scholarly journals Discharge Communication and Patient Involvement are Associated with Unplanned Hospital Readmissions: Results from a Validated Hospital Experience Survey

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Kyle Kemp ◽  
Maria Santana ◽  
Rachel Jolley ◽  
Danielle Southern ◽  
Hude Quan
Keyword(s):  
Hospital Discharge ◽  
Patient Involvement ◽  
Hospital Readmissions ◽  
Post Discharge ◽  
Individual Level ◽  
Written Information ◽  
Hospital Experience ◽  
Patient Reported ◽  
Returning Home ◽  
One Year

ABSTRACTObjectivesUnplanned hospital readmissions are an indicator of quality of care, and are associated with significant costs to healthcare systems. Previous research has shown that poor communication and discharge experiences are associated with higher readmission rates. This, however, has only been examined in the short-term, and in many instances, at the hospital-level. The purpose of the study was to examine the relationship between aspects of inpatient communication and discharge instructions and unplanned readmissions at the individual-level up to one-year post-discharge. ApproachThe Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) telephone survey was completed by patients within 6 weeks of hospital discharge in Alberta, Canada. Survey data were linked to corresponding inpatient records using personal health number, discharge date, and facility codes. Unplanned readmissions (yes vs. no; all causes) from 43 to 365 days post-hospital discharge comprised the outcome variable. Independent variables included selected demographic characteristics, clinical variables, and five survey questions: a) patient involvement in their care decisions, b) receiving written information at discharge, c) understanding the purpose of taking medications, d) understanding responsibility for one’s health, and e) discussing help needed when returning home. Multivariate logistic regression was used to examine each question in the presence of the other predictors. Odds ratios and 95% confidence intervals were calculated. ResultsFrom April 2011 to March 2014, 24,868 patients completed a survey which was successfully linked to the corresponding inpatient record. The cohort had a mean age of 52.8±19.8 years of age (range=18-100), and was predominantly female (65.4%). 18.6% of patients (n=4,620) experienced an unplanned hospital readmission within 43 to 365 days post-discharge. Patients who felt that they were not involved in their care decisions were more likely to be readmitted (OR=1.79; 95%CI: 1.59-2.01), as were patients who did not receive written information at discharge (OR=1.96; 95%CI: 1.83-2.11). Odds of unplanned readmissions did not differ according to understanding of medications (OR=1.08; 95%CI: 0.90-1.30), understanding responsibility for one’s health (OR=1.02; 95%CI: 0.86-1.20), or discussion of help needed when returning home (OR=1.03; 95%CI: 0.93-1.14). ConclusionOur results demonstrate that a lack of patient involvement in their care and not receiving written information at discharge is associated with increased unplanned readmission rate up to one-year post-discharge. This present study provides an example of how patient-reported measures may be linked to individual-level administrative data to drive healthcare improvements. Future research examining patient-reported hospital experience and other health system measures is warranted.

Patient-reported health and 1-year mortality in patients with ischemic heart disease – findings from the Denheart study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Rasmussen ◽  
B Borregaard ◽  
P Palm ◽  
R Mols ◽  
A.V Christensen ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Roc Curves ◽  
Screening Tools ◽  
Ischemic Heart ◽  
Time To Death ◽  
Patient Reported ◽  
Returning Home ◽  
One Year ◽  
Pro Instruments

Abstract Background Though survival has improved markedly in ischemic heart disease (IHD), it remains a leading cause of death worldwide. Screening tools to identify patients at risk are ever in demand. Large-scale studies exploring the association between patients' self-reported mental and physical health and mortality are lacking. Purpose (i) to describe patient-reported outcomes (PROs) at discharge in IHD patients deceased and alive at one year, (ii) to investigate the discriminant predictive performance of PRO instruments on mortality, (iii) to investigate differences in time to death among survey responders/non-responders and among three diagnostic sub-groups (chronic ischemic heart disease/stable angina, non-STEMI/unstable angina and STEMI), and (iv) to investigate predictors of one-year mortality among sociodemographic, clinical and self-reported factors. Methods Data from the national DenHeart survey with register-data linkage was used. A total of 14,115 adults with IHD were discharged during one year. Eligible (n=13,476) were invited to complete a questionnaire and 7,167 (53%) responded. Questionnaires included the Health survey short form 12-items (SF-12), Hospital Anxiety and Depression Scale (HADS), EuroQoL-5-dimensions (EQ-5D), HeartQoL, Edmonton Symptom Assessment Scale (ESAS) and ancillary questions. Clinical and demographic characteristics were obtained from registries as were data on one-year mortality. Comparative analyses investigated differences in PROs, and discriminant PRO-performance was explored by Receiver Operating Characteristics (ROC) curves. Kaplan-Meier survival analysis explored differences in time to death across sub-groups. Predictors of mortality were explored using multifactorially adjusted cox regression analyses with time to death as underlying timescale. Results Highly significant and clinically important differences in PROs were found between those alive and those deceased at one year. The best discriminant performance was observed for the physical component scale of the SF-12 (Area Under the Curve (AUC) 0.706) (Figure 1). One-year mortality among responders and non-responders was 2% and 7%, respectively. Significant differences in time to death was observed between responders and non-responders (p<0.001) and among diagnostic subgroups (p<0.001). Strongest predictors of one-year mortality included STEMI (hazard ratio (HR) 2.9 95% confidence interval (CI) 2.3–3.7), Tu comorbidity index score 3+ (HR 3.6, 95% CI 2.7–4.8) and patient-reported feeling unsafe about returning home from hospital (HR 2.07, 95% CI 1.2–3.61). Conclusions One-year post-discharge mortality was expectedly low, however notably higher in certain subgroups. Though clinical predictors may be difficult to modify, factors such as feeling unsafe about returning home should be addressed at discharge. PRO-performance estimates may guide clinicians and researchers in choosing appropriate predictive patient-reported outcome tools. Figure 1. PRO instruments ROC curves Funding Acknowledgement Type of funding source: None

Recovery of symptom burden and functioning for patients with late discharge after an open surgery for GYN tumors.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18083-e18083
Author(s):  
Charles S. Cleeland ◽  
Qiuling Shi ◽  
Larissa Meyer ◽  
Ting-Yu Chen ◽  
Araceli Garcia-Gonzalez ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Physical Functioning ◽  
Open Surgery ◽  
Symptom Burden ◽  
Gynecologic Surgery ◽  
Post Discharge ◽  
Patient Reported ◽  
Discharged Patients ◽  
Delayed Recovery ◽  
Md Anderson

e18083 Background: The symptom burden and functional recovery of patients after hospital discharge is important to understand in order to provide more patient centered care. This study evaluated longitudinal quantitative patient-reported outcome (PRO) data using a validated PRO symptom and functional interference measure after hospital discharge from open gynecologic surgery. Methods: Patients with GYN tumors scheduled for laparotomy at MD Anderson Cancer Center were recruited prospectively. The MD Anderson Symptom Inventory gynecology perioperative care module (MDASI-PeriOp-GYN) was used to assess symptoms post discharge on Day 3, 7, and weekly up to 6 weeks. Median survival time and log-rank test was used for comparing time to return to no or mild level (≤3 in a 0-10 scale) of symptoms during the post discharge period between groups who discharged within and beyond the median length of stay (LOS) days. Results: From Feb 2018–Dec 2018, 83 patients were evaluable. The median LOS was 3 days. Compared to patients who were discharged within 3 days (70% of sample), 30% patients were discharged after 3 days after surgery (range of 4-10 days). Except distress, all other PROs on MDASI-PeriOp-GYN were not significantly different between the two groups on the day of discharge. However, those late discharged patients had significantly delayed recovery on fatigue (median recovery time > 56 days vs. 17 days), dry mouth (10 days vs. 6 days) (both P< .01), and drowsiness (12 days vs. 6 days, P< .05). The recovery of physical functioning (MDASI general activity interference item) was prolonged among late discharged patients compared to patients who were discharge within 3 days ( > 56 days vs. 30 days, P< .01). Conclusions: Even though all patients were under a standardized Enhanced Recovery Program, about 30% of patients post GYN open surgery were discharged beyond the median LOS. Patients in this group continued to have delayed recovery after hospital discharge as evidenced by persistent fatigue and slower return of physical functioning. Implementation of post-discharge PROs may help identify patients at risk for prolonged recovery and help triage patients to more intensive supportive care.

scholarly journals Clinical characteristics with inflammation profiling of Long-COVID and association with one-year recovery following hospitalisation in the UK: a prospective observational study

2021 ◽  
Author(s):  
Rachael Andrea Evans ◽  
Olivia C Leavy ◽  
Matthew Richardson ◽  
Omer Elneima ◽  
Hamish J C McAuley ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Hospital Discharge ◽  
Protein Profiling ◽  
Full Recovery ◽  
Patient Reported ◽  
One Year ◽  
The Uk ◽  
Prospective Longitudinal

Background There are currently no effective pharmacological or non-pharmacological interventions for Long-COVID. To identify potential therapeutic targets, we focussed on previously described four recovery clusters five months after hospital discharge, their underlying inflammatory profiles and relationship with clinical outcomes at one year. Methods PHOSP-COVID is a prospective longitudinal cohort study, recruiting adults hospitalised with COVID-19 across the UK. Recovery was assessed using patient reported outcomes measures (PROMs), physical performance, and organ function at five-months and one-year after hospital discharge. Hierarchical logistic regression modelling was performed for patient-perceived recovery at one-year. Cluster analysis was performed using clustering large applications (CLARA) k-medoids approach using clinical outcomes at five-months. Inflammatory protein profiling from plasma at the five-month visit was performed. Findings 2320 participants have been assessed at five months after discharge and 807 participants have completed both five-month and one-year visits. Of these, 35.6% were female, mean age 58.7 (SD 12.5) years, and 27.8% received invasive mechanical ventilation (IMV). The proportion of patients reporting full recovery was unchanged between five months 501/165 (25.6%) and one year 232/804 (28.9%). Factors associated with being less likely to report full recovery at one year were: female sex OR 0.68 (95% CI 0.46-0.99), obesity OR 0.50 (95%CI 0.34-0.74) and IMV OR 0.42 (95%CI 0.23-0.76). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate/cognitive, mild relating to the severity of physical, mental health and cognitive impairments at five months in a larger sample. There was elevation of inflammatory mediators of tissue damage and repair in both the very severe and the moderate/cognitive clusters compared to the mild cluster including interleukin-6 which was elevated in both comparisons. Overall, there was a substantial deficit in median (IQR) EQ5D-5L utility index from pre-COVID (retrospective assessment) 0.88 (0.74-1.00), five months 0.74 (0.60-0.88) to one year: 0.74 (0.59-0.88), with minimal improvements across all outcome measures at one-year after discharge in the whole cohort and within each of the four clusters. Interpretation The sequelae of a hospital admission with COVID-19 remain substantial one year after discharge across a range of health domains with the minority in our cohort feeling fully recovered. Patient perceived health-related quality of life remains reduced at one year compared to pre-hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

OPEN-EYED ONE-LEG STANDING BALANCE TIME ON INTACT LEG OF HOSPITALIZED ELDERLY LEG FRACTURE PATIENTS: ASSOCIATION WITH AND PREDICTOR OF LOCOMOTIVE ABILITY AND LIVING PLACE AFTER HOSPITAL DISCHARGE

2012 ◽  
Vol 15 (01) ◽  
pp. 1250008
Author(s):  
Tanaka Konagi ◽  
Ohe Takashi ◽  
Uehara Kosuke
Keyword(s):  
Hospital Discharge ◽  
Muscle Power ◽  
Mineral Density ◽  
Post Discharge ◽  
Gait Performance ◽  
Hospitalized Elderly ◽  
Returning Home ◽  
Care Of Elderly ◽  
Group B ◽  
Leg Fracture

Open-eyed one-leg balance (OLB) time on the intact leg of patients aged 65+, hospitalized with leg fracture was measured once a week from start of rehabilitation until discharge to estimate association between OLB time and changes of locomotive ability and post-discharge living place. Patients were in three groups: Group A, OLB time of at least 1 s at all measurements, Group B, OLB under 1 s at first, but 1 s or more by time of discharge, and Group C, OLB under 1 s throughout hospitalization. Patients in Groups A and B showed no significant differences in gait performance or rate of returning home after discharge, but both Groups A and B had better gait ability, and significantly higher rates of home return than Group C. Better OLB time, even only for intact leg, associated significantly with better gait performance and higher home return rate. OLB training is known to increase muscle power, bone mineral density, and balance, and is recommended in the concept of "locomotive syndrome". We considered that increasing OLB time might improve gait ability and probability of returning home after hospital discharge. This could be an effective counterplan against increasing cost for nursing care of elderly people.

scholarly journals Effect of post-hospital discharge telephonic intervention on hospital readmissions in a privately insured population in Australia

2018 ◽  
Vol 42 (3) ◽  
pp. 241 ◽  
Author(s):  
G. Brent Hamar ◽  
Carter Coberley ◽  
James E. Pope ◽  
Andrew Cottrill ◽  
Scott Verrall ◽  
...  
Keyword(s):  
Treatment Group ◽  
Hospital Discharge ◽  
Negative Binomial ◽  
Comparison Group ◽  
Hospital Readmissions ◽  
Study Groups ◽  
Management Program ◽  
Post Discharge ◽  
Logistic Regression Models ◽  
Quasi Experimental

Objective The aim of the present study was to evaluate the effect of telephone support after hospital discharge to reduce early hospital readmission among members of the disease management program My Health Guardian (MHG) offered by the Hospitals Contribution Fund of Australia (HCF). Methods A quasi-experimental retrospective design compared 28-day readmissions of patients with chronic disease between two groups: (1) a treatment group, consisting of MHG program members who participated in a hospital discharge (HODI) call; and (2) a comparison group of non-participating MHG members. Study groups were matched for age, gender, length of stay, index admission diagnoses and prior MHG program exposure. Adjusted incidence rate ratios (IRR) and odds ratios (OR) were estimated using zero-inflated negative binomial and logistic regression models respectively. Results The treatment group exhibited a 29% lower incidence of 28-day readmissions than the comparison group (adjusted IRR 0.71; 95% confidence interval (CI) 0.59–0.86). The odds of treatment group members being readmitted at least once within 28 days of discharge were 25% lower than the odds for comparison members (adjusted OR 0.75; 95% CI 0.63–0.89). Reduction in readmission incidence was estimated to avoid A$713 730 in cost. Conclusions The HODI program post-discharge telephonic support to patients recently discharged from a hospital effectively reduced the incidence and odds of hospital 28-day readmission in a diseased population. What is known about the topic? High readmission rates are a recognised problem in Australia and contribute to the over 600 000 potentially preventable hospitalisations per year. What does this paper add? The present study is the first study of a scalable intervention delivered to an Australian population with a wide variety of conditions for the purpose of reducing readmissions. The intervention reduced 28-day readmission incidence by 29%. What are the implications for practitioners? The significant and sizable effect of the intervention support the delivery of telephonic support after hospital discharge as a scalable approach to reduce readmissions.

Patient-reported outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses: Findings from the national DenHeart survey

2018 ◽  
Vol 26 (6) ◽  
pp. 624-637 ◽  
Author(s):  
Selina K Berg ◽  
Charlotte B Thorup ◽  
Britt Borregaard ◽  
Anne V Christensen ◽  
Lars Thrysoee ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hospital Discharge ◽  
Patient Reported Outcomes ◽  
Severe Symptom ◽  
Poor Quality ◽  
Anxiety And Depression ◽  
Cardiac Events ◽  
Patient Reported ◽  
One Year

Aims Patient-reported quality of life and anxiety/depression scores provide important prognostic information independently of traditional clinical data. The aims of this study were to describe: (a) mortality and cardiac events one year after hospital discharge across cardiac diagnoses; (b) patient-reported outcomes at hospital discharge as a predictor of mortality and cardiac events. Design A cross-sectional survey with register follow-up. Methods Participants: All patients discharged from April 2013 to April 2014 from five national heart centres in Denmark. Main outcomes Patient-reported outcomes: anxiety and depression (Hospital Anxiety and Depression Scale); perceived health (Short Form-12); quality of life (HeartQoL and EQ-5D); symptom burden (Edmonton Symptom Assessment Scale). Register data: mortality and cardiac events within one year following discharge. Results There were 471 deaths among the 16,689 respondents in the first year after discharge. Across diagnostic groups, patients reporting symptoms of anxiety had a two-fold greater mortality risk when adjusted for age, sex, marital status, educational level, comorbidity, smoking, body mass index and alcohol intake (hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.52–2.42). Similar increased mortality risks were found for patients reporting symptoms of depression (HR 2.29, 95% CI 1.81–2.90), poor quality of life (HR 0.46, 95% CI 0.39–0.54) and severe symptom distress (HR 2.47, 95% CI 1.92–3.19). Cardiac events were predicted by poor quality of life (HR 0.71, 95% CI 0.65–0.77) and severe symptom distress (HR 1.58, 95% CI 1.35–1.85). Conclusions Patient-reported mental and physical health outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses.

Quality of Transition From Hospital to Home: The Influence of Nurse- and Patient-Reported Readiness

2016 ◽  
Vol 27 (2) ◽  
pp. 129-147 ◽  
Author(s):  
Andrea S. Wallace ◽  
Yelena Perkhounkova ◽  
Nicole L. Bohr
Keyword(s):  
Predictive Model ◽  
Hospital Discharge ◽  
Health Care Systems ◽  
Post Discharge ◽  
Transition Experience ◽  
Patient Reported ◽  
Care Systems ◽  
Poor Outcomes ◽  
Hospital To Home

Identifying those at risk of poor outcomes after hospital discharge is a central focus of health care systems. Our purpose was to better understand whether and how patient- and nurse-assessed readiness for discharge (Pt- and RN-RHDS) is related to patient experiences after discharge. We conducted a prospective survey of 70 Veterans and their assigned nurses on the day of, and again with Veterans 2 weeks after, hospital discharge. The predictive model for post-discharge coping difficulty included educational level ( p = .05) and an interaction between Pt-RHDS ratings and Pt-RN RHDS discordance ( p = .01). The predictive model for patient-reported quality of hospital to home transition experience included Pt-RN RHDS discordance and an interaction between Pt-RHDS and the number of people living with the patient ( p = .05). Our findings demonstrate that agreement between Pt- and RN-RHDS may be an important measure in work aiming to improve patient outcomes post-hospitalization.

scholarly journals Burden of Hospital Readmissions for Venous Thromboembolism Among Patients with Cancer

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 365-365
Author(s):  
Alpesh J. Amin ◽  
Steven Deitelzweig ◽  
Jay Lin ◽  
Melissa Lingohr-Smith ◽  
Brandy Menges ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Primary Diagnosis ◽  
Post Discharge ◽  
Vte Prophylaxis ◽  
Patients With Cancer ◽  
Diagnosis Codes ◽  
The Mean

Abstract Background: Cancer or history of cancer are important risk factors for hospitalized patients to develop venous thromboembolism (VTE), manifesting as deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Patients hospitalized for cancer are thus at risk for VTE. However, several studies show that VTE prophylaxis in these patients is challenging and underutilized, with almost 70% of patients with cancer not receiving any VTE prophylaxis as evaluated by our previous analysis. Therefore, this patient population is at risk of recurrent VTE and re-hospitalization. The clinical and economic burden of VTE-related hospital readmissions among these patients is not well understood in the real-world setting. The goal of this retrospective study was thus to analyze the frequency and associated cost of VTE-related hospital readmissions among patients with cancer in the US. Methods: Patients hospitalized for acute medical illness, including cancer, based on the primary hospital discharge diagnosis codes were identified from the MarketScan databases between 7/1/2011 and 3/31/2015. Eligible patients were ≥40 years and required to have continuous insurance enrollment in the 6 months prior to initial (index) hospitalizations (baseline period) and in the 6 months after hospital discharge (follow-up period). The study endpoints included the proportion of patients with VTE as either the primary or any position (VTE-related) of discharge diagnosis codes among hospital readmissions during the follow-up period, and the associated costs for VTE-related or primary VTE readmissions. Results: Of the whole study population of acute medically ill patients (n=12,785; mean age: 68.3 years; 51.6% female), 15.7% (n=2,002) were hospitalized for cancer; the mean age was 63.4 years (62% were <65 years) and 49.1% were female. Among patients with cancer, 3.9% had a VTE-related hospital readmission in the 6 months following hospital discharge, of which 51.3% were for a primary diagnosis of VTE (Table). The frequency of readmissions for patients with cancer were the highest among all medical illnesses investigated in this study (acute heart failure, infectious diseases, ischemic stroke, respiratory diseases, and rheumatic diseases). Over one-quarter (28.2%) of the VTE-related hospital readmissions occurred within the first 30 days of post-discharge (Table). For VTE-related readmissions, the mean length of hospital stay (LOS) was 7.6 days and the mean total cost for a hospital readmission was $35,012. For primary VTE readmissions, the mean LOS was 5.2 days and the mean total cost of a readmission was $19,961; for readmissions with a primary diagnosis of DVT, PE, and DVT/PE, mean total costs were $12,968, $13,029, and $41,574, respectively. Conclusions: In this real-world study, many patients hospitalized for cancer experienced a VTE event requiring re-hospitalization, which was the highest proportion of readmitted patients among acute medical illnesses analyzed in this study, with almost 30% readmitted within 30 days of post-discharge. Total costs of readmissions were substantial, as high as $41K for resubmissions due to primary diagnosis of DVT/PE. Improvement in VTE prophylaxis for patients with cancer may reduce the risk and frequency of VTE, and thus hospital readmissions, reducing the clinical and economic burden of VTE in this patient population. Sponsorship: Portola Pharmaceuticals Disclosures Amin: UC Irvine: Employment; Portola: Consultancy; BMS: Consultancy; Pfizer: Consultancy. Deitelzweig:Ochsner Health System: Employment; Portola: Consultancy, Research Funding, Speakers Bureau; BMS: Consultancy, Research Funding, Speakers Bureau; Pfizer: Consultancy, Speakers Bureau; Boeringer Ingelheim: Consultancy. Lin:Bristol-Myers Squibb: Consultancy; Novosys Health: Employment. Lingohr-Smith:Novosys Health: Employment. Menges:Novosys Health: Employment. Neuman:Portola Pharmaceuticals: Employment.

scholarly journals Systemic inflammation is negatively associated with early post discharge growth following acute illness among severely malnourished children - a pilot study

2021 ◽  
Vol 5 ◽  
pp. 248
Author(s):  
James M. Njunge ◽  
Gerard Bryan Gonzales ◽  
Moses M. Ngari ◽  
Johnstone Thitiri ◽  
Robert H.J. Bandsma ◽  
...  
Keyword(s):  
Weight Gain ◽  
Hospital Discharge ◽  
Systemic Inflammation ◽  
Acute Illness ◽  
Severe Malnutrition ◽  
Post Discharge ◽  
Soluble Cd14 ◽  
Negatively Associated ◽  
One Year ◽  
The Relationship

Background: Rapid growth should occur among children with severe malnutrition (SM) with medical and nutritional management. Systemic inflammation (SI) is associated with death among children with SM and is negatively associated with linear growth. However, the relationship between SI and weight gain during therapeutic feeding following acute illness is unknown. We hypothesised that growth post-hospital discharge is associated with SI among children with SM. Methods: We conducted secondary analysis of data from HIV-uninfected children with SM (n=98) who survived and were not readmitted to hospital during one year of follow-up. We examined the relationship between changes in absolute deficits in weight and mid-upper-arm circumference (MUAC) from enrolment at stabilisation to 60 days and one year later, and untargeted plasma proteome, targeted cytokines/chemokines, leptin, and soluble CD14 using multivariate regularized linear regression. Results: The mean change in absolute deficit in weight and MUAC was -0.50kg (standard deviation; SD±0.69) and -1.20cm (SD±0.89), respectively, from enrolment to 60 days later. During the same period, mean weight and MUAC gain was 3.3g/kg/day (SD±2.4) and 0.22mm/day (SD±0.2), respectively. Enrolment interleukins; IL17-alpha and IL-2, and serum amyloid P were negatively associated with weight and MUAC gain during 60 days. Lipopolysaccharide binding protein and complement component 2 were negatively associated with weight gain only. Leptin was positively associated with weight gain. Soluble CD14, beta-2 microglobulin, and macrophage inflammatory protein 1 beta were negatively associated with MUAC gain only. Glutathione peroxidase 3 was positively associated with weight and MUAC gain during one year. Conclusions: Early post-hospital discharge weight and MUAC gain were rapid and comparable to children with uncomplicated SM treated in the community. Higher concentrations of SI markers were associated with less weight and MUAC gain, suggesting inflammation negatively impacts recovery from wasting. This finding warrants further research on reducing inflammation on growth among children with SM.

scholarly journals Post-discharge Telemonitoring of Physical Activity, Vital Signs, and Patient-Reported Symptoms in Older Patients Undergoing Cancer Surgery

2021 ◽  
Author(s):  
Leonie T. Jonker ◽  
Maarten M. H. Lahr ◽  
Maaike H. M. Oonk ◽  
Geertruida H. de Bock ◽  
Barbara L. van Leeuwen
Keyword(s):  
Physical Activity ◽  
Pain Score ◽  
Older Patients ◽  
Hospital Readmissions ◽  
Vital Signs ◽  
Home Monitoring ◽  
Cancer Surgery ◽  
Post Discharge ◽  
Patient Reported ◽  
After Cancer

Abstract Background Postoperative home monitoring could potentially detect complications early, but evidence in oncogeriatric surgery is scarce. Therefore, we evaluated whether post-discharge physical activity, vital signs, and patient-reported symptoms are related to post-discharge complications and hospital readmissions in older patients undergoing cancer surgery. Methods In this observational cohort study, we monitored older patients (≥65 years of age) undergoing cancer surgery, for 2 weeks post-discharge using tablet-based applications and connected devices. Outcome measures were post-discharge complications and readmissions; physical activity and patient-reported symptoms over time; and threshold violations for physical activity (step count <1000 steps/day), vital signs (temperature <36°C or >38°C; blood pressure <100/60 mmHg or >150/100 mmHg; heart rate <50 bpm or >100 bpm; weight −5% or +5% of weight at discharge); and patient-reported symptoms (pain score greater than the previous day; presence of dyspnea, vomiting, dizziness, fever). Results Of 58 patients (mean age 72 years), 24 developed a post-discharge complication and 13 were readmitted. Measured parameters indicated 392 threshold violations out of 5379 measurements (7.3%) in 40 patients, mostly because of physical inactivity. Patients with readmissions had lower physical activity at discharge and at day 9 after discharge and violated a physical activity threshold more often. Patients with post-discharge complications had a higher median pain score compared with patients without these adverse events. No differences in threshold violations of other parameters were observed between patients with and without post-discharge complications and readmissions. Conclusion Our results show the potential of telemonitoring older patients after cancer surgery but confirm that detecting post-discharge complications is complex and multifactorial.

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