暂无摘要。

Patients who discharge themselves against medical advice comprise 1%-2% of hospital admissions. Discharge against medical advice (DAMA) is defined as when a hospitalised patient chooses to leave the hospital before the treating medical team recommends discharge. The act of DAMA impacts on both the patient, the staff and their ongoing care. Specifically, this means that the patient\'s medical problems maybe inadequately assessed or treated. Patients who decide to DAMA tend to be young males, from a lower socioeconomic background and with a history of mental health or substance misuse disorder. DAMA has an associated increased risk of morbidity and mortality. In this review of studies across Western healthcare settings, specifically adult medical inpatients, we will review the evidence and seek to address the causes, consequences and possible corrective measures in this common scenario.

BACKGROUND: Symptoms such as impairment of postural balance, mobility and muscle strength can last up to 12 months post COVID-19 hospitalization, need to be better understood, as they can have repercussions in activities of daily living.
OBJECTIVE: What happens to postural balance, mobility, and handgrip strength of COVID-19 patients after hospitalization?
METHODS: A prospective cohort study was conducted with patients of both sexes, aged ≥18, admitted to hospital diagnosed with COVID-19. Outcomes were assessed at 1, 4, 6, and 12 months post-discharge, including: postural balance - Brief-Balance Evaluation Systems Test, mobility - Timed \"Up & Go\" Test, and handgrip strength - dynamometry. Prevalence values of impaired postural balance and mobility and lower-than-expected handgrip strength were calculated by point estimate and 95 % confidence interval. Shapiro-Wilk test showed that our data did not have a normal distribution, so the Friedman Test and the test of proportions were used for the statistical analysis.
RESULTS: Performance on postural balance was improved after four months of hospital discharge, but the improvement in mobility and handgrip strength only occurred after six months. After six months of discharge, the proportion of individuals with impairments began to decrease. A higher prevalence of impairments in postural balance and mobility occurred at one month post-discharge, which reduced over time. However, the values of impairments for postural balance and mobility were still high after 12 months of follow-up.
CONCLUSIONS: There was a high prevalence of postural balance and mobility impairment 1 month after discharge, which was still high 12 months after discharge. The prevalence of lower-than-expected handgrip strength demonstrated limited change over time. Results highlight the need for assessment of postural balance, mobility and hand grip strength in post COVID-19 related hospitalization protocols, and long-term physical therapy interventions to address these impairments when identified to improve long term outcomes.

BACKGROUND: Hospitalized patients infected with SARS-CoV-2 should recover within a few weeks. However, even those with mild versions can experience symptoms lasting 4 weeks or longer. These post-COVID-19 condition (PCC) comprise various new, returning, or ongoing symptoms that can last for months or years and cause disability. Few studies have investigated PCC using self-reports from discharged patients infected with SARS-CoV-2 to complement clinical and biomarker studies.
OBJECTIVE: This study aimed to investigate self-reported, persistent PCC among patients infected with SARS-CoV-2 who were discharged during the second and third waves of the COVID-19 pandemic.
METHODS: We designed, pretested, and posted an ad hoc paper questionnaire to all eligible inpatients discharged between October 2020 and April 2021. At 4 months post discharge, we collected data on PCC and scores for the Multidimensional Fatigue Inventory (MFI), the Patient Health Questionnaire-4 (PHQ-4), a Brief Memory Screening Scale (Q3PC), and a posttraumatic stress disorder scale (PCL-5). Descriptive, inferential, and multivariate linear regression statistics assessed PCC symptomatology, associations, and differences regarding sociodemographic characteristics and hospital length of stay (LOS). We examined whether our variables of interest significantly predicted MFI scores.
RESULTS: Of the 1993 valid questionnaires returned, 245 were from discharged patients with SARS-CoV-2 (median age 71, IQR 62.7-77 years). Only 28.2% (69/245) of respondents were symptom-free after 4 months. Women had significantly more persistent PCC symptoms than men (P≤.001). Patients with a hospital LOS ≥11 days had more PCC symptoms as well (P<.001)-women had more symptoms and longer LOS. No significant differences were found between age groups (18-64, 65-74, and ≥75 years old; P=.50) or between intensive care units and other hospitalization units (P=.09). Patients self-reported significantly higher PHQ-4 scores during their hospitalization than at 4 months later (P<.001). Three-fourth (187/245, 76.4%) of the respondents reported memory loss and concentration disorders (Q3PC). No significant differences in the median MFI score (56, IQR 1-3, range 50-60]) were associated with sociodemographic variables. Patients with a hospital LOS of ≥11 days had a significantly higher median PCL-5 score (P<.001). Multivariate linear regression allowed us to calculate that the combination of PHQ-4, Q3PC, and PCL-5 scores, adjusted for age, sex, and LOS (of either ≥11 days [median 2 symptoms, IQR 1-5] or <11 days), did not significantly predict MFI scores (R2=0.09; F4,7 =1.5; P=.22; adjusted R2=0.06).
CONCLUSIONS: The majority of inpatients infected with SARS-CoV-2 presented with PCC 4 months after discharge, with complex clinical pictures. Only one-third of them were symptom-free during that time. Based on our findings, MFI scores were not directly related to self-reported depression, anxiety, or posttraumatic scores adjusted for age, sex, or LOS. Further research is needed to explore PCC and fatigue based on self-reported health experiences of discharged inpatients infected with SARS-CoV-2.

BACKGROUND: Schizophrenia is a pervasive and severe mental disorder characterized by significant disability and high rates of recurrence. The persistently high rates of readmission after discharge present a serious challenge and source of stress in treating this population. Early identification of this risk is critical for implementing targeted interventions. The present study aimed to develop an easy-to-use predictive instrument for identifying the risk of readmission within 1-year post-discharge among schizophrenia patients in China.
METHODS: A prediction model, based on static factors, was developed using data from 247 schizophrenia inpatients admitted to the Mental Health Center in Wuxi, China, from July 1 to December 31, 2020. For internal validation, an additional 106 patients were included. Multivariate Cox regression was applied to identify independent predictors and to create a nomogram for predicting the likelihood of readmission within 1-year post-discharge. The model\'s performance in terms of discrimination and calibration was evaluated using bootstrapping with 1000 resamples.
RESULTS: Multivariate cox regression demonstrated that involuntary admission (adjusted hazard ratio [aHR] 4.35, 95% confidence interval [CI] 2.13-8.86), repeat admissions (aHR 3.49, 95% CI 2.08-5.85), the prescription of antipsychotic polypharmacy (aHR 2.16, 95% CI 1.34-3.48), and a course of disease ≥ 20 years (aHR 1.80, 95% CI 1.04-3.12) were independent predictors for the readmission of schizophrenia patients within 1-year post-discharge. The area under the curve (AUC) and concordance index (C-index) of the nomogram constructed from these four factors were 0.820 and 0.780 in the training set, and 0.846 and 0.796 for the validation set, respectively. Furthermore, the calibration curves of the nomogram for both the training and validation sets closely approximated the ideal diagonal line. Additionally, decision curve analyses (DCAs) demonstrated a significantly better net benefit with this model.
CONCLUSIONS: A nomogram, developed using pre-discharge static factors, was designed to predict the likelihood of readmission within 1-year post-discharge for patients with schizophrenia. This tool may offer clinicians an accurate and effective way for the timely prediction and early management of psychiatric readmissions.

UNASSIGNED: Hospital readmissions are costly for patients, their families and healthcare systems. Identifying and addressing risk factors can reduce the number of people who experience readmission. Few studies have explored modifiable risk factors such as health beliefs from patients\' perspective to explore the complexity of risk factors for readmission. This study aimed to identify modifiable readmission risk factors from the perspectives of patients who have experienced readmission and their families.
UNASSIGNED: Adults (≥18 years) readmitted within 30 days of discharge to a general medical or surgical ward at a large urban hospital in New Zealand were invited to participate in a semi-structured interview to explore their readmission experience. Interviews were conducted during the readmission and were analysed using inductive thematic analysis.
UNASSIGNED: A total of 30 participants were interviewed. Six themes relating to readmission were identified: inadequate communication between health professionals and patients, misalignment between patient illness perceptions and treatment, unclear or missing information, poor health literacy, poor medication mismanagement, and health system factors.
UNASSIGNED: These findings highlight the importance of considering patient experiences, such as their expectations, illness and treatment beliefs, to reduce readmissions. Ensuring communication is patient centred and quality professional-patient relationships could reduce readmissions.

UNASSIGNED: The purpose of this study was to explore the mediating roles of care receiver clinical factors on the relationship between care partner preparedness and care partner desire to seek long-term care admission for persons living with dementia at hospital discharge.
UNASSIGNED: This study analyzed data from the Family centered Function-focused Care (Fam-FFC), which included 424 care receiver and care partner dyads. A multiple mediation model examined the indirect effects of care partner preparedness on the desire to seek long-term care through care receiver clinical factors (behavioral and psychological symptoms of dementia [BPSD], comorbidities, delirium severity, physical function, and cognition).
UNASSIGNED: Delirium severity and physical function partially mediated the relationship between care partner preparedness and care partner desire to seek long-term care admission (B = -.011; 95% CI = -.019, -.003, and B = -.013; 95% CI = -.027, -.001, respectively).
UNASSIGNED: Interventions should enhance care partner preparedness and address delirium severity and physical function in hospitalized persons with dementia to prevent unwanted nursing home placement at hospital discharge.
UNASSIGNED: Integrating care partner preparedness and care receiver clinical factors (delirium severity and physical function) into discharge planning may minimize care partner desire to seek long-term care.

UNASSIGNED: Multiple studies have explored the needs and experiences of patients, family members, and healthcare professionals regarding hospital-to-home transitions. Our study aimed to identify, critically appraise, and summarize these studies in a qualitative meta-synthesis.
UNASSIGNED: Medline, CINAHL and Embase were systematically searched to identify eligible articles from inception to June 2024. Qualitative studies were included and critically appraised using the Critical Appraisal Skills Program. Insufficient-quality papers were excluded. We performed a meta-synthesis following (1) open coding by two independent researchers and (2) discussing codes during reflexivity meetings.
UNASSIGNED: Ninety-eight studies were appraised, of which 53 were included. We reached thematic saturation, four themes were constructed: (1) care coordination and continuity, (2) communication, (3) patient and family involvement, and (4) individualized support and information exchange. For patients and families, tailored information and support are prerequisites for a seamless transition and an optimal recovery trajectory after hospital discharge. It is imperative that healthcare professionals communicate effectively within and across care settings to ensure multidisciplinary collaboration and care continuity.
UNASSIGNED: This study identifies essential elements of optimal transitional care. These findings could be supportive to researchers and healthcare professionals when (re)designing transitional care interventions to ensure care continuity after hospital discharge.
Patients and their families need to receive tailored information and support, which are prerequisites for a seamless transition from hospital to homeProfessionals must communicate effectively within and across hospital and primary care settingsProfessional roles should be clarified to ensure effective collaboration and continued high-quality care after hospital discharge.Integrated allied health pathways addressing coordination and communication are needed to ensure seamless transitions.

BACKGROUND: A growing number of countries have reported sharp increases in the use and harm of opioid analgesics. High rates of new opioid initiation are observed in postoperative patients. In response, various tertiary care institutions have developed opioid exit plans (OEPs) to curb potential opioid-related harm.
METHODS: PubMed and Embase were systematically searched to identify, summarize, and compare the interventional elements of OEPs for postoperative patient populations published from January 1, 2000, to June 4, 2024. Two researchers independently screened the articles for eligibility following the PRISMA 2020 guidelines, extracted the data, and assessed the study quality and risk of bias. Data synthesis was performed for study characteristics, intervention details, efficacy, and development.
RESULTS: A total of 2,585 articles were screened, eight of which met the eligibility criteria. All studies were conducted in North America and focused on orthopedic surgery patients following total hip or knee arthroplasty (n = 5) or neurosurgery (n = 3). Most studies (n = 7) included a pre-post (n = 4) or randomized clinical design (n = 3). Three studies were of good quality, and none had a low risk of bias. The interventions varied and ranged from educational sessions (n = 1) to individualized tapering protocols (n = 4) or a combination of the two (n = 2). Key elements were instructions on how to anticipate patients\' postoperative need for opioid analgesics and tapering strategies based on 24-h predischarge opioid consumption. Six studies included efficacy as an endpoint in their analysis, of which four assessed statistical significance, with all four identifying that the OEPs were successful in reducing postoperative opioid use.
CONCLUSIONS: Despite differences in design and implementation, the identified OEPs suggest that they are efficacious in reducing outpatient opioid consumption. They provide a robust estimate of postoperative analgesic requirements and a rationale for tapering duration and rate. However, more rigorous studies are needed to evaluate their real-world effectiveness.

OBJECTIVE: To identify the current practices with long half-life lipoglycopeptides (LGPs) and potential use/position of oritavancin.
RESULTS: Despite their indication being limited to skin and soft tissue infections (SSTIs), long half-life lipoglycopeptides are mainly used off-label to treat bone and joint infections (BJIs) and infective endocarditis. Oritavancin and dalbavancin are both semisynthetic lipoglycopeptide antibiotics with activity against Gram-positive organisms. The game-changing property of these two antibiotics is their one-time dosing. Due to its shorter half-life, oritavancin might have an advantage over dalbavancin for a treatment duration of less than 2 weeks, as it could be used both in prolonged treatments of complicated patients in BJIs or administered as a single-dose treatment for Gram-positive cocci infections usually treated by a 5- to 10-day antibiotic course. These infections include urinary tract infections, bacteremias, catheter-related infections, etc. In addition to the possibility of being used as an end-of-treatment injection, oritavancin could be used as an empiric therapy treatment in the postoperative period in the context of device-associated especially prosthetic joint infections to allow for the early discharge of the patient.
METHODS: A qualitative survey was conducted in March 2022 including sixteen infectiologists, one internist, five hospital pharmacists, and one pharmacologist.
CONCLUSIONS: Long half-life lipoglycopeptides contribute to changing the paradigm in the management of acute bacterial infections, as infectiologists now consider a range of indications and patient profiles for one single drug. Oritavancin strengthens the therapeutic arsenal in numerous infections from BJIs to urinary tract infections and could help to manage specific clinical situations, on top of providing potential benefits for the hospital\'s budget.