; Patient outcomes; Private equity; Venture capital EN Centers for Medicare and Medicaid Healthcare costs Patient outcomes Private equity Venture capital 63 69 7 06/20/23 20230401 NES 230401 Hospital-at-home (H@H) is an old idea that garnered widespread enthusiasm and more use when the COVID-19 pandemic overwhelmed the capacity of many hospitals to meet the surge in patient demand. A major concern is the growing interest of financial actors such as private equity (PE), hedge funds (HF) and venture capital (VC) firms in taking an ownership role in these programs Existing evidence suggests that a modest number of hospitals have adopted the CMS program, but many more intend to do so now that the waiver has been extended. Hospitals are motivated to participate in the CMS program because it is financially attractive: reimbursements for the AHCaH are the same as those provided at hospitals, including the facilities fee designed to cover hospital maintenance costs. [Extracted from the article]

Background: Teamwork and communication are essential tools for doctors, nurses and other team members in the management of critically ill patients. Early interprofessional education during study, using acute care simulation, may improve teamwork and communication between interprofessional team members on the long run. Methods: A comparative sequential quantitative–qualitative study was used to understand interprofessional learning outcomes in nursing and medical students after simulation of acute care. Students were assigned to a uni- or interprofessional training. Questionnaires were used to measure short and long term differences in interprofessional collaboration and communication between the intervention and control group for nursing and medical students respectively. Semi-structured focus groups were conducted to gain a better understanding of IPE in acute simulation. Results: One hundred and ninety-one students participated in this study (131 medical, 60 nursing students). No differences were found between the intervention and control group in overall ICCAS scores for both medical and nursing students (p = 0.181 and p = 0.441). There were no differences in ICS scores between the intervention and control group. Focus groups revealed growing competence in interprofessional communication and collaboration for both medical and nursing students. Conclusions: Interprofessional simulation training did show measurable growth of interprofessional competencies, but so did uniprofessional training. Both medical and nursing students reported increased awareness of perspective and expertise of own and other profession. Furthermore, they reported growing competence in interprofessional communication and collaboration in transfer to their workplace. [ABSTRACT FROM AUTHOR]

(1) Background: Strong evidence supports the persuasive positive effects of exercise for cancer patients and survivors. Different approaches of exercise programs have been established; however, the special interests of young adults (YAs) with cancer have rarely been considered in exercise interventions. Therefore, the study YOUng EXercisers (YOUEX) aimed to investigate exercise preferences in YAs. (2) Methods: YOUEX was a three-arm, patient preference-based non-randomized, longitudinal, pre–post exercise intervention, offering three different exercise modules to YAs during or after acute therapy (Module 1: online supervised group-based (M1); Module 2: online unsupervised (M2); Module 3: in-person supervised (M3)). The intervention period was 12 weeks with another 12-week follow-up period, the modules could be changed or amended after 6 and 12 weeks. (3) Results: 92 YAs were allocated to the study. At baseline, 50 YAs (54%) chose M2, 32 YAs (35%) M1 and 10 YAs (11%) M3. The analysis revealed high acceptability and feasibility of the online exercise programs (M1, M2). There was a high impact of the COVID-19 pandemic on the execution of M3. YAs showed diverse preferences in module selection due to differences in, e.g., cancer therapy status or favored level of supervision. (4) Conclusions: YAs need personalized exercise programs that consider their individual interests and needs. Online exercise programs can be a promising addition to existing exercise opportunities. They are an effective way to increase physical activity levels in YAs. [ABSTRACT FROM AUTHOR]

Stroke accounts for 5.5% of the national Global Burden of Disease (GBD) and ~2,000 deaths per year in Uruguay. To respond to this medical emergency, the Ministry of Public Health (MPH) of Uruguay devised the National Stroke Plan (NSP). Scientific associations, universities, scholars, and patient organizations, both at the national and international levels, took part in the process, which ended with the generation of the national stroke management guidelines, including measures based on the best evidence available. This was accompanied by presidential regulatory decrees and several ordinances that set the foundations of the legal framework for their implementation as of 2020. Forty-two Stroke Ready Centers (SRC) and seven Comprehensive Stroke Centers (CSC) were strategically established and interlinked to ensure compliance with international accessibility recommendations, offering, in turn, the required training for their healthcare teams. A pre-hospital care protocol was also created for all countrywide mobile units. For NSP assessment, stroke was included as a "Care Goal (objective)" for the whole health system, providing the involved healthcare organizations with a financial incentive for compliance with the basic objectives related to the treatment of hyper acute stroke. The NSP came into force during the COVID-19 pandemic and, considering the special circumstances imposed, it made it possible to maintain hyper acute medical care and increase population access to recanalization treatment, particularly mechanical thrombectomy. The purpose of this article is to share our experience in the development of the NSP by describing some preliminary outcomes. [ABSTRACT FROM AUTHOR]

Background: Japan's health care system may be providing inpatient care inefficiently with a low number of physicians per hospital bed and a long average length of stay (LOS). The present study examined associations of acute medical care with hospital-level factors, such as the transfer and acceptance rates, and mediation effect of LOS, using medical service fees per day as an outcome measure for the provision of acute medical care in hospitals in a region with limited medical resources. Methods: To analyze the associations of acute medical care with hospital-level factors, this research used multilevel structural equation modeling (SEM) of a dataset that included 225,203 patients admitted to 99 hospitals in Fukushima, Japan. The characteristics of the patients, medical activities, and hospitals, such as the transfer and acceptance rates, were assumed to have both direct and indirect effects through LOS on medical service fees per day. Results: The final analysis used data from 165,413 patients discharged or transferred from 79 hospitals. After separating patient-level effects using multilevel SEM, the results revealed that, at the hospital level, the transfer rate had a significant and positive association with increased medical service fees per day, both directly (standardized coefficient [SC] = 0.215) and indirectly (SC = 0.057) through shortened LOS. The number of first hospitalized patients per physician had a significant and positive association with increased medical service fees per day only indirectly through shortened LOS (SC = 0.063). The acceptance rate had a significant and negative association with medical service fees per day only indirectly through prolonged LOS (SC = -0.078). Conclusions: Hospital-level factors, such as enhanced transfer function, reduced acceptance function, and a large number of patients for treatment of acute episodes per physician, had positive associations with increased medical service fees per day, either directly or indirectly through LOS. [ABSTRACT FROM AUTHOR]

Background: The prevalence of elder abuse has only rarely been investigated in Sweden and never in a hospital setting. Therefore, the aims of this study were to: 1) Estimate the prevalence of elder abuse and life-course victimization among hospitalized older adults in Sweden, 2) Explore factors associated with elder abuse in the same sample, and 3) Explore the associations between life-course victimization and mental ill-health.Methods: The study was conducted at a university hospital in Sweden. Adults over the age of 65 years admitted to a medical or geriatric acute care ward during spring 2018 were consecutively recruited. The participant rate was 44% (n = 135/306). Participants were assessed via a face-to-face interview about their experiences of elder abuse and abuse earlier in life. Mental ill-health was measured using a self-administered depression assessment (Patient Health Questionnaire-9), along with information about medications and diagnoses retrieved from medical records.Results: Altogether, 40.7% (n = 55) of the participants reported some form of abusive experience during their life course. The prevalence of elder abuse was 17.8% (n = 24), and 58% (n = 14) of elder abuse victims also reported victimization earlier in life. Being abused before the age of 65 was the only background factor associated with elder abuse (OR = 5.4; 95% CI 1.9-15.7). Reporting abusive experiences both before and after the age of 65 was associated with current anti-depressant medication (OR = 6.6; 95% CI 1.1-39.2), a PHQ-9 result of 10 or more (OR = 10.4; 95% CI 2.1-51.0), and nine or more symptom diagnoses (OR = 4.0, 95% CI 1.0-16.1). Being abused only before or after the age of 65 was not significantly associated with any mental ill-health outcome measure.Conclusions: Elder abuse and victimization earlier in life are highly prevalent among hospitalized older patients, and our findings underline the importance of a life-course perspective both in research on elder abuse and in clinical practice. Identifying and caring for older adults who have been subjected to abuse should be a priority in health care. [ABSTRACT FROM AUTHOR]

The ongoing rapid expansion of point-of-care ultrasound (POCUS) and its corresponding supporting literature leaves the frontline clinician in a difficult position when trying to keep abreast of the latest developments. Our group of POCUS experts has selected ten influential POCUS-related papers from the past twelve months and provided a short summary of each. Our aim is to give to emergency physicians, intensivists, and other acute care providers key information, helping them to keep up to date on rapidly evolving POCUS literature. [ABSTRACT FROM AUTHOR]

Background and purpose: Acute ischemic stroke is one of the leading causes of disability and mortality globally, with increasing incidence in Africa, as the continent is already burdened with infectious diseases. Rapid diagnosis and efficient treatment are crucial, as even a slight delay in reperfusing the brain significantly affects the recovery outcome. Neuroimaging is vital for optimal care and thrombolytic or endovascular therapy in specialized stroke care units. This review aims to discuss the burden of acute ischemic stroke in Africa and how health care systems have tried to reduce the incidence and improve outcomes for the disease. Methods: Data were collected through the online databases PubMed, Ovid MEDLINE, ScienceDirect, and Embase. All articles related to acute ischemic stroke in Africa were considered. Results: The medical care for acute ischemic stroke in Africa is far from optimal, with little adherence to recommended protocols. There is a lack of public awareness of the disease, imaging infrastructure, personnel, stroke care units, and recovery facilities due to poor funding. Poor knowledge of stroke signs and symptoms results in delay in treatment and poor prognosis. Conclusions: We urge African leaders and private entities to invest in stroke care by building appropriate infrastructures, providing medical equipment, and implementing guidelines and sustainable follow‐up systems. Telehealth is a suggested strategy to mitigate the scarcity of health personnel, and international and national efforts to increase treatment affordability should be doubled. Further extensive research on the impact of acute ischemic stroke on the African population is encouraged. [ABSTRACT FROM AUTHOR]

Children with Autism Spectrum Disorder (ASD) experience increased hospitalizations as compared to the general population, particularly in the context of mental health crises. Given the unique needs of children with ASD and behavioral health needs that can either lead to or emerge during hospitalization, an understanding of hospital experiences is critical. To date, research on caregiver experiences in acute care medical hospital settings is limited. Therefore, the purpose of this qualitative study was to investigate caregiver experiences with inpatient care for children with ASD and behavioral health needs, including factors and practices that impacted or were desirable for care. Two focus groups were conducted with a total of 12 parents of children with ASD admitted to a large pediatric hospital. Data were analyzed using interpretive description. Emerging themes pointed to the child, family, and staff factors and practices that intersect to influence hospitalization experiences. Child factors included the child’s communication, sensory, behavioral, medical, and safety needs. Family factors included the family’s relationship with the healthcare team, own needs, and advocacy experiences. Staff factors included staff communication practices, comfort, and knowledge when providing care. Overall, this research demonstrates the complexity of factors and practices that impact the behavioral health hospitalization experience for children with ASD and their caregivers. Experiences varied widely and were guided by the unique needs of each child. Findings point to care practices that can be adopted to best meet the needs of all stakeholders during hospitalization and offer implications for future educational initiatives. [ABSTRACT FROM AUTHOR]

Introduction: Chronic heart failure (CHF) is a leading etiology for both morbidity and mortality on a global level, resulting in an increase in both prevalence and health care costs. Recently, our understanding has changed from a mere hemodynamic condition to a much more complicated approach, including neuroendocrine and immune activation. Uric acid (UA) is the end product of purine breakdown and is excreted by the kidneys. Xanthine oxidase and xanthine dehydrogenase are two enzymes responsible for uric acid breakdown and production. Both enzymes catalyze the oxidation of hypoxanthine to xanthine which is the main enzyme in purine metabolism and contribute to the generation of oxygen free radicals which increased oxidative stress. Materials and Methods: This is an observational study conducted at tertiary care Teaching Hospital over a period of 1 year. All patients who are admitted with symptoms and signs of Heart Failure in the wards like Intensive Care Unit, Acute Medical Care, Intensive Cardiac Care unit, Medical Wards, Cardiac Wards both paid and general rooms were recruited in the study. The sample size was 100 patients after evaluation by clinical and 2D echocardiography findings. Patients with signs and symptoms of Heart Failure and by satisfying inclusion and exclusion criteria were recruited. Results: A total of 100 patients with heart failure and ejection fraction less than 50 who presented to the department of general medicine. 26 male patients had ACS as the precipitating cause of heart failure compared to 29 female patients. In the present study the range of uric acid was observed between 7.1 - 10 mg/dl, the mean uric acid levels were observed to be 8.6 ± 0.67. In the present study, the range of Ejection fraction was observed between 28 - 48%, the mean ejection fraction was observed to be 34.8 ± 6.65. In the present study, it was observed that there was a significant and inverse correlation observed between uric acid levels and ejection fraction r = -0.808 p<0.001. Conclusions: These data suggest that there is a link between heart failure and the level of uric acid, where one can infer that the metabolic derangements that induce an increase in serum uric acid are likely responsible for the increase in morbidity and mortality as a result of hyperuricemia heart failure patients. In addition, in patients newly diagnosed with hyperuricemia, the risk of identifying a lower ejection fraction is higher. [ABSTRACT FROM AUTHOR]

Objective: Studies exploring the epidemiological characteristics of scaphoid fracture nonunion are important to understand the causes and lead to effective prevention strategy. However, such knowledge is limited especially in China. This study aims to reveal the clinical and epidemiological features of scaphoid fracture nonunion in Chinese patients. Methods: This was a retrospective study, which was based on patients with scaphoid fracture nonunion treated in a Chinese national orthopedic referral center from 1 August 2009 to 1 August 2020. The basic demographic and clinical characteristics, including gender, age at diagnosis of scaphoid fracture nonunion, dominant hand, the location of fracture, the side, the causes of the injury, age of the injury, age of the treatment for scaphoid fracture nonunion, and the delay period, were retrieved from the medical records. The patients were divided into a non‐delay group and a delay group based on whether they had visited the doctor within 1 month after the injury. Scaphoid fracture was classified into the proximal, waist, and distal fractures according to the location. The t‐test or Mann–Whitney U test was used to compare the difference between groups when the dependent variable is continuous, while a chi‐square test was used when the dependent variable is categorical. Results: A total of 363 patients were included in this study. The mean age at the diagnosis of scaphoid fracture nonunion was 32 (ranging from 14 to 78). Waist fracture nonunion (76.5%) was most common. Among the 169 patients who sought medical care within 1 month after the injury (non‐delay group), more than half (90 cases) were misdiagnosed. 23 cases could not recall the injury, so the time of delay could not be determined. Among the 171 patients who did not seek medical care for acute injury (delay group), the average time was 52 months between the initial injury and the treatment. The proportion of waist nonunions was higher among patients in the delay group than that in the non‐delay group. Conclusions: Nonunion of scaphoid fracture is caused mainly by delayed treatment and misdiagnosis in China, suggesting that timely treatment and improved diagnosis could lower the prevalence. The fracture location may be a factor contributing to the delaying of seeking medical care. [ABSTRACT FROM AUTHOR]

Introduction/aim: Frail and cognitively impaired older patients are particularly vulnerable groups during the pandemic. Lockdowns, social isolation, and physical inactivity considerably affect physical and mental wellbeing. During the pandemic process, routine medical checks and acute medical care services may be disrupted. The study aimed to demonstrate the feasibility and effectiveness of telemedicine in the delivery of healthcare services to elderly patients during the pandemic. Materials andmethods: E-mails sent to the e-mail address of the department of geriatrics, which has been actively used for 4 years, between April 2020 and June 2021, were retrospectively evaluated. The time and reason for each application, referral to the patients, demographic data of the patients, and chronic diseases were recorded. E-mail frequencies were considered monthly time series, and time series charts for e-mail frequencies frompatients were produced. Results: A total of 374 e-mails that 213 patients sent were assessed. A vast majority, 97.6% of the e-mails, were sent by proxies. The mean age of patients was 78.7 ± 8.1 years, and 59.2% were women. Hypertension and dementia were the most common comorbidities. The applications mostly occurred in April-May and October-November 2020. The most common complaint in dementia was behavioral disturbances (13.6%). Geriatric outpatient appointments were arranged for 29.9% of the applicants, 14.2% were referred to the emergency department, and 23.0% were offered medical treatment. Outpatient examination and treatment were completed in 15% of the patients and 10.4% of them were hospitalized. The time series charts showed that e-mails were sentmore frequently by patients with dementia than the others (p = 0.03). Conclusions: Telemedicine, which enables many problems of patients to be solved in geriatric practice without face-to-face appointments, can also prevent infections and unnecessary hospitalizations, especially during these unusual pandemic days. [ABSTRACT FROM AUTHOR]

Objective: To validate an Urgency Classification Model developed for telephone triage in Dutch nursing homes., Design: Retrospective observational study., Setting and Participants: Retrospective analysis of triage data of nursing home residents in a medical service organization, active in 40 nursing homes across the Netherlands., Methods: An Urgency Classification Model for nursing home care was developed through a collaborative cocreation session by modifying existing acute medical care delivery models. All inquiries to central triage personnel during regular working hours between April 1 and April 30, 2022, were retrospectively categorized according to the new Urgency Classification Model ("urgency," consisting of 6 levels from U0 to U5; and "goals of care and treatment limitations," consisting of 4 options) by 2 independent physicians to evaluate the reliability using Cohen's kappa. To ascertain validity, the categorized data were juxtaposed with the executed treatment plan as documented in the patient records., Results: Of 387 inquiries, consensus between assessors using the Urgency Classification Model was reached upon initial independent classification of urgency in 77.0% (n = 298, Cohen's kappa 0.654) of cases and in 77.3% (n = 299, Cohen's kappa 0.649) of goals of care and treatment limitations classification, representing substantial interrater reliability. A strong positive correlation was found between the urgency identified through the Urgency Classification Model and the observed urgency in the executed treatment, r s  = 0.662, P < .001; the same urgency was given in 71.5% (n = 276) of all inquiries. Overtriage (meaning the model classified the inquiry as more urgent than the executed treatment plan) occurred in 9.8% (n = 38) and undertriage in 18.7% (n = 72)., Conclusion and Implications: The new Urgency Classification Model is a valid and reliable classification tool for implementation within its intended target population. Universal and comprehensive implementation is expected to lead to more appropriate care delivery, while realizing integration with the acute medical care frameworks already in place., Competing Interests: Disclosures D.J.A.J. has received non-personal lecture fees from AstraZeneca, Chiesi, and Abbott within the previous 3 years. No further conflicts of interest exist., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: Cerebral palsy refers to a heterogeneous group of non-progressive neurodevelopmental disorders manifesting in infancy or childhood and varying in severity. It characterized by impaired motor function, sensation, and depressed intellectual abilities. Functional limitations in patients with cerebral palsy may result in chronic dependency, thereby compromising caregivers' mental health and interfering with the integrity of the family structure. Objectives: This study aimed to determine the different factors affecting the mental health of caregivers of children with cerebral palsy and to raise awareness among healthcare providers. Methods: A cross-sectional study was conducted among caregivers of children with cerebral palsy in National Guard Health Affairs-Jeddah, Saudi Arabia, using the Depression Anxiety Stress Scale-21, a validated questionnaire assessing: depression, anxiety, and stress. This questionnaire was used to assess the mental health of the caregivers. In addition, factors reflecting child's health condition, such as visual impairment, number of emergency department visits, and number of Pediatric Intensive Care Unit admissions were reported to investigate the impact on the caregiver's mental health. Results: The sample included 40 caregivers, of which 72.5% were mothers. According to the Depression Anxiety Stress Scale-21 score, 12.5% (n = 5) of the caregivers had moderate depression scores, 10% (n = 4) revealed extremely severe depression, and 10% (n = 4) showed moderate anxiety. Furthermore, 12.5% (n = 5), 15% (n = 6), and 7.5% (n = 3) of the caregivers have scored as moderate, severe, and extremely severe stress levels, respectively. Caregivers' depression, anxiety, and stress scores were significantly (p ≤ 0.05) associated with the impact of vision of their dependent children, frequent hospital admissions, and frequent emergency department visits. Increased Pediatric Intensive Care Unit admissions in the past year were also significantly associated with higher caregiver anxiety scores. Conclusions: To the best of our knowledge, the dimension of caregivers' stress and anxiety and their association with the children's dependency level is not well documented in our region. Caregivers of children with cerebral palsy reported having mental health challenges associated with the children's vision, frequent need for acute medical care, and hospital admissions. Healthcare workers should provide early and proactive planning of medical and social support for children and their families using a family-centered approach. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]