Early Discharge of Newborns and Mothers: A Critical Review of the Literature

PEDIATRICS ◽  
1995 ◽  
Vol 96 (4) ◽  
pp. 716-726 ◽  
Author(s):  
Paula Braveman ◽  
Susan Egerter ◽  
Michelle Pearl ◽  
Kristen Marchi ◽  
Carol Miller
Keyword(s):  
Low Income ◽  
Critical Review ◽  
English Language ◽  
Discharge Planning ◽  
A Priori ◽  
Early Discharge ◽  
Clinic Visit ◽  
Adverse Outcomes ◽  
Hospital Stays ◽  
The Impact

Objective. To determine whether research supports the advisability of early discharge of healthy newborns and mothers. Methods. Critical review of English-language literature cited in the Index Medicus or the International Nursing Index. Findings. No adequately designed studies have examined discharge before 48 hours after delivery without additional postdischarge services. Few studies have examined the consequences of recommending a clinic visit within the first days after discharge; studies of this practice among low-income populations found high no-show rates. Some small studies suggest that early discharge is likely to be safe for selected populations at low psychosocial, socioeconomic, and medical risk, with careful antenatal screening and preparation and multiple postpartum home visits. Some studies suggested adverse outcomes associated with early discharge even with early follow-up. Conclusions. Published research provides little knowledge of the consequences of short maternal/newborn hospital stays or varying postdischarge practices for the general population. The studies that have concluded that early discharge was safe were applied under restricted circumstances or were too small to detect clinically significant effects on important outcomes. Further research is needed to inform clinical and reimbursement policy on health services in the first days of life and parenting. Rigorous studies of sufficient size are needed to examine the impact of different hospital stays and different postdischarge practices on a range of outcomes for mothers and newborns in diverse populations and settings. Given a priori concerns, decisions on neonatal/obstetric discharge planning should be made cautiously.

scholarly journals Management of superficial and deep surgical site infection: an international multidisciplinary consensus

2021 ◽  
Author(s):  
Gabriele Sganga ◽  
Mohamed Baguneid ◽  
Pascal Dohmen ◽  
Evangelos J. Giamarellos-Bourboulis ◽  
Emilio Romanini ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Early Discharge ◽  
Multidrug Resistant ◽  
Steering Committee ◽  
Resistant Bacteria ◽  
Modified Delphi ◽  
Hospital Stays ◽  
New Treatment ◽  
The Impact

AbstractSurgical site infections represent a considerable burden for healthcare systems. To obtain a consensus on the impact and future clinical and economic needs regarding SSI management in an era of multidrug resistance. A modified Delphi method was used to obtain consensus among experts from five European countries. The Delphi questionnaire was assembled by a steering committee, verified by a panel of experts and administered to 90 experts in 8 different surgical specialities (Abdominal, Cancer, Cardiac, General surgery, Orthopaedic, Thoracic, Transplant and Vascular and three other specialities (infectious disease, internal medicine microbiology). Respondents (n = 52) reached consensus on 62/73 items including that resistant pathogens are an increasing matter of concern and increase both treatment complexity and the length of hospital stay. There was strong positive consensus on the cost-effectiveness of early discharge (ED) programs, improvement of quality of life with ED and association between increased length of stay and economic burden to the hospital. However, established ED protocols were not widely available in their hospitals. Respondents expressed a positive consensus on the usefulness of antibiotics that allow ED. Surgeons are aware of their responsibility in an interdisciplinary team for the treatment of SSI, and of the impact of multidrug-resistant bacteria in the context of SSI. Reducing the length of hospital stays by applying ED protocols and implementing new treatment alternatives is crucial to reduce harm to patients and costs for the hospital.

62 Geriatric Surgical Liaison Staff Perspectives of Geriatric Care Before and After Introduction of An Embedded Service

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i18-i20
Author(s):  
K Shah ◽  
R Kyzy ◽  
H Pittaway
Keyword(s):  
Older Patients ◽  
Discharge Planning ◽  
Adverse Outcomes ◽  
Ageing Population ◽  
Emergency Setting ◽  
Complication Rates ◽  
Before And After ◽  
Key Indicators ◽  
The Impact ◽  
Multi Disciplinary Team

Abstract Introduction National evidence demonstrates that older people having surgery, both in the elective and emergency setting, have more adverse outcomes postoperatively when compared with their younger counterparts (1). National reports have recommended daily input from a geriatric team for older patients having surgery (2). At our hospital we have introduced a geriatric surgical liaison consultant as a formal post to ensure daily geriatric input or review for patients over the age of 70 or comorbid younger patients as requested. The aim of this study was to review perspectives across the multi-disciplinary team on care provided to these patients before and after introduction of the surgical liaison team. Methods We created a 10 part questionnaire, which was distributed amongst all members of the multi-disciplinary team, asking them to rate confidence out of 10 in management of comorbidity, polypharmacy, discharge planning, pain assessments and nutrition. These data were then analysed to produce median scores for each category before and after the introduction of the service. We compared the change in scores between the foundation year 1 (FY1) doctors and the remainder of the respondents. Results The below table demonstrates the median scores across all 36 respondents in their confidence with the assessment and management of the 10 key domains before and after the liaison service was introduced: Conclusions Universally within our survey, staff reported improvement in all 10 key indicators of care of older patients on surgery with the introduction of a geriatric surgical liaison team. Greatest benefit was seen within the FY1 group. References 1. McVeigh TP, Al-Azawi D, O'Donoghue GT, Kerin MJ. Assessing the impact of an ageing population on complication rates and in-patient length of stay, Int J Surg, 2013, vol. 11 (pg. 872–5). 2. Wilkinson K. An age old Problem: A Review of the Care Received by Elderly Patients Undergoing Surgery: A Report by the National Confidential Enquiry Into Patient Outcome and Death. London, 2010.

scholarly journals Global Use of Traditional and Complementary Medicine in Childhood Cancer: A Systematic Review

2017 ◽  
Vol 3 (6) ◽  
pp. 791-800 ◽  
Author(s):  
Caroline Diorio ◽  
Catherine G. Lam ◽  
Elena J. Ladas ◽  
Festus Njuguna ◽  
Glenn M. Afungchwi ◽  
...  
Keyword(s):  
Complementary Medicine ◽  
Pediatric Oncology ◽  
Active Treatment ◽  
Low Income ◽  
Data Extraction ◽  
A Priori ◽  
Low Income Countries ◽  
Middle Income ◽  
Treatment Abandonment ◽  
The Impact

Purpose Traditional and complementary medicine (T&CM) strategies are commonly used in pediatric oncology. Patterns may vary based on country income. We systematically reviewed published studies describing T&CM use among pediatric oncology patients in low-income countries (LIC/LMIC), middle-income countries (UMIC), and high-income countries (HIC). Objectives included describing estimated prevalence of use, reasons for use, perceived effectiveness, modalities used, rates of disclosure, and reporting of delayed or abandoned treatment. Methods MEDLINE, EMBASE, Global Health, CINAHL, PsycINFO, Allied and Complementary Medicine Database, Cochrane Database of Systematic Reviews, and ProceedingsFirst were searched. Inclusion criteria were primary studies involving children younger than the age of 18 years, undergoing active treatment of cancer, and any T&CM use. Exclusion criteria included no pediatric oncology–specific outcomes and studies involving only children off active treatment. Data were extracted by two reviewers using a systematic data extraction form determined a priori. Results Sixty-five studies published between 1977 and 2015 were included, representing 61 unique data sets and 7,219 children from 34 countries. The prevalence of T&CM use ranged from 6% to 100%. Median rates of use were significantly different in LIC/LMIC (66.7% ± 19%), UMIC (60% ± 26%), and HIC (47.2% ± 20%; P = .02). Rates of disclosure differed significantly by country income, with higher median rates in HIC. Seven studies reported on treatment abandonment or delays. Conclusion The use of T&CM in pediatric oncology is common worldwide, with higher median prevalence of use reported in LIC/LMIC. Further research is warranted to examine the impact on treatment abandonment and delay.

The impact of Twitter on libraries: a critical review of the literature

2015 ◽  
Vol 33 (4) ◽  
pp. 795-809 ◽  
Author(s):  
Evgenia Vassilakaki ◽  
Emmanouel Garoufallou
Keyword(s):  
Critical Review ◽  
Social Networking Sites ◽  
Design Methodology ◽  
English Language ◽  
Relevant Literature ◽  
Library Science ◽  
Content Type ◽  
Marketing Tool ◽  
The Impact ◽  
Published Research

Purpose – The paper aims to present a critical review on the adoption and use of Twitter in libraries. Twitter, a microblogging service, is becoming more and more popular among libraries as a means of reaching users and as a marketing tool for their services. Design/methodology/approach – The method of systematic review is used to identify, collect and critically present all relevant literature. Papers’ aims were analyzed to identify the emergent themes and sub-themes in an effort to gain a better understanding of libraries’ use of Twitter. Findings – A systematic and critical analysis of the literature revealed the specific reasons why a library should adopt Twitter; the specific examples and thoughts on how Twitter could be used to promote libraries’ interests; the different ways Twitter had affected diverse aspects and functionalities of libraries; and the attempts to provide guidelines for librarians. Research limitations/implications – This literature review has implications for research in that libraries could explore the way public view their presence on social networking sites such as Twitter to better gain from it. In addition, it indicates what libraries should expect when they adopt Twitter. This study reviews only papers published between 2007 and 2013 in the English language. Originality/value – This paper contributes in identifying, collecting, analyzing and critically presenting published research referring to the adoption of Twitter in the field of Library Science. In addition, it identifies and discusses the main issues librarians and libraries need to consider, when faced with the challenge of adopting Twitter.

scholarly journals Predictors and Prognostic Models for Early Discharge Planning of Hospitalized Acute Geriatric Patients, A Retrospective Study

2021 ◽  
Author(s):  
Annette Hoppe ◽  
Bernhard Hoppe
Keyword(s):  
Functional Outcome ◽  
Physical Function ◽  
Discharge Planning ◽  
Logistic Models ◽  
Early Discharge ◽  
Early Rehabilitation ◽  
Walking Distance ◽  
Geriatric Ward ◽  
Predictive Quality ◽  
The Impact

Abstract Motivation: When treated for an acute disorder, older adults are vulnerable for functional losses and the need of care after discharge. In a specialised geriatric ward, patients get a comprehensive treatment complementary to medical care in order to maintain and improve mobility and activities of daily living (ADL) to facilitate the return to domesticity. The aim of this paper is to identify the relevant predictors for the impact of geriatric treatment on the status at discharge, which are then used in logistic models to predict a patient’s potential to reach a certain level of independence during treatment.Method: In a retrospective cohort study with 580 patients, we analysed the impact of acute geriatric early rehabilitation on the functional outcome after treatment. As a sufficient improvement of ADLs and mobility we defined as a suitable endpoint at least 60 Barthel Points (ADL) and the ability for „Timed-Up-and-Go-Test“(TUG) when discharged from acute hospital care. To identify relevant predictors in the set of the screening assessments at admission we used linear and logistic regressions as well as odds-ratios. Multivariate logistic models are used to predict the probability that at patient reaches the endpoint. Their predictive quality is tested on additional 120 test patients from a different cohort. Results: Statistical analysis shows that all patients improved during early rehabilitation significantly in ADLs and the physical function (TUG). Barthel-Score, walking distance and handgrip on admission are the strongest predictors for the outcome after geriatric treatment. Logistic models predict the outcome correctly in 70% to 80% of the cases. These models once established for a certain cohort of patients can be applied with similar accuracy to different sets of patients as well. Clinical condition, the medical treatment before admission, length of hospitalization, age or gender have no predictive quality.Discussion: We were able to show that all patients benefit significantly from early rehabilitation in an acute geriatric ward. Only a few assessments on admission related to physical function are sufficient to indicate the functional outcome after geriatric treatment. Logistic models based on these predictors are reliable with a generic predictive quality for the expected level of independence at discharge. This facilitates early discharge planning.Trial registration: The study was retrospectively registered on 2nd July 2018 by the ethic commission of the hospital und filed under registration number (MG1/569/770/2019).

scholarly journals In Silico Mathematical Modelling for Glioblastoma: A Critical Review and a Patient-Specific Case

2021 ◽  
Vol 10 (10) ◽  
pp. 2169
Author(s):  
Jacopo Falco ◽  
Abramo Agosti ◽  
Ignazio G. Vetrano ◽  
Alberto Bizzi ◽  
Francesco Restelli ◽  
...  
Keyword(s):  
Mathematical Modelling ◽  
Mathematical Models ◽  
Critical Review ◽  
English Language ◽  
Theoretical Models ◽  
Patient Specific ◽  
Tumor Control ◽  
Tumor Evolution ◽  
Radiological Data ◽  
The Impact

Glioblastoma extensively infiltrates the brain; despite surgery and aggressive therapies, the prognosis is poor. A multidisciplinary approach combining mathematical, clinical and radiological data has the potential to foster our understanding of glioblastoma evolution in every single patient, with the aim of tailoring therapeutic weapons. In particular, the ultimate goal of biomathematics for cancer is the identification of the most suitable theoretical models and simulation tools, both to describe the biological complexity of carcinogenesis and to predict tumor evolution. In this report, we describe the results of a critical review about different mathematical models in neuro-oncology with their clinical implications. A comprehensive literature search and review for English-language articles concerning mathematical modelling in glioblastoma has been conducted. The review explored the different proposed models, classifying them and indicating the significative advances of each one. Furthermore, we present a specific case of a glioblastoma patient in which our recently proposed innovative mechanical model has been applied. The results of the mathematical models have the potential to provide a relevant benefit for clinicians and, more importantly, they might drive progress towards improving tumor control and patient’s prognosis. Further prospective comparative trials, however, are still necessary to prove the impact of mathematical neuro-oncology in clinical practice.

Pre-Arthroplasty Rehabilitation is Effective in Reducing Hospital Stay

2003 ◽  
Vol 70 (2) ◽  
pp. 88-96 ◽  
Author(s):  
Jean Crowe ◽  
Jennifer Henderson
Keyword(s):  
Length Of Stay ◽  
Usual Care ◽  
Discharge Planning ◽  
Cost Effective ◽  
Early Discharge ◽  
Rehabilitation Program ◽  
Clinic Visit ◽  
Physical Conditioning ◽  
Actual Length ◽  
Complex Needs

Backround. The purpose of the trial was to evaluate the effect on length of stay of individually tailored rehabilitation for clients who were undergoing hip or knee arthroplasty. Method. Clients (n = 133) with complex needs (comorbid conditions or limited social support) were randomly assigned to receive preoperative usual care (UC) or rehabilitation (R). Usual care clients received a single preoperative clinic visit. Rehabilitation clients were individually assessed and received multi disciplinary rehabilitation to optimize functional capacity, education about the in-hospital phase and early discharge planning. All rehabilitation subjects received interdisciplinary counseling/education focused on preparation for discharge home. The intervention for approximately half the rehabilitation clients was a single, cost-effective session, while others received physical conditioning. Results. Clients receiving rehabilitation achieved discharge criteria earlier (R = 5.4, UC = 8 days) and had a shorter actual length of stay (R = 6.5, UC = 10.5 days). Clinical Implications. This preoperative, individually tailored, rehabilitation program reduced length of stay.

scholarly journals Adverse perinatal outcomes among children in Switzerland: the impact of national origin and socio-economic group

2020 ◽  
Vol 65 (9) ◽  
pp. 1613-1621
Author(s):  
Philippe Wanner
Keyword(s):  
Low Income ◽  
Perinatal Outcomes ◽  
Adverse Outcomes ◽  
Health Policies ◽  
Extreme Prematurity ◽  
Economic Level ◽  
Swiss Population ◽  
Logistic Regressions ◽  
Adverse Perinatal Outcomes ◽  
The Impact

Abstract Objectives We examined the effect of the mother’s origin and socio-economic characteristics on adverse perinatal outcomes in Switzerland. Methods Births occurring from 2011 to 2017 were identified in the Swiss population register and merged with the Swiss civil register and the Register of the first pillar to obtain information on the migration origin and socio-economic level. Four indicators of adverse perinatal outcomes were defined. Results Logistic regressions show that both the migration origin and the socio-economic level are measured by the parents’ income, influence risk. Compared to the children of mothers born in Switzerland, those of mothers from EU/EFTA countries have a lower risk of infant mortality, low birth weight and extreme prematurity. The highest risk is observed for children born to mothers from the rest of the world. High levels of risk consistently characterize children with low-income parents (first decile). Conclusions Our results justify further investigations at the level of health services to better identify the factors causing differences in the prevalence of adverse outcomes and to take them into account in adapted health policies.

Demonstrating Nutrient Cost Gradients: A Brooklyn Case Study

2014 ◽  
Vol 84 (5-6) ◽  
pp. 244-251 ◽  
Author(s):  
Robert J. Karp ◽  
Gary Wong ◽  
Marguerite Orsi
Keyword(s):  
Low Income ◽  
Energy Content ◽  
Food Selection ◽  
The United States ◽  
United States Department ◽  
Micronutrient Deficiencies ◽  
Caloric Density ◽  
Low Income Families ◽  
The Cost ◽  
The Impact

Abstract. Introduction: Foods dense in micronutrients are generally more expensive than those with higher energy content. These cost-differentials may put low-income families at risk of diminished micronutrient intake. Objectives: We sought to determine differences in the cost for iron, folate, and choline in foods available for purchase in a low-income community when assessed for energy content and serving size. Methods: Sixty-nine foods listed in the menu plans provided by the United States Department of Agriculture (USDA) for low-income families were considered, in 10 domains. The cost and micronutrient content for-energy and per-serving of these foods were determined for the three micronutrients. Exact Kruskal-Wallis tests were used for comparisons of energy costs; Spearman rho tests for comparisons of micronutrient content. Ninety families were interviewed in a pediatric clinic to assess the impact of food cost on food selection. Results: Significant differences between domains were shown for energy density with both cost-for-energy (p < 0.001) and cost-per-serving (p < 0.05) comparisons. All three micronutrient contents were significantly correlated with cost-for-energy (p < 0.01). Both iron and choline contents were significantly correlated with cost-per-serving (p < 0.05). Of the 90 families, 38 (42 %) worried about food costs; 40 (44 %) had chosen foods of high caloric density in response to that fear, and 29 of 40 families experiencing both worry and making such food selection. Conclusion: Adjustments to USDA meal plans using cost-for-energy analysis showed differentials for both energy and micronutrients. These differentials were reduced using cost-per-serving analysis, but were not eliminated. A substantial proportion of low-income families are vulnerable to micronutrient deficiencies.

The Impact of Anglicizing Former German-Language Psychology Journals on Authorship and Citation Frequencies

2012 ◽  
Vol 17 (3) ◽  
pp. 190-198 ◽  
Author(s):  
Günter Krampen ◽  
Thomas Huckert ◽  
Gabriel Schui
Keyword(s):  
Side Effects ◽  
English Language ◽  
General Trend ◽  
Native Language ◽  
Impact Factors ◽  
German Language ◽  
Journal Articles ◽  
Number Of Citations ◽  
The Impact ◽  
Number Of Authors

Exemplary for other than English-language psychology journals, the impact of recent Anglicization of five former German-language psychology journals on (1) authorship (nationality, i.e., native language, and number of authors, i.e., single or multiple authorships), (2) formal characteristics of the journal (number of articles per volume and length of articles), and (3) number of citations of the articles in other journal articles, the language of the citing publications, and the impact factors (IF) is analyzed. Scientometric data on these variables are gathered for all articles published in the four years before anglicizing and in the four years after anglicizing the same journal. Results reveal rather quick changes: Citations per year since original articles’ publication increase significantly, and the IF of the journals go up markedly. Frequencies of citing in German-language journals decrease, citing in English-language journals increase significantly after the Anglicization of former German-language psychology journals, and there is a general trend of increasing citations in other languages as well. Side effects of anglicizing former German-language psychology journals include the publication of shorter papers, their availability to a more international authorship, and a slight, but significant increase in multiple authorships.

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