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Specialize? Diversify? Do patients care? The authors investigate the demand-side effects of a hospital's portfolio strategy, which entails decisions about the depth and breadth of its service offerings. Positing that both depth (focus) and breadth (related focus) signal expertise, the authors use both archival and experimental evidence to examine these effects. The archival study is based on Florida's State Inpatient Databases for 2006–2015 and spans all major departments in health care delivery. The empirical analysis exploits plausible exogenous variation from other health care markets and reveals that patient choice is positively influenced by a hospital's depth (focus) and breadth (related focus) of expertise in a department. Complementing the archival evidence, the authors also conducted online experiments to examine the signaling effects of hospital portfolio strategy on patient choice behavior. The results provide support for the idea that hospital portfolio strategy influences patients' perceptions of hospital expertise in focal and related areas and, subsequently, their choice behavior. The authors also highlight potential synergistic effects between focus and related focus and heterogeneity in the effects across departments, payer types, and hospital profit status. These findings underscore the need for managers to adopt a targeted approach to portfolio decisions in health care. [ABSTRACT FROM AUTHOR]

PurposeAdults' comments on patient experience surveys explain variation in provider ratings, with negative comments providing more actionable information than positive comments. We investigate if narrative comments on the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey of inpatient pediatric care (Child HCAHPS) account for global perceptions of the hospital beyond that explained by reports about specific aspects of care.MethodsWe analyzed 545 comments from 927 Child HCAHPS surveys completed by parents and guardians of hospitalized children with at least a 24-h hospital stay from July 2017 to December 2020 at an urban children's hospital. Comments were coded for valence (positive/negative/mixed) and actionability and used to predict Overall Hospital Rating and Willingness to Recommend the Hospital along with Child HCAHPS composite scores.ResultsComments were provided more often by White and more educated respondents. Negative comments and greater actionability of comments were significantly associated with Child HCAHPS global rating measures, controlling for responses to closed-ended questions, and child and respondent characteristics. Each explained an additional 8% of the variance in respondents' overall hospital ratings and an additional 5% in their willingness to recommend the hospital.ConclusionsChild HCAHPS narrative comment data provide significant additional information about what is important to parents and guardians during inpatient pediatric care beyond closed-ended composites.Practice implicationsQuality improvement efforts should include a review of narrative comments alongside closed-ended responses to help identify ways to improve inpatient care experiences. To promote health equity, comments should be encouraged for racial-and-ethnic minority patients and those with less educational attainment.

BackgroundEach year an estimated 2.3 million newborns die in the first 28 days of life. Most of these deaths are preventable, and high-quality neonatal care is fundamental for surviving and thriving. Service readiness is used to assess the capacity of hospitals to provide care, but current health facility assessment (HFA) tools do not fully evaluate inpatient small and sick newborn care (SSNC).MethodsHealth systems ingredients for SSNC were identified from international guidelines, notably World Health Organization (WHO), and other standards for SSNC. Existing global and national service readiness tools were identified and mapped against this ingredients list. A novel HFA tool was co-designed according to a priori considerations determined by policymakers from four African governments, including that the HFA be completed in one day and assess readiness across the health system. The tool was reviewed by > 150 global experts, and refined and operationalised in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania between September 2019 and March 2021.ResultsEight hundred and sixty-six key health systems ingredients for service readiness for inpatient SSNC were identified and mapped against four global and eight national tools measuring SSNC service readiness. Tools revealed major content gaps particularly for devices and consumables, care guidelines, and facility infrastructure, with a mean of 13.2% (n = 866, range 2.2-34.4%) of ingredients included. Two tools covered 32.7% and 34.4% (n = 866) of ingredients and were used as inputs for the new HFA tool, which included ten modules organised by adapted WHO health system building blocks, including: infrastructure, pharmacy and laboratory, medical devices and supplies, biomedical technician workshop, human resources, information systems, leadership and governance, family-centred care, and infection prevention and control. This HFA tool can be conducted at a hospital by seven assessors in one day and has been used in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania.ConclusionThis HFA tool is available open-access to adapt for use to comprehensively measure service readiness for level-2 SSNC, including respiratory support. The resulting facility-level data enable comparable tracking for Every Newborn Action Plan coverage target four within and between countries, identifying facility and national-level health systems gaps for action.

Introduction  Patient experience is a crucial aspect of healthcare delivery, and it encompasses various elements that contribute to a patients perception of the care they receive. Patient satisfaction and patient experience are related but distinct concepts. Patient experience focuses on whether specific aspects of care occurred, while patient satisfaction gauges whether patient expectations were met. It goes beyond mere satisfaction and delves into the broader aspects of how patients interact with the healthcare system and the quality of those interactions, with health plans, doctors, nurses, and staff in various healthcare facilities. Other aspects highly valued by patients include elements such as timely access to care and information, good communication with the healthcare team, and friendly staff. Patient experience can influence both the healthcare and financial outcomes of healthcare facilities. It is well understood that positive patient experiences may lead to better care adherence, improved clinical outcomes, enhanced patient safety, and better care coordination. Payers, both public and private, have recognized the importance of patient experience. Improving patient experience benefits healthcare facilities financially by strengthening customer loyalty, building a positive reputation, increasing referrals, and reducing medical malpractice risk and staff turnover.  Methodology A multidisciplinary retrospective quality improvement initiative was initiated to effectively improve nurse-physician communication and organizational outcomes in several hospital units. Results Using an innovative staff-developed and driven acronym, IMOMW (Im on my way), the study demonstrated significant positive outcomes such as increased Epic documentation (Epic Systems Corporation, Verona, Wisconsin, United States) of physician and nursing rounding by 13%, a 10.5% rise in recommend facility net promoter score (NPS) patient experience survey scores, 13.4% increase in physician and nurse team communication, 5.4% increase in nursing communication, and a 5.3% increase in physician communication. Moreover, pilot units outperformed the control group consisting of medical-surgical units located in newer portions of the hospital. Conclusion This quality improvement study demonstrates improved interdisciplinary nurse-physician communication, Epic documentation, and patient experience scores. Further investigation is necessary to better understand the specific factors and/or processes that influence the sustainability of interventions that improve nurse-physician communication and patient experience.

Background: Stroke is a leading cause of death, reducing disability-free life expectancy. After acute treatment, patients require rehabilitation to prevent recurrence. Continued use of medication is crucial for recurrence prevention and risk management, even after the transition from acute-care institutions to other medical institutions. Although "discharge summaries on medications" are shared between hospitals and community pharmacists, no reports have addressed medication continuity for patients with stroke transferred to other institutions after discharge. This study aimed to clarify medication continuity, particularly for medications adjusted during hospitalization that should be continued even after discharge, by investigating the medication use histories of patients with stroke transferred from acute care hospitals to outpatient hospitals. Methods: We enrolled patients who were discharged from an acute ward between June 11, 2022, and March 31, 2023, after receiving inpatient care at the Japan Community Healthcare Organization, Hoshigaoka Medical Center for acute stroke, and transferred to other outpatient hospitals. This study was conducted between June 2022 and April 2023. We extracted and assessed prescription continuity and carefully examined clinically relevant discrepancies after comparing the discharge prescription with that at the first outpatient visit. Results: Of the 42 patients enrolled, seven (16.7%) had one or more discrepancies involving 13 medications. Based on the medicinal efficacy classification, four patients treated with other blood and body fluids-related agents (antiplatelet drugs), three patients treated with agents for hyperlipidemia (statins), two patients with agents for peptic ulcers, two patients with vasodilators, one patient treated with antihypertensives, and one patient with other agents affecting digestive organs (antiemetic agents that acts on the central nervous system) had discrepancies. Furthermore, discrepancies in medication discontinuation or reduction recommended by a stroke specialist, which may increase the risk of stroke recurrence, were identified in five patients (seven drugs: four antiplatelet drugs and three statins). Of 13 discrepancies, community pharmacists inquired about 3 cases with physicians, none were approved. Conclusion: The medication to prevent stroke recurrence might not be continued after transit to another outpatient after discharge. Reconsidering patient information sharing between hospital and community pharmacists and establishing a more strengthened sharing system is necessary to achieve seamless pharmacotherapy. [ABSTRACT FROM AUTHOR]

Background: Stroke is a leading cause of long-term disability among survivors. Past literature already investigated the biological sex differences in stroke outcome; still limited work on gender differences is published. Therefore, the study aimed at investigating whether biological sex and sociocultural gender of survivors play a role as determinants of disability and quality of life among stroke survivors across Europe and Canada. Methods: Data were gathered from the European Health Information Survey (EHIS, n = 316,333) and Canadian Community Health Survey (CCHS, n = 127,462) data sets. Main outcomes of interest were disability, assessed through evaluating the impairment of Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (iADL), and inpatient care needs, such as hospitalization or institutionalization. Multivariate logistic regression models were utilized to identify factors independently associated with outcomes. Federated analysis was conducted for cross-country comparisons. Data were adjusted for the country-specific Gender Inequality Index (GII), with higher score corresponding to more gender inequality toward females. Results: Female survivors showed greater impairments in iADL (odds ratio [OR] = 1.73, 95% confidence interval [CI]:1.53–1.96) and ADL (OR = 1.25, 95% CI: 1.09–1.44), without a corresponding increase in inpatient care needs. Socioeconomic factors such as marital status and income level were significant predictors of disability, with low income and being single/divorced associated with higher risks. The impact of sex was more pronounced in countries with higher GII, indicating the influence of gender inequality on stroke outcomes. Interpretation: The findings highlight the significant impact of biological sex and gender-related social determinants on post stroke disability, with female sex and unfavorable socioeconomic conditions being associated with worse outcomes. [ABSTRACT FROM AUTHOR]

Palliative care aims to improve the quality of life in patients with progressive diseases such as cancer. Effective cancer pain management is a major challenge of palliative treatment. Empirical data on the prevalence of cancer pain, the efficiency of pain treatment and influencing factors are scarce. Here, we investigated pain in cancer patients treated on inpatient palliative care wards in Germany. N = 4779 data sets provided by the German Palliative Care Registry from yearly evaluation periods between 2015 and 2020 were included. Pain ratings were assessed by professionals through a checklist of symptoms and problems (HOPE-SP-CL). More than half of the included patients suffered from moderate/severe pain at the beginning of inpatient palliative care and in 71% of these patients, pain relief was achieved at the end of inpatient treatment. Pain intensity, depression and ECOG performance status at admission were weak predictors of later pain relief. The highest pain intensity at the beginning and least pain relief were found in patients with bone and cartilage cancer. The highest percentage of adequate pain control (81%) was seen in 2020. Data from the German Palliative Care Registry confirmed that although increasingly better addressed over the years, insufficiently controlled cancer pain remains a challenge for palliative care units. Patient-specific (e.g. psychological comorbidity) and cancer-related (e.g. bone or cartilage cancer) risk factors for poor pain treatment underline the need for individualized multimodal pain management including psychological support. [ABSTRACT FROM AUTHOR]

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Background: Number of drugs are increasing with older age and present a risk factor for various adverse health outcomes. A comprehensive medication therapy management (MTM) before admission for elective surgery may help reduce unnecessary and potentially inadequate medications (PIM) and thus improve patient health. Our goal was to evaluate the implementation of PHAROS, a perioperative MTM intervention study, from the perspective of health care providers. The PHAROS intervention aimed to improve medication appropriateness in older inpatients at the outpatient / inpatient interface. Methods: We performed a qualitative interview study within a pilot intervention study comparing a comprehensive MTM with standard care in older inpatients (≥ 65 years) in Germany. Semi-structured interviews with health care professionals were performed from March to July 2021. The Consolidated Framework for Implementation Research (CFIR) was used to guide development of interview guide, data coding, analysis, and reporting of findings. Results: Ten health care professionals involved in the implementation of PHAROS were interviewed. Based on CFIR-constructs, facilitators included need for and meaningfulness of the intervention as well as positive and supportive cooperation within the project team. Implementation of MTM at the interface of inpatient to outpatient care before elective surgery was hampered by personal and organizational barriers as well as barriers resulting from broader health care structures in Germany. In particular, lack of documentation standards, missing compatibility with clinical workflow, difficulties in stakeholder engagement, as well as communication barriers between outpatient and inpatient care interfaces hindered implementation of the intervention. Conclusions: Further studies should consider focusing on facilitators to pharmaceutical implementations such as transparent and clear communication structures between stakeholders, standardization of medication documentation, and intervention structures that are adapted to hospital workflows. Trial registration: https://drks.de Identifier: DRKS00014621, this study was part of the PHAROS study. [ABSTRACT FROM AUTHOR]

Background: The effect of antidiabetic agents on mortality outcomes is unclear for individuals with diabetes mellitus (DM) who are hospitalized for COVID-19. Purpose: To examine the relationship between antidiabetic agent use and clinical outcomes in individuals with DM hospitalized for COVID-19. Methods: A systematic review of the literature (2020-2024) was performed across five databases. Included articles reported primary research (English) reporting clinical outcomes of adult patients (≥18 yrs.) with DM receiving antidiabetic agents who were hospitalized for COVID-19. Following PRISMA guidelines articles underwent independent dual review. Quality appraisal was completed for included studies. Independent reviewers used a structured data extraction form to retrieve relevant data. Aggregated data were synthesized by treatment regimen and reported descriptively. Random effects meta-analyses were performed to assess relative risk and prevalence of mortality. Results: After removing duplicates, title and abstract screening of 4,898 articles identified 118 articles for full-text review and 35 articles were retained for analysis. Included articles were primarily from China (15/35, 43%) and retrospective in nature (31/35, 89%). Fourteen studies (40%) assessed multiple antidiabetic agents, fifteen studies (42%) focused on metformin, three studies (9%) assessed the use of DPP-4 inhibitors, and three single studies (9%) investigated the use of insulin, TZD, and SGLT2 inhibitors. Despite differences among studies, the overall relative risk of mortality among metformin and DPP-4 inhibitor users was 0.432 (95% CI = 0.268-0.695, z = 3.45, p < 0.001) and the overall prevalence of mortality among all antidiabetic users was 16% (95% CI = 13%–19%, z = 10.70, p < 0.001). Conclusions and implications: Synthesis of findings suggest that patients who remained on oral agents (with/without supplemental insulin therapy) exhibited decreased mortality and lower inflammatory markers. Results indicate that individuals with DM should continue oral antidiabetic agents with additional basal insulin as needed to improve glycemic control and reduce mortality. Further work is needed to uncover mechanism(s) and clarify medical management approaches. [ABSTRACT FROM AUTHOR]

Introduction: Common mental disorders represent psychiatric co-morbidity in medical illness, which leads to poor adherence to treatment, increased exposure to diagnostic procedures and the cost of treatment, longer hospital stay, and increasing the risk of complications that result in morbidity and mortality among patients admitted to non-psychiatric wards. There is a dearth of evidence related to the prevalence of common mental disorders and associated factors among adult patients admitted to non-psychiatric wards, particularly in the study area. This study aimed to assess the prevalence of common mental disorders and associated factors among adult patients admitted to non-psychiatric wards of public hospitals in the Harari region, eastern Ethiopia. Methods: An institutional-based cross-sectional study was conducted among 640 randomly selected patients admitted to non-psychiatric wards from November 15 to December 15, 2022. A systematic random sampling technique was employed to select the study participants. Data were collected by interviewer-administered structured and semi-structured questionnaires. Self-report questionnaire (SRQ-20) was used to assess the presence of common mental disorders. The collected data were entered into Epi-data version 3.1 and exported to STATA version 14 for analysis. Bivariable and multivariable logistic regression were used to evaluate the association between independent and the outcome variable. Variables with a p-value < 0.05 were taken as statistically significant with an adjusted odds ratio and 95% confidence interval. Results: The prevalence of common mental disorders among adult patients admitted to non-psychiatric wards was found to be 45.3%, with a 95% CI: of 41.3–49.2. Age 41–51 years (AOR = 1.732, 95% CI: 1.030, 2.913), age 51 and above (AOR = 2.429, 95% CI: 1.515, 3.894), staying at hospital for 1–2 weeks (AOR = 1.743, 95% CI: 1.065, 2.853), staying at hospital for more than 4 weeks (AOR = 2.12, 95% CI: 1.77, 3.29), history of mental illness (AOR = 5.841, 95% CI: 2.274, 15.004), stressful life events (AOR = 1.876, 95% CI: 1.206, 2.9196), current substance use (AOR = 1.688, 95% CI: 1.75, 2.650), and poor social support (AOR = 2.562, 95% CI:1.166, 5.629) were factors significantly associated with common mental disorders. Conclusion: The prevalence of common mental disorders among patients admitted to non-psychiatric wards was high. It appears to be significantly associated with age, length of hospital stay, history of mental illness, stressful life events, current substance use, and social support. The study suggested that patients who are admitted to non-psychiatric wards should be screened for common mental disorders and its associated factors as part of routine inpatient care. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity is associated with significant out-of-pocket expenditures (OOPE) and catastrophic health expenditure (CHE), especially in low- and middle-income countries like India. Despite this, there is limited research on the financial burden of multimorbidity in outpatient and inpatient care, and cross-state comparisons of CHE are underexplored. Methods: We conducted a cross-sectional analysis using nationally representative data from the National Sample Survey 75th Round 'Social Consumption in India: Health (2017–18)', focusing on patients aged 30 and above in outpatient and inpatient care in India. We assessed multimorbidity prevalence, OOPE, CHE incidence, and CHE intensity. Statistical models, including linear, log-linear, and logistic regressions, were used to examine the financial risk, with a focus on non-communicable diseases (NCDs), healthcare facility choice, and socioeconomic status and Epidemiological Transition Levels (ETLs). Results: Multimorbidity prevalence in outpatient care (6.1%) was six times higher than in inpatient care (1.1%). It was most prevalent among older adults, higher MPCE quintiles, urban patients, and those with NCDs. Multimorbidity was associated with higher OOPE, particularly in the rich quintile, patients seeking care from private providers, low ETL states, and rural areas. CHE incidence was highest in low ETL states, private healthcare users, poorest quintile, males, and patients aged 70 + years. CHE intensity, measured by mean positive overshoot, was greatest among the poorest quintile, low ETL states, rural, and male patients. Log-linear and logistic regressions indicated that multimorbidity patients with NCDs, those seeking private care, and those in low ETL states had higher OOPE and CHE risk. The poorest rural multimorbidity patients had the greatest likelihood of experiencing CHE. Furthermore, CHE intensity was significantly elevated among multimorbidity patients with NCDs (95% CI: 19.29–45.79), patients seeking care in private, poorest, and from low ETL states (95% CI: 7.36–35.79). Conclusions: The high financial burden of OOPE and CHE among multimorbidity patients, particularly those with NCDs, highlight the urgent need for comprehensive health policies that address financial risk at the primary care level. To alleviate the financial burden among multimorbidity patients, especially in low-resource settings, it is crucial to expand public healthcare coverage, incorporate outpatient care into financial protection schemes, advocate for integrated care models and preventive strategies, establish standardized treatment protocols for reducing unnecessary medications linked to polypharmacy, and leverage the support of digital health technologies. [ABSTRACT FROM AUTHOR]

Due to the ethical conflict potential and far-reaching negative consequences of coercive measures (CM) in acute psychiatry, approaches to reduce the use of CM are investigated increasingly. One approach is the recovery-, resilience-, and patient-centered "Weddinger Modell" (WM) for inpatient psychiatric care. The present study evaluates the WM and investigates whether cases affected by CM, cases affected by seclusion or restraint, and the number, total duration, and average individual duration of CM per case are significantly reduced after WM-implementation. This is a retrospective study based on data from patient records. The main implementation phase of the WM (WM-MIP) was defined as the period between May and August 2020. Cases treated between July 2019 and June 2021 were included. To compare changes in the use of CM before and after the WM-MIP, different multilevel regression models were applied (with n = 1656 cases and n = 194 cases affected by CM, respectively). Cases affected by seclusion and the number of CM per case were significantly reduced after WM-MIP. No significant difference was found in terms of CM affected (total) or restraint affected, total CM duration, and average single CM duration per case. The results indicate a positive effect of the WM with regard to the reduction of CM. In terms of further spread of the WM, the implementation process should be studied in detail, especially to identify key components to reduce CM. The WM should be considered as an approach to reduce CM. • After implementation of the WM a significant reduction in cases affected by seclusion and number of CM per case was found. • Recovery-oriented, multiprofessional psychiatric care concepts like the WM should be considered as an approach to reduce CM. • Lower age, involuntary admission, police involvement, male gender, poor communication, psychosis, mania, or longer stay raise CM risk. [ABSTRACT FROM AUTHOR]

Positive behavioral support plans have been employed since the 1980s in the service of those with developmental disabilities and in school systems and show efficacy for decreasing challenging behaviors and facilitating skill building. Recent years have seen an increased use of positive behavior support (PBS) technology with adults who experience serious mental illness. Inpatient psychiatric units can be traumatizing places as a consequence of the acuity of units and their use of containment methods to address challenging behaviors, such as aggression against others and self-injury. This has resulted in socially just movements from coercive measures in inpatient care, informed by psychotherapeutic, trauma-informed, and recovery-oriented principles that emphasize safety, person-centered values, and developing a life of meaning while ensuring trustworthiness, collaboration, and empowerment. This article describes the effectiveness of a trauma-informed and recovery-oriented PBS approach, informed by psychotherapeutic principles, in the treatment of individuals with serious mental illness on an inpatient unit in decreasing the frequency and intensity of challenging behaviors. The PBS approach is also founded on the ideals of social justice that all individuals have the right to equity and to the pursuit of a meaningful life in society. This is especially true of persons who experience the most marginalization, such as those who are involuntarily hospitalized and who face coercive measures, and who deserve interventions to help them live a life of meaning. Findings suggest that this psychotherapy integration approach leads to significant decreases in aggressive behaviors while decreasing the likelihood of exposure to traumatic experiences for patients and staff alike. Public Policy Relevance Statement: This article seeks to offer innovative methods of working with those with serious mental illness with concerning behavioral challenges in inpatient settings. This approach seeks social justice change in the delivery of integrative services while seeking healing and honoring human rights. Outcomes have implications for mechanisms to make positive change within the mental health field. [ABSTRACT FROM AUTHOR]

This cohort study examines nationwide registry data for Swedish residents with a diagnosis of alcohol use disorder to determine whether hospitalization risk for an individual is decreased during periods of GLP-1 agonist use vs periods of nonuse. Key Points: Question: Are glucagon-like peptide-1 receptor (GLP-1) agonists effective in the treatment of alcohol use disorder? Findings: This cohort study with a median follow-up time of more than 8 years indicates that individuals are at markedly lower risk of alcohol-related hospitalizations and hospitalizations due to somatic reasons when using GLP-1 agonists, especially semaglutide, as compared with times they are not using them. Meaning: GLP-1 agonists, especially semaglutide, offer promise as a novel treatment to reduce alcohol consumption and to prevent development of alcohol-related outcomes, but randomized clinical trials are needed to verify these initial findings. Importance: Preliminary studies suggest that glucagon-like peptide-1 receptor (GLP-1) agonists, used to treat type 2 diabetes and obesity, may decrease alcohol consumption. Objective: To test whether the risk of hospitalization due to alcohol use disorder (AUD) is decreased during the use of GLP-1 agonists compared with periods of nonuse for the same individual. Design, Setting, and Participants: This cohort study was an observational study conducted nationwide in Sweden using data from January 2006 to December 2023. The population-based cohort was identified from registers of inpatient care, specialized outpatient care, sickness absence, and disability pension. Participants were all residents aged 16 to 64 years who had a diagnosis of AUD. Exposures: The primary exposure was use of individual GLP-1 agonists (compared with nonuse of GLP-1 agonists), and the secondary exposure was medications with indication for AUD. Main Outcomes and Measures: The primary outcome was AUD hospitalization analyzed in a Cox regression within-individual model. Secondary outcomes were any substance use disorder (SUD)–related hospitalization, somatic hospitalization, and suicide attempt. Results: The cohort included 227 866 individuals with AUD; 144 714 (63.5%) were male and 83 154 (36.5%) were female, with a mean (SD) age of 40.0 (15.7) years. Median (IQR) follow-up time was 8.8 (4.0-13.3) years. A total of 133 210 individuals (58.5%) experienced AUD hospitalization. Semaglutide (4321 users) was associated with the lowest risk (AUD: adjusted hazard ratio [aHR], 0.64; 95% CI, 0.50-0.83; any SUD: aHR, 0.68; 95% CI, 0.54-0.85) and use of liraglutide (2509 users) with the second lowest risk (AUD: aHR, 0.72; 95% CI, 0.57-0.92; any SUD: aHR, 0.78; 95% CI, 0.64-0.97) of both AUD and SUD hospitalization. Use of any AUD medication was associated with a modestly decreased risk (aHR, 0.98; 95% CI, 0.96-1.00). Semaglutide (aHR, 0.78; 95% CI, 0.68-0.90) and liraglutide (aHR, 0.79; 95% CI, 0.69-0.91) use were also associated with decreased risk of somatic hospitalizations but not associated with suicide attempts (semaglutide: aHR, 0.55; 95% CI, 0.23-1.30; liraglutide: aHR, 1.08; 95% CI, 0.55-2.15). Conclusions and Relevance: Among patients with AUD and comorbid obesity/type 2 diabetes, the use of semaglutide and liraglutide were associated with a substantially decreased risk of hospitalization due to AUD. This risk was lower than that of officially approved AUD medications. Semaglutide and liraglutide may be effective in the treatment of AUD, and clinical trials are urgently needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background and Objectives: Palliative care is a very important part of medicine, aimed at ensuring an improvement in quality of life and a reduction in distressing symptoms in patients with serious, incurable, progressive diseases. The issues of the accessibility and quality of these services should be a focus for health policymakers and researchers, although it is acknowledged that a significant portion of the public has not heard about this service. For this reason, it is important to investigate the experience of the accessibility and quality of palliative care services in primary healthcare facilities. Materials and Methods: A quantitative study was conducted in institutions providing outpatient and inpatient palliative care services. A total of 784 patients and 219 family members participated in the study. Participants expressed their opinions through a questionnaire containing 24 statements, to which they responded by indicating their level of agreement on a Likert scale. The collected data were analyzed using statistical analysis software. Results: Palliative care services are widely available in large cities, but their accessibility is very limited in small towns and rural areas. Patients and their families are not familiar with the concept of palliative care, often equating it with the provision of treatment and nursing services, and they see the support of clergy as unnecessary. Although patients and their families rate the quality of the services received positively, they note shortcomings related to communication among staff. Conclusions: Palliative care services are provided within the primary healthcare system by specialists with qualifications regulated by legislation; however, patients do not see the need to receive assistance from clergy members. Based on the study results, it can be concluded that in Lithuania, the accessibility of palliative care is ensured in larger cities but is insufficient in smaller towns and rural areas. Patients tend to rate indicators reflecting the quality of palliative care services positively; however, they are not convinced that these services improve their quality of life. [ABSTRACT FROM AUTHOR]

While research on blended therapy (BT), i.e. the combination of face-to-face and digital treatment, has grown rapidly, integrating BT into routine practice remains limited, especially in inpatient settings. This study seeks to investigate the potential barriers healthcare providers and patients are confronted with in implementing BT to inpatients. Here, a retrospective, explorative qualitative research design was employed to gain insights into the experiences of healthcare professionals and inpatients in a real-world clinical setting. Specifically, we utilized semi-structured interviews to explore three key aspects: time resources, organizational support, and integration. A total of 11 therapists and 6 patients were interviewed. To our knowledge, this is one of the first studies to examine the implementation of blended therapy in the routine care of inpatients. We found that therapists emphasized several barriers including overwhelming workloads with insufficient time allocated for the work with the digital tools, inadequate time adjustments, a lack of ongoing training, and the necessity for a well-defined concept and setting of how to implement blended therapy. Interestingly, fewer barriers were reported by patients, who viewed the e-mental health platform as a valuable addition to their standard therapy. They also judged guidance and integration by their therapists as satisfactory and appreciated the adaptability offered in managing their workload in a flexible setting. [ABSTRACT FROM AUTHOR]

Objective Study Setting and Design Data Sources and Analytic Sample Principal Findings Conclusions To determine whether rural hospital closures affected hospital and post‐acute care (PAC) use and outcomes.Using a staggered difference‐in‐differences design, we evaluated associations between 32 rural hospital closures and changes in county‐level: (1) travel distances to and lengths of stay at hospitals; (2) functional limitations at and time from hospital discharge to start of PAC episode; (3) 30‐day readmissions and mortality and hospitalizations for a fall‐related injury; and (4) population‐level hospitalization and death rates.100% Medicare claims and home health and skilled nursing facility clinical data to identify approximately 3 million discharges for older fee‐for‐service Medicare beneficiaries.We found that hospitals that closed compared to those remaining open served more minoritized, lower‐income populations, including more Medicaid and fewer commercial patients, and had lower profit margins. Following a closure, quarterly hospitalization rates (111.6 quarterly hospitalizations per 10,000 older adults; 95% CI: 53.4, 170.9) and average hospital lengths of stay increased (0.34 days; 95% CI: 0.13, 0.56 days). We observed no change in the average distance between patients' residential ZIP code and the hospital used (0.29 miles; 95% CI: −1.06, 1.64 miles); average number of standardized ADL limitations at PAC (0.08 SDs from the pre‐closure average; 95% CI: −0.12, 0.28 SDs); or PAC time to start (0.02 days; 95% CI: −1.2, 1.2 days). Among more isolated hospitals, closures were associated with an increase in the likelihood of readmission (0.10 percentage‐points; 95% CI: 0.00, 0.19).Closures were not associated with notably worsened health care access, function, or health, potentially because closures triggered care delivery adjustments involving increased numbers of patients seeking out higher quality care. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals play an important role in successfully implementing digital interventions in routine mental healthcare settings. While a larger body of research has focused on the experiences of mental healthcare professionals with the combination of digital interventions and face-to-face outpatient treatment, comparatively little is known about their experiences with digital interventions combined with inpatient treatment. This is especially true for acute psychiatric inpatient care, where studies on the implementation of digital interventions are more rare. The current study aimed to investigate healthcare professionals' experiences with an internet-based emotion regulation intervention added to acute psychiatric inpatient treatment. Methods: Physicians, nurses, psychologists, social workers, and occupational therapists from three acute inpatient wards (n = 20) were interviewed regarding their experiences. A thematic analysis approach was used to analyze the interview data. Results: The following themes and corresponding subthemes were identified: lack of experience (few or no previous experiences, no expectations, few points of contact), the intervention as a contemporary complement (positive expectations, necessary and contemporary, positive effects on therapeutic work and patients, characteristics of the internet-based program), concerns about fit for acute psychiatric inpatient care (fit for acute psychiatric inpatients, doubts about implementation), the human factor as essential for implementation (the team makes or breaks it, guidance is key, patient characteristics), and requirements for implementation beyond the human factor (integration into existing treatment structure, resources, changes to the internet-based program, timing). Conclusions: While healthcare professionals reported few points of contact with the intervention, they saw it as a contemporary complement to acute psychiatric inpatient care with benefits for therapeutic work and patients. The findings further suggest that specific concerns regarding the fit for acute psychiatric inpatient care remain and that human factors such as support from the ward team, human guidance during the intervention and being mindful of specific patient characteristics are considered important for implementation. Moreover, factors such as integration of the intervention into the ward program, resource availability and the timing of the intervention during a patient's individual stay should be considered for successful implementation. Trial registration: Clinicaltrials.gov, NCT04990674, 04/08/2021. [ABSTRACT FROM AUTHOR]

IntroductionMethods and designDiscussionRegistrationBest practice guidelines state that psychosocial interventions should be the first line of treatment for people with dementia who are experiencing distress. However, little research explores psychosocial support for those experiencing the most complex symptoms of distress in inpatient mental health wards. Music therapy may reduce behaviours of distress and staff report it to be helpful, yet interventions are not common in the National Health Service (NHS) in the United Kingdom, and the type and method of delivery vary.This study, funded by the National Institute for Health and Care Research, will co-develop and pilot a standardised protocol and guide, MELODIC (Music Therapy Embedded in the Life Of Dementia Inpatient Care), for music therapy in NHS inpatient mental health dementia wards. Two reviews, using realist and systematic methods, will be conducted to increase understanding of the current evidence base. Focus groups will then be facilitated to explore experiences of distress and the use of music on wards. MELODIC v1 will then be co-designed with experts by experience and stakeholders, and piloted on two NHS wards with differing experiences of music therapy. Mixed methods data collection will support protocol and theory refinement and establish the appropriateness of the methods to inform a future trial. Ethical approval has been received for all research activities.The protocol and findings will be disseminated in academic, clinical and public spaces. MELODIC can then be tested for feasibility and acceptability, with clinical and cost-effectiveness ultimately established in a definitive randomised controlled trial.Realist review: CRD42023409635; systematic review: CRD42023429983. [ABSTRACT FROM AUTHOR]

Background: Post-dural puncture headache (PDPH) is still mostly regarded a minor complication after lumbar puncture. In the International Classification of Headache Disorders (ICHD)-3 headaches lasting longer than 14 days or persisting after epidural blood patch (EBP) are not even considered. We illustrate that there may be many patients with persisting headaches and a large disease burden. Methods: In a retrospective, single center analysis from 04/2018 to 03/2022 we assessed patients with a dural puncture and orthostatic headache of >14 days duration, resistant to one or more EBPs. Socioeconomic factors and individual patient history were assessed by a specifically designed questionnaire. Results: We included 30 patients with a mean age of 36.4 (±10.6) years. The median duration of acute inpatient care was 31 (Interquartile ratio (IQR) = 32) days and of sick leave 381 (IQR = 666.3) days. Patients consulted a median of 5 (IQR = 6.5) different physicians/ institutions due to chronic post-dural puncture headache (cPDPH). All patients reported major negative impact of cPDPH on their social and work life. Conclusion: Despite long hospitalizations and a profound impairment of social and work lives cPDPH was neglected and underrated in all patients. We conclude that cPDPH needs to be considered and might be an underreported, severe condition which requires further prospective studies. [ABSTRACT FROM AUTHOR]

Introduction: Tovertafel® is a VR-based serious game for dementia care (SGDC) that aims to stimulate residents affected by dementia in nursing homes, promote social and cognitive skills and reduce apathy. The aim of this study is to investigate the effects of using Tovertafel® on apathy, social interaction and social activity of people with dementia (PWD) in long-term inpatient care in Germany. Methods: In this monocentric intervention study, 25 residents of an inpatient long-term care facility with moderate or severe dementia had two weekly applications of Tovertafel® over a period of 8 weeks. Effects on the residents' social interaction and activity were recorded before (T1), during (T2) and 1 h after (T3) each intervention using the Engagement of a Person with Dementia Scale (EPWDS). The degree of apathy was assessed using the Apathy Evaluation Scale (AES). Effects of Tovertafel® were examined using a simple repeated measures analysis of variance (ANOVA). Results: Thirteen residents with moderate (52%) and 12 residents with severe dementia (48%) were included. Results showed that residents' apathy changed over the course of the trial and was partially reduced. ANOVA revealed significant changes in the positive expression of social participation in the overall group between individual observation times (p < 0.001; T1: MW = 2.67, SD = 1.352; T2: MW = 3.66, SD = 1.365; T3: MW = 3.10, SD = 1.300) and a significantly lower negative expression of social participation at T2 (MW = 1.09, SD = 0.358) than at T1 (MW = 1.19, SD = 0.579; p = 0.028). There was a significantly higher positive expression of behavioral involvement in the overall group at T3 (MW = 1.17, SD = 0.552) than at T1 (p = 0.003) or T2 (p = 0.045). Analyses did not find any significant interaction between observation times and degree of dementia. Discussion: Results of the study show that the use of Tovertafel® over a period of 2 months had significant effects on apathy, social activity and social interaction in people with moderate or severe dementia. Symptoms of apathy could be reduced and social interaction and activity increased. However, due to limitations of the study design and special circumstances of the COVID-19 pandemic situation, findings might be overestimated and must be interpreted with care. Further research is necessary. [ABSTRACT FROM AUTHOR]

Background: The impact of light exposure on mental health is increasingly recognised. Modifying inpatient evening light exposure may be a low-intensity intervention for mental disorders, but few randomised controlled trials (RCTs) exist. We report a large-scale pragmatic effectiveness RCT exploring whether individuals with acute psychiatric illnesses experience additional benefits from admission to an inpatient ward where changes in the evening light exposure are integrated into the therapeutic environment. Methods and findings: From 10/25/2018 to 03/29/2019, and 10/01/2019 to 11/15/2019, all adults (≥18 years of age) admitted for acute inpatient psychiatric care in Trondheim, Norway, were randomly allocated to a ward with a blue-depleted evening light environment or a ward with a standard light environment. Baseline and outcome data for individuals who provided deferred informed consent were used. The primary outcome measure was the mean duration of admission in days per individual. Secondary outcomes were estimated mean differences in key clinical outcomes: Improvement during admission (The Clinical Global Impressions Scale–Improvement, CGI-I) and illness severity at discharge (CGI-S), aggressive behaviour during admission (Broset Violence Checklist, BVC), violent incidents (Staff Observation Aggression Scale-Revised, SOAS-R), side effects and patient satisfaction, probabilities of suicidality, need for supervision due to suicidality, and change from involuntary to voluntary admission. The Intent to Treat sample comprised 476 individuals (mean age 37 (standard deviation (SD) 13.3); 193 (41%) were male, 283 (59%) were female). There were no differences in the mean duration of admission (7.1 days for inpatients exposed to the blue-depleted evening light environment versus 6.7 days for patients exposed to the standard evening light environment; estimated mean difference: 0.4 days (95% confidence interval (CI) [−0.9, 1.9]; p = 0.523). Inpatients exposed to the blue-depleted evening light showed higher improvement during admission (CGI-I difference 0.28 (95% CI [0.02, 0.54]; p = 0.035), Number Needed to Treat for clinically meaningful improvement (NNT): 12); lower illness severity at discharge (CGI-S difference −0.18 (95% CI [−0.34, −0.02]; p = 0.029), NNT for mild severity at discharge: 7); and lower levels of aggressive behaviour (difference in BVC predicted serious events per 100 days: −2.98 (95% CI [−4.98, −0.99]; p = 0.003), NNT: 9). There were no differences in other secondary outcomes. The nature of this study meant it was impossible to blind patients or clinical staff to the lighting condition. Conclusions: Modifying the evening light environment in acute psychiatric hospitals according to chronobiological principles does not change duration of admissions but can have clinically significant benefits without increasing side effects, reducing patient satisfaction or requiring additional clinical staff. Trial registration: Clinicaltrials.gov NCT03788993; 2018 (CRISTIN ID 602154). Håvard Kallestad and colleagues report that modifying the evening light environment may improve clinical outcomes for patients admitted to acute psychiatric inpatient units. Author summary: Why was this study done?: The quality and fabric of many psychiatric inpatient facilities have improved over recent decades, but little attention has been given to how to use the environment of the unit to further optimise treatment and improve the mental state of patients. Evening exposure to light at specific frequencies in the blue spectrum may have deleterious effects on sleep, circadian rhythms, and mental state. Reducing evening exposure to blue light may improve clinical outcomes for patients with mental disorders, but few studies have been performed. What did the researchers do and find?: We built a new acute psychiatric unit with 2 wards, where each hospital ward had the same staffing levels, layout, and facilities, but had different evening light environments: standard light and blue-depleted light. We then randomly allocated 476 patients admitted for acute inpatient psychiatric care to the ward with the blue-depleted evening light environment or the ward with the standard light environment. All patients received standard care, and there were no differences in length of stay, but we observed that patients admitted to the blue-depleted light environment had additional clinical improvement and displayed less aggressive behaviour during admission. The effect sizes indicated moderate but clinically relevant effects, especially considering the short exposure in this study, where patients had a median length of admission of about 4 days, and the unobtrusiveness of the intervention, which was without adverse events or side effects. What does these findings mean?: Modifying the evening light environment may improve clinical outcomes for patients admitted to acute psychiatric inpatient units. This may also be relevant for inpatient units in different populations and specialties. Future research may address dosage and adherence, as well as finding optimal patient populations. A limitation with the study was that it was not possible to blind patients or clinical staff to the randomised lighting condition. [ABSTRACT FROM AUTHOR]

AbstractTRIAL REGISTRATIONThere is a need to transform hospital care for persons with psychotic disorders so that service users and next-of-kin are involved in care decisions. We conducted a staff educational intervention designed to increase person-centredness in inpatient care for persons with psychotic disorders. This study aimed to elucidate service user and next-of-kin experiences of inpatient care after the intervention in order to receive ideas about which aspects of care that still might need to be addressed to increase person-centredness. Service users (n = 5) and next-of-kin (n = 11) were interviewed regarding their experiences of inpatient care post intervention. The data was analyzed with inductive thematic analysis. Two main themes emerged from the data analysis: Care environment and Care quality. Regarding sub-themes related to the care environment, some participants elaborated on issues involving negative experiences including unwelcoming and hostile care environment, and limited access to staff. Others, however, described situations that reflected features of person-centred care. The same was the case for sub-themes related to experiences of care quality. While some elements of person-centred care could be identified in the narratives, there was ample room for improvement. Further intervention research is sorely needed to increase person-centredness in inpatient care for persons with psychotic disorders.NCT03182283 [ABSTRACT FROM AUTHOR]

Background and objectives: The Elixhauser Comorbidity Model is a prominent, freely-available risk adjustment model which performs well in predicting outcomes of inpatient care. However, because it relies solely on diagnosis codes, it may not capture the full extent of patient complexity. Our objective was to enhance and validatethe Elixhauser Model by incorporating additional clinical and demographic data to improve the accuracy of outcome prediction. Methods: This retrospective observational cohort study included 55,945 admissions to the internal medicine service of a large tertiary care hospital in Jerusalem. A model was derived and validated to predict four primary outcomes. The four primary outcomes measured were length of stay (LOS), in-hospital mortality, readmission within 30 days, and increased care. Results: Initially, the Elixhauser Model was applied using standard Elixhauser definitions based on diagnosis codes. Subsequently, clinical variables such as laboratory test results, vital signs, and demographic information were added to the model. The expanded models demonstrated improved prediction compared to the baseline model. For example, the R2 for log LOS improved from 0.101 to 0.281 and the c-statistic to predict in-hospital mortality improved from 0.711 to 0.879. Conclusions: Adding readily available clinical and demographic data to the base Elixhauser model improves outcome prediction by a considerable margin. This enhanced model provides a more comprehensive representation of patients' health status. It could be utilized to support decisions regarding admission and to what setting, determine suitability for home hospitalization, and facilitate differential payment adjustments based on patient complexity. [ABSTRACT FROM AUTHOR]

Objective: To explore variation in rates of acute care utilization for mental health conditions, including hospitalizations and emergency department (ED) visits, across high‐income countries before and during the COVID‐19 pandemic. Data Sources and Study Setting: Administrative patient‐level data between 2017 and 2020 of eight high‐income countries: Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US). Study Design: Multi‐country retrospective observational study using a federated data approach that evaluated age‐sex standardized rates of hospitalizations and ED visits for mental health conditions. Principal Findings: There was significant variation in rates of acute mental health care utilization across countries. Among the subset of four countries with both hospitalization and ED data, the US had the highest pre‐COVID‐19 combined average annual acute care rate of 1613 episodes/100,000 people (95% CI: 1428, 1797). Finland had the lowest rate of 776 (686, 866). When examining hospitalization rates only, France had the highest rate of inpatient hospitalizations of 988/100,000 (95% CI 858, 1118) while Spain had the lowest at 87/100,000 (95% CI 76, 99). For ED rates for mental health conditions, the US had the highest rate of 958/100,000 (95% CI 861, 1055) while France had the lowest rate with 241/100,000 (95% CI 216, 265). Notable shifts coinciding with the onset of the COVID‐19 pandemic were observed including a substitution of care setting in the US from ED to inpatient care, and overall declines in acute care utilization in Canada and France. Conclusion: The study underscores the importance of understanding and addressing variation in acute care utilization for mental health conditions, including the differential effect of COVID‐19, across different health care systems. Further research is needed to elucidate the extent to which factors such as workforce capacity, access barriers, financial incentives, COVID‐19 preparedness, and community‐based care may contribute to these variations. What is known on this topic: Approximately one billion people globally live with a mental health condition, with significant consequences for individuals and societies.Rates of mental health diagnoses vary across high‐income countries, with substantial differences in access to effective care.The COVID‐19 pandemic has exacerbated mental health challenges globally, with varying impacts across countries. What this study adds: This study provides a comprehensive international comparison of hospitalization and emergency department visit rates for mental health conditions across eight high‐income countries.It highlights significant variations in acute care utilization patterns, particularly in countries that are more likely to care for people with mental health conditions in emergency departments rather than inpatient facilitiesThe study identifies temporal and cross‐country differences in acute care management of mental health conditions coinciding with the onset of the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between physician–hospital integration within accountable care organizations (ACOs) and inpatient care utilization and expenditure. Data Sources: The primary data were Massachusetts All‐Payer Claims Database (2009–2013). Study Setting: Fifteen provider organizations that entered a commercial ACO contract with a major private payer in Massachusetts between 2009 and 2013. Study Design: Using an instrumental variable approach, the study compared inpatient care delivery between patients of ACOs demonstrating high versus low integration. We measured physician–hospital integration within ACOs by the proportion of primary care physicians in an ACO who billed for outpatient services with a place‐of‐service code indicating employment or practice ownership by a hospital. The study sample comprised non‐elderly adults who had continuous insurance coverage and were attributed to one of the 15 ACOs. Outcomes of interest included total medical expenditure during an episode of inpatient care, length of stay (LOS) of the index hospitalization, and 30‐day readmission. An inpatient episode was defined as 30, 45, and 60 days from the admission date. Data Collection/Extraction Methods: Not applicable. Principal Findings: The study examined 33,535 admissions from patients served by the 15 ACOs. Average medical expenditure within 30 days of admission was $24,601, within 45 days was $26,447, and within 60 days was $28,043. Average LOS was 3.5 days, and 5.4% of patients were readmitted within 30 days. Physician–hospital integration was associated with a 10.6% reduction in 30‐day expenditure (95% CI, −15.1% to −5.9%). Corresponding estimates for 45 and 60 days were − 9.7% (95%CI, −14.2% to −4.9%) and − 9.6% (95%CI, −14.3% to −4.7%). Integration was associated with a 15.7% decrease in LOS (95%CI, −22.6% to −8.2%) but unrelated to 30‐day readmission rate. Conclusions: Our instrumental variable analysis shows physician–hospital integration with ACOs was associated with reduced inpatient spending and LOS, with no evidence of elevated readmission rates. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, reports from several European mental health care systems hinted at important changes in utilization. So far, no study examined changes in utilization in the German mental health care inpatient and outpatient mental health care system comprehensively. Methods: This longitudinal observational study used claims data from two major German statutory health insurances, AOK PLUS and BKK, covering 162,905 inpatients and 2,131,186 outpatients with mental disorders nationwide. We analyzed changes in inpatient and outpatient mental health service utilization over the course of the first two lockdown phases (LDPs) of the pandemic in 2020 compared to a pre-COVID-19 reference period dating from March 2019 to February 2020 using a time series forecast model. Results: We observed significant decreases in the number of inpatient hospital admissions by 24–28% compared to the reference period. Day clinic admissions were even further reduced by 44–61%. Length of stay was significantly decreased for day clinic care but not for inpatient care. In the outpatient sector, the data showed a significant reduction in the number of incident outpatient diagnoses. Conclusion: Indirect evidence regarding the consequences of the reductions in both the inpatient and outpatient sector of care described in this study is ambiguous and direct evidence on treatment outcomes and quality of trans-sectoral mental healthcare is sparse. In line with WHO and OECD we propose a comprehensive mental health system surveillance to prepare for a better oversight and thereby a better resilience during future global major disruptions. [ABSTRACT FROM AUTHOR]

Purpose: Informal caregivers (ICs) in Africa perform a long list of tasks to support hospitalization care. However, available studies are weak in accounting for the experiences of everyday role-routines of hospital-based informal caregiving (HIC) in under-resourced settings. This article explored the experiences of role-routines among informal caregivers in a Nigerian tertiary health facility. Methods: The ethnographic exploratory study relied on primary data collected from 75 participants, including 21 ICs, 15 inpatients, 36 hospital staff, and 3 ad-hoc/paid carers in a tertiary health facility in Southwestern Nigeria. Results: ICs perform several essential roles for hospitalized relatives, with each role characterized by a range of tasks. An integrative narrative of everyday routines of HIC as experienced by ICs showed critical complexities and complications involved in seemingly simple tasks of assisting hospitalized relatives with hygiene maintenance, medical investigations, blood donation, resource mobilization, errand-running, patient- and self-care and others. The role-routines are burdensome and ICs' experiences of them revealed the undercurrents of how health systems dysfunctions condition family members to support hospitalization care in Nigeria. Conclusion: The intensity and repetitive nature of role-routines is suggestive of "routinization of suffering". We recommend the closing of gaps driving hospital-based informal caregiving in Africa's under-resourced settings. [ABSTRACT FROM AUTHOR]

Background: Despite the introduction of the diagnosis-related groups (DRG) system, costs in the German healthcare system have risen continuously for years. In order to reduce costs the federal government is aiming to shift inpatient services to the outpatient sector. Outpatient services affect many areas of medicine, including proctological operations as these are common and can often be carried out on an outpatient basis. Objective: The aim of the present work is to discuss which areas of proctology are suitable for outpatient treatment and which structural requirements are necessary. Material and methods: The present article is intended to provide a narrative overview with reference to the literature on the topic of outpatient care in proctology. A literature search was carried out using the following keywords: outpatient care, selective sector-level remuneration, day care, proctological operations, AOP catalog and hybrid DRG. Results: In proctology, outpatient surgical care is implementable in many cases; however, not every patient is suitable for this. In addition to previous illnesses, patient compliance and the possibility of postoperative care from relatives must also be taken into account. In addition, emergency treatment must be guaranteed. Contraindications include severe heart and circulatory diseases as well as severe coagulation or organ dysfunction. Extensive abscesses, complex fistulas or sphincter reconstructions should be surgically treated in an inpatient setting. The prerequisite for successful outpatient care is to make the sector boundaries between outpatient and inpatient patient care more permeable and to adequately remunerate the interventions. Conclusion: In addition to the surgical indications, the prerequisites for successful proctological operations are the correct assessment of the operational capability and compliance. From an organizational and economic perspective, better networking between outpatient and inpatient treatment and equal remuneration across the sector boundaries are crucial. [ABSTRACT FROM AUTHOR]

Background: Neonatal seizures are diagnostically challenging and predominantly electrographic-only. Multichannel video continuous electroencephalography (cEEG) is the gold standard investigation, however, out-of-hours access to neurophysiology support can be limited. Automated seizure detection algorithms (SDAs) are designed to detect changes in EEG data, translated into user-friendly seizure probability trends. The aim of this study was to evaluate the diagnostic accuracy of the Persyst neonatal SDA in an intensive care setting. Methods: Single-centre retrospective service evaluation study in neonates undergoing cEEG during intensive care admission to Great Ormond Street Hospital (GOSH) between May 2019 and December 2022. Neonates with <44 weeks corrected gestational age, who had a cEEG recording duration >60 minutes, whilst inpatient in intensive care, were included in the study. One-hour cEEG clips were created for all cases (seizures detected) and controls (seizure-free) and analysed by the Persyst neonatal SDA. Expert neurophysiology reports of the cEEG recordings were used as the gold standard for diagnostic comparison. A receiver operating characteristic (ROC) curve was created using the highest seizure probability in each recording. Optimal seizure probability thresholds for sensitivity and specificity were identified. Results: Eligibility screening produced 49 cases, and 49 seizure-free controls. Seizure prevalence within those patients eligible for the study, was approximately 19% with 35% mortality. The most common case seizure aetiology was hypoxic ischaemic injury (35%) followed by inborn errors of metabolism (18%). The ROC area under the curve was 0.94 with optimal probability thresholds 0.4 and 0.6. Applying a threshold of 0.6, produced 80% sensitivity and 98% specificity. Conclusions: The Persyst neonatal SDA demonstrates high diagnostic accuracy in identifying neonatal seizures; comparable to the accuracy of the standard Persyst SDA in adult populations, other neonatal SDAs, and amplitude integrated EEG (aEEG). Overdiagnosis of seizures is a risk, particularly from cEEG recording artefact. To fully examine its clinical utility, further investigation of the Persyst neonatal SDA's accuracy is required, as well as confirming the optimal seizure probability thresholds in a larger patient cohort. [ABSTRACT FROM AUTHOR]

Introduction: In Ethiopia approximately 3,200,000 babies are born annually and 41.09 per 10,000 live births are affected by spina bifida. Hydrocephalus (HCP) is another common pediatric neurosurgical condition with studies in Ethiopia showing the most common etiology is post spina bifida closure. The out-of-pocket expense (OOPE) and indirect expense of patients treated surgically for spina bifida and hydrocephalus during the first year of life were assessed. Methods: A prospective hospital-based study was done on patients treated surgically for spina bifida and HCP in two university-affiliated hospitals, between April 1st, 2022, and April 1st, 2023. Data on direct and indirect expenses were collected during inpatient care and follow-up. Catastrophic health expenditure (CHE) was assessed, defined as total expenditure exceeding 10% of the total annual household expenditure. Result: A total of 245 patients were eligible for analysis. The median annual total expenditure of households for treatment was ETB 11,510.00 with ETB 5700.00 being indirect expenditure. Forty-nine percent of the households suffered CHE. In multivariate analysis, the factors which were found to have a statistically significant association with CHE were the hospital where the patient received the treatment, the household's wealth quintile, the place of residency, and pre-admission duration of stay. Conclusion: Our study revealed a high CHE in households with spina bifida and HCP. We recommend working on primary prevention of spina bifida, expanding surgical services regionally to minimize costs associated with travel for surgical care, and reducing pre-admission duration of stay by improving evaluation and investigations at outpatient clinics. [ABSTRACT FROM AUTHOR]

Aims: Estimates of the occurrence of bipolar disorder among adolescents vary from country to country and from time to time. Long delays from first symptoms to diagnosis of bipolar disorder have been suggested. Studies among adults suggest increased mortality, particularly due to suicide and cardiovascular diseases. We set out to study the prognosis of adolescent onset bipolar disorder in terms of rehospitalizations, diagnostic stability, and mortality. Methods: The study comprised a register‐based follow‐up of all adolescents admitted to psychiatric inpatient care for the first time in their lives at age 13–17 during the period 1980–2010. They were followed up in the National Care Register for Health Care and Causes of death registers until 31 December 2014. Results: Incidence of bipolar disorder among 13‐ to 17‐year‐old adolescents over the whole study period was 2.8 per 100, 000 same aged adolescents, and across decades, the incidence increased six‐fold. Patients with bipolar disorder during their first‐ever inpatient treatment were rehospitalized more often than those treated for other reasons. Conversion from bipolar disorder to other diagnoses was far more common than the opposite. Mortality did not differ between those firstdiagnosed with bipolar disorder and those treated for other reasons. Conclusion: The incidence of adolescent onset bipolar disorder has increased across decades. The present study does not call for attention to delayed diagnosis of bipolar disorder. Adolescent onset bipolar disorders are severe disorders that often require rehospitalization, but diagnostic stability is modest. Mortality is comparable to that in other equally serious disorders. [ABSTRACT FROM AUTHOR]

Background: Antibiotic treatment is a well-known risk factor for Clostridioides difficile infection (CDI). The time from start of antibiotic exposure to onset of CDI for different antibiotics is sparsely studied. CDI with onset in the community is often treatable without in-hospital care while CDI patients treated in hospital need isolation, resulting in higher costs and infection control measures. Objectives: To determine the time from start of antibiotic exposure to onset of healthcare facility-associated CDI for different antibiotics. Methods: Time between antibiotic exposure and disease onset was evaluated retrospectively with chart reading in a two-centre Swedish setting. A case was attributed to an antibiotic group if this represented more than 2/3 of total antibiotic exposure 30 days before onset of CDI. Results: Cephalosporins caused CDI faster (mean 7.6 days), and more often during ongoing antibiotic therapy (81% of the cases) than any other antibiotic group. All other common agents had between 2–3 times longer period between start of exposure to onset of CDI (quinolones more than 3 times). Conclusions: The time gap between antibiotic exposure and onset of CDI is markedly different between different antibiotics. Decreased cephalosporin use could delay onset of healthcare facility-associated CDI and limit infections with onset within the hospital. This might decrease costs for inpatient care, need of infection control measures and shortage of beds in the hospital. [ABSTRACT FROM AUTHOR]

• Markedly impaired functional capacity is a cardinal feature of HFpEF. • The 6MWT is a widely used method of assessing functional capacity in HF. • The prognostic role of 6MWT in HFpEF still is undefined. • We investigated the prognostic role of 6MWT in 482 patients with HFpEF. • The distance covered during 6MWT was strongly associated with 3-year mortality. While the prognostic value of six-minute walking test (6MWT) in patients with heart failure (HF) and reduced ejection fraction has been firmly established, there are few or no data correlating the distance walked during 6MWT (6MWD) with mortality in patients with HF with preserved ejection fraction (HFpEF) We studied 482 patients with HFpEF who had been admitted to inpatients cardiac rehabilitation. The primary outcome was 3-year all-cause mortality. The association between 6MWD and the primary outcome was assessed using multivariable models. Established risk markers were incorporated into the models. 174 patients died during the 3-year follow-up. Taking the highest tertile of 6MWD (≥360 m) as reference, the adjusted hazard ratio (HR) of the primary outcome was 2.23 (95 % CI 1.31–3.78; p =.003) for the patients in the intermediate tertile (241–359 m) and 4.94 (95 % CI 2.90–8.39; p <.001) for those in the lowest tertile (≤240 m). The annual mortality rate was 25.0 % in the lowest tertile, 10.9 % in the intermediate tertile, and 5.3 % in the highest tertile. When the distance walked was normalized for age, sex, and body mass index and expressed as percent-of-predicted walking distance, the adjusted HR was 1.30 (95 % CI 0.76–2.22; p =.331) for the patients in the intermediate tertile (58.2 % to 77.6 %) and 3.52 (95 % CI 2.12–5.85; p <.001) for those in the lowest tertile (≤58.1 %). Our findings suggest that measuring functional capacity by evaluating the distance that a patient can walk over a period of 6 min provides important prognostic information in HFpEF. Decreasing functional capacity, as assessed by six-minute walking test, was independently associated with increasing long-term risk of mortality in HFpEF. In a separate analysis, the distance walked during six-minute walking test remained independently associated with risk of death, after further adjustment for NT-proBNP. * adjustment for age, sex, obesity, diabetes mellitus, chronic obstructive pulmonary disease, anemia, atrial fibrillation, NYHA class, transfer from acute care to the inpatient CR units after a hospitalization for HF, systolic blood pressure, blood urea nitrogen, estimated glomerular filtration rate, hyponatremia, and treatment with beta-blockers/renin-angiotensin-aldosterone system inhibitors. [Display omitted] [ABSTRACT FROM AUTHOR]

Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor with a poor prognosis and limited survival. Patients with GBM have a high demand for palliative care. In our present case, a 21-year-old female GBM patient received inpatient palliative care services including symptom management, mental and psychological support for the patient, psychosocial and clinical decision support for her family members, and pre- and post-death bereavement management for the family. Furthermore, we provided the family members with comprehensive psychological preparation for the patient's demise and assisted the patient's family throughout the mourning period. The aim of this study is to provide a reference and insights for the clinical implementation of palliative care for patients with malignant brain tumors. [ABSTRACT FROM AUTHOR]

Zusammenfassung: Einleitung/Hintergrund: Bedarfsgerechte und ressourcenorientierte Versorgungsentscheidungen für die hochaltrige Bevölkerung werden immer bedeutsamer. Das Grazer Geriatrie Tool (GGT) wurde entwickelt, um Zuweiser:innen bei der Zuordnung geriatrischer Patient:innen zu den einzelnen spezialisierten Versorgungsformen zu unterstützen. Ziel: In der Studie wurde die Praxistauglichkeit des GGT getestet. Material und Methoden: Im Rahmen dieser Studie wurde eine tatsächliche Zuweisungsentscheidung von Health Professionals mit der Empfehlung des GGT verglichen. Anschließend wurde der tatsächliche Aufenthaltsort nach ein bis acht Wochen nach Transfer der Patient:innen mittels telefonischer Nachfrage evaluiert. Ergebnisse: Von 90 Zuweisungen stimmten die Zuweiser:innenentscheidungen bei 81,1% (n=73) mit dem GGT überein. Der tatsächliche Aufenthaltsort der Patient:innen stimmte mit den Zuweiser:innen zu 85,6% (95%KI: 78,0 – 92,5) überein und mit dem GGT zu 68,9% (95%KI: 58,4 -78,0). Diskussion: Das GGT weist eine höhere Anzahl an Zuweisungen zu ambulanten bzw. teilstationären Versorgungsstrukturen auf als es die Zuweiser:innenentscheidungen und insbesondere die tatsächlichen Aufenthaltsorte letztendlich zeigen. Dieses Ergebnis zeigt die stationäre Dominanz und Lücken im derzeit bestehenden Versorgungssystem auf, welches noch zu geringe Kapazitäten im ambulanten und mobilen Bereich aufweist. Außerdem können die zugrundeliegenden Finanzierungsmodelle eine Tendenz zu stationären Strukturen begünstigen, die in der Regel für die Betroffenen kostengünstiger und bürokratischer sind, als mobile Betreuungsstrukturen, die mit Selbstbehalten behaftet sind. Background: It is becoming increasingly important to make needs- and resource-based decisions about the care of the very old population group. The Grazer Geriatrie Tool (GGT) was developed, to support health professionals in assigning geriatric patients to the individual specialized forms of care. Objective: In this study, the practicability of the GGT was tested. Material and methods: As part of this study, an actual allocation decision by health professionals was compared with the recommendation of the GGT. Subsequently, the actual place of residence was evaluated by telephone inquiry one to eight weeks after the patient's transfer. Results: Out of 90 referrals, 81.1% (n=73) of the referrers' decisions by health professionals were in line with the GGT. The patient's actual place of residence agreed with the referrers' decisions in 85,6% (95%KI: 78,0 – 92,5) of cases and with the GGT's recommendations in 68,9% (95%KI: 58,4 – 78,0) of cases. Conclusion: The GGT shows a higher number of allocations towards outpatient or semi-inpatient care structures than the referrers' decisions by health professionals and especially the patient's actual places of residence show. This result may reveal the dominance of inpatient care and the gaps in the current care system, which still has too little capacity in the outpatient and mobile areas. In addition, the underlying financing models could favour a trend towards inpatient structures, which are generally more cost-effective and bureaucratic for those affected than mobile care structures, which are subject to deductibles. [ABSTRACT FROM AUTHOR]

Acute care provided in the hospital's emergency department (ED) is a key component of the healthcare system that serves as an essential bridge between outpatient and inpatient care. However, due to the emergency-driven nature of presenting problems and the urgency of care required, the ED is more prone to unintended medication regimen changes than other departments. Ensuring quality use of medicines (QUM), defined as "choosing suitable medicines and using them safely and effectively", remains a challenge in the ED and hence requires special attention. The role of pharmacists in the ED has evolved considerably, transitioning from traditional inventory management to delivering comprehensive clinical pharmacy services, such as medication reconciliation and review. Emerging roles for ED pharmacists now include medication charting and prescribing and active participation in resuscitation efforts. Additionally, ED pharmacists are involved in research and educational initiatives. However, the ED setting is still facing heightened service demands in terms of the number of patients presenting to EDs and longer ED stays. Addressing these challenges necessitates innovation and reform in ED care to effectively manage the complex, rising demand for ED care and to meet government-imposed service quality indicators. An example is redesigning the medication use process, which could necessitate a shift in skill mix or an expansion of the roles of ED pharmacists, particularly in areas such as medication charting and prescribing. Collaborative efforts between pharmacists and physicians have demonstrated positive outcomes and should thus be adopted as the standard practice in improving the quality use of medicines in the ED. [ABSTRACT FROM AUTHOR]

Inpatient care facilities globally are facing a critical shortage of staff, posing significant challenges to resident well-being and care quality. This issue is further compounded by demographic shifts and increasing care demands. While technological advancements offer promise in alleviating nursing staff burdens, their effective integration remains complex, with nursing staff acceptance playing a pivotal role. This paper describes a systematic approach designed to streamline the process of identifying, categorizing, and prioritizing suitable technologies in inpatient care settings. By taking into account the specific needs and requirements of nursing staff, this approach, validated through a comprehensive case study, aims to facilitate targeted technology adoption, thereby contributing to the successful digitization of this occupational domain. [ABSTRACT FROM AUTHOR]

Hospital inpatient care relies on constant monitoring and reliable real-time data. Continuous improvement, adaptability, and state-of-the-art technologies are critical for ongoing efficiency, productivity, and readiness growth. When appropriately used, technologies, such as blockchain and IoT-enabled devices, can change the practice of medicine and ensure that it is performed based on correct assumptions and reliable data. The proposed electronic health record (EHR) can obtain context information from beacons, change the user interface of medical devices according to their location, and provide a more user-friendly interface for medical devices. The data generated, which are associated with the location of the beacons and devices, were stored in Hyperledger Fabric, a permissioned distributed ledger technology. Overall, by prompting and adjusting the user interface to context- and location-specific information while ensuring the immutability and value of the data, this solution targets a decrease in medical errors and an increase in the efficiency in healthcare inpatient care by improving user experience and ease of access to data for health professionals. Moreover, given auditing, accountability, and governance needs, it must ensure when, if, and by whom the data are accessed. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective Chart Review. Objective: The lifestyle of the Amish exposes them to unique mechanisms of injury, making them an important patient population from a facial trauma standpoint. This study analyzes the demographic and clinical risk factors of facial trauma in the Amish. Methods: This retrospective chart review identified all Amish patients presenting with facial trauma at a single institution between 2013-2023. Results: There were 87 Amish facial trauma patients. The median age was 9 years old, and 67.8% were male. Most injuries occurred on the road (41.4%), farm (28.7%), or at home (25.3%). The most frequent mechanisms were buggies (27.6%), falls (26.4%), and animals (18.4%). Fifty-eight patients sustained facial fractures, with orbital (n = 40), maxillary (n = 25), and nasal (n = 19) fractures being the most prevalent. The most common cause of facial fractures was buggy injuries (n = 17). Facial reconstruction was performed in 54.2% of buggy injuries, 31.3% of animal injuries, and 8.7% of falls. Patients with buggy injuries presented with the lowest Glasgow Coma Scale (GCS) scores (median 13.5) and had the longest inpatient hospital stay (median 3 days). Conclusions: Increased injury prevention efforts, especially towards buggy injuries, are necessary. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives: Readmissions to inpatient care shortly after discharge are considered a problem. In psychiatry, repeated readmissions are referred to as a “revolving door” phenomenon and are assumed to illustrate failure of care. We set out to study readmissions in adolescent psychiatry. The aim of our study was to determine the proportion of patients who are readmitted to the hospital in general during adolescent years, and those who are readmitted within 30 days of discharge. We investigated the association of various sociodemographic, psychosocial, and symptom- and disorder-related factors with readmission. Materials and methods: We conducted a retrospective chart review of all patients admitted to the adolescent psychiatric ward at Tampere University Hospital from 2016 to 2020. We collected data on patient age, gender, family risk factors, diagnoses, symptoms and any new treatment episodes. We cross-tabulated gender, child protection involvement, diagnoses, symptoms and family risk factors with overall readmission, readmission within 30 days of discharge and the number of readmissions. To explore independent associations of the partially overlapping explaining variables, we used multivariable analyses. Results: Nearly half of the patients (48.4%) experienced a readmission during adolescent years. Thirteen per cent of patients were readmitted within 30 days of discharge. In bivariate associations female gender, diagnosis from schizophrenia group, diagnosis from somatoform disorder group and a child welfare contact predicted readmission in general. The only factor increasing readmission within 30 days of discharge was female gender. In the multivariable analyses, female gender, a diagnosis from the schizophrenia disorder group, mood disorder group, anxiety disorder group and somatoform disorder group predicted readmission. Additionally, symptoms of psychosis, self-harm and eating disorders increased the risk of readmission. Conversely, depressive symptoms and concerning alcohol and substance use were found to be protective against readmissions. Conclusions: In our study, the overall readmission rates were significantly higher than in many other studies. However, the 30-day readmission rates were closer to those found in other research. These differences are likely due to variations in patient populations, healthcare systems and treatment practices as well as a longer follow-up time used in the present study. Readmissions were predicted by severe disorders such as schizophrenia group and somatoform group disorders and self-harm. This suggests that illness-related factors play a major role. However, female gender predicted readmissions in general and within 30 days when disorder-related factors were accounted for. Such gender difference may warrant societal attention to gender inequalities.

Abstract We investigate the factors that influence the variance in hospital charges and inpatient care for kidney transplant cases in the US. Using the AHRQ’s (Agency for Healthcare Research and Quality) HCUP’s (Hospital Cost and Utilization Project) NIS (National Inpatient Sample) database, we find that variance in hospital charges and inpatient care is driven by patient demographics and hospital variables. We find that variance in hospital charges and inpatient care is determined by patient-specific factors including age, gender, race, and income, and hospital factors such as size, type, and location. Our results provide a deeper understanding of the non-clinical factors that impact hospital charges and inpatient care for kidney transplant patients.

Abstract Background During the coronavirus disease 2019 (COVID-19) pandemic, inpatient nurses faced various work stressors. Little is known about organizational interventions that can mitigate the negative consequences of pandemic-related stressors. Objective The aim was to provide a synopsis of the literature concerning the types and outcomes of organizational interventions performed during the COVID-19 pandemic that directly (re)organized the work structures of inpatient nurses to address pandemic-related work stressors or to increase nurses’ ability to cope. Methods Within this preregistered systematic literature review, we searched four databases (PubMed, PsycINFO, PsycARTICLES, CINAHL) and two preprint databases (MedRxiv, PsyArXiv) for interventional studies of organizational interventions published between 01/2020 and 03/2023 (k = 990 records). We included 12 primary studies after title-abstract and full-text screening. A synthesis of results without meta-analysis was conducted. Risk of bias was assessed with the Cochrane risk-of-bias tool for randomized trials – version 2 (RoB-2) and Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool. Results All interventions were implemented in hospitals. The reasons given for implementation included pandemic-related work stressors such as a high workload, understaffing, and a lack of medical resources. To respond to the various work stressors, half of the studies took a multilevel approach combining organizational and person-oriented interventions (k = 6). Most studies (k = 8) took a secondary prevention approach, focusing on the organization of rest breaks (k = 5). With respect to outcomes, the studies examined nurse-related stress and resilience, turnover intention, job satisfaction, and other factors. Risk-of-bias analyses revealed that conclusions about the effectiveness of the interventions are limited due to confounding factors and self-selection. Conclusions The identified interventions provide a basis for future research to draw conclusions on the effectiveness of organizational interventions during pandemics. The promotion of adequate work breaks could be useful if the work stressors associated with strain and negative consequences cannot be changed directly. However, the same stressors (e.g., high workload) can hinder nurses from participating in offered interventions. This emphasizes the importance of directly addressing inpatient nurses’ work stressors. Registration Prospero-ID CRD42023364807 (March 2023).

Objective: to conduct a comparative analysis of the previously valid “Card” with a new form of “Card” filled in for patients receiving medical care in a hospital setting with the focus of the attention of practitioners on the new paragraphs of this document.Materials and methods: a comparative analysis of the medical record of an inpatient patient approved by the order of the Ministry of Health of the USSR dated October 4, 1980 was carried out. No. 1030 “On Approval of Forms of primary Medical Documentation of healthcare institutions” and the Medical record of a patient receiving medical care in inpatient conditions, in a Day hospital, approved by the Order of the Ministry of Health of the Russian Federation dated August 5, 2022 No. 530n “On Approval of Unified Forms of medical documentation used in medical organizations providing medical care in inpatient conditions, in the conditions of the day hospital and the procedures for their management”.Results: based on the results of the study of two forms of “Cards”, the advantages of the new form have been established, which improve the quality of medical documentation and, as a result, taking into account the fact that the ECMP is carried out according to medical documentation, lead to a reduction in the risks of imposing financial sanctions on medical organizations during the relevant examinations. In particular, a number of shortcomings of the new form of the “Map” are indicated, requiring additional study and discussion with possible additions in the future.Conclusions: the relevance of the examination of the quality of medical care, which, as a rule, is carried out according to the medical documentation of completed cases, is reflected. It is noted that the correct filling in of all the provided graphs and lines will minimize the number of defects in the registration of medical documentation, which in turn will reduce the financial sanctions imposed on medical organizations during the ECMP.

Introduction: Pregnancy and the postnatal period represent a time of heightened risk for women to experience mental health difficulties. Some mothers may require specialist inpatient psychiatric support made available through Mother and Baby units (MBUs). Although there is evidence of the therapeutic benefits of MBUs, many studies have utilised methodologies vulnerable to interviewer and social desirability biases. The repertory grid technique (RGT), derived from personal construct theory (PCT), has been successfully used to explore how the way in which a person thinks about and defines the self (i.e., self-construal) changes following therapeutic intervention in samples of people experiencing mental health conditions. Therefore, this study aimed to explore change in maternal self-construal following MBU admission, utilising the RGT, thereby enhancing our understanding for the therapeutic role of MBU admissions in women's mental health recoveries. Methods: Participants were recruited from two MBUs in England. RGT was undertaken with participants shortly after admission and again at discharge, allowing for comparisons between grids to assess change in how a mother viewed herself in relation to certain aspects of the self (e.g., ideal self) and other people, a concept referred to as construing in PCT. Data were analysed using principal component analysis, Slater analysis, and content analysis. Results: There were 12 participants who completed repertory grids at admission, with eight (66.67%) participants also completing discharge grids. Most of the eight participants demonstrated improvements in overall self-esteem and self-esteem as a mother, a shift towards a more positive self-perception, and increased construed similarity between the self and positively construed others, and construing became more varied. Conversely, a few participants displayed a reduction in self-esteem, particularly in the maternal role and increased construed similarity between the self and negatively construed others, and construing became more rigid. Conclusions: All participants exhibited changes to construing during their MBU admission, with most participants displaying positive changes to self-esteem and self-perception and a more adaptive process of construing. Potential implications are offered for service users, families, clinicians, and stakeholders. Recommendations for future research are also provided. [ABSTRACT FROM AUTHOR]

Introduction: Decisions to prescribe opioids to patients depend on many factors, including illness severity, pain assessment, and patient age, race, ethnicity, and gender. Gender and sex disparities have been documented in many healthcare settings, but are understudied in inpatient general medicine hospital settings. Objective: We assessed for differences in opioid administration and prescription patterns by legal sex in adult patient hospitalizations from the general medicine service at a large urban academic center. Designs, Setting, and Participants: This study included all adult patient hospitalizations discharged from the acute care inpatient general medicine services at the University of California, San Francisco (UCSF) Helen Diller Medical Center at Parnassus Heights from 1/1/2013 to 9/30/2021. Main Outcome and Measures: The primary outcomes were (1) average daily inpatient opioids received and (2) days of opioids prescribed on discharge. For both outcomes, we first performed logistic regression to assess differences in whether or not any opioids were administered or prescribed. Then, we performed negative binomial regression to assess differences in the amount of opioids given. We also performed all analyses on a subgroup of hospitalizations with pain-related diagnoses. Results: Our study cohort included 48,745 hospitalizations involving 27,777 patients. Of these, 24,398 (50.1%) hospitalizations were female patients and 24,347 (49.9%) were male. Controlling for demographic, clinical, and hospitalization-level variables, female patients were less likely to receive inpatient opioids compared to male patents (adjusted OR 0.87; 95% CI 0.82, 0.92) and received 27.5 fewer morphine milligram equivalents per day on average (95% CI - 39.0, - 16.0). When considering discharge opioids, no significant differences were found between sexes. In the subgroup analysis of pain-related diagnoses, female patients received fewer inpatient opioids. Conclusions: Female patients were less likely to receive inpatient opioids and received fewer opioids when prescribed. Future work to promote equity should identify strategies to ensure all patients receive adequate pain management. [ABSTRACT FROM AUTHOR]